Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations.
Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations.
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DOI：
10.1186/s12888-022-04290-7
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发表时间：
2022-10-11
期刊：
影响因子：
4.4
通讯作者：
中科院分区：
文献类型：
--
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成人ADHD是一种常见的神经发育性精神健康状况。然而，诊断、临床管理和监测往往受到资源稀缺、专家服务能力低以及初级和二级保健认识或培训有限的制约。因此，许多ADHD患者在获得所需护理方面遇到严重障碍。初级、二级和三级护理领域的专业人士齐聚一堂，讨论英国成人多动症的临床护理。讨论确定了服务提供方面的制约因素，以及有可能改善医疗保健服务获得和提供的服务提供模式。该小组旨在提供一个路线图，以改善ADHD治疗的可及性，确定在当前限制下改善提供的途径，并在长期内创新提供。国家健康与护理卓越研究所（NICE）的指导方针被用作讨论的基准。专家组确定了三个相互关联的制约因素。首先，在提供ADHD护理的背景下，对什么是“专家”的解释不一致。第二，限制提供能力有限的二级或三级保健服务。第三，财务限制或冲突会降低能力并使医疗保健部门之间的护理转移变得困难。该小组建议在初级保健中发展ADHD专科，沿着将常规和直接的治疗监测转移到初级保健服务中。从长远来看，ADHD护理途径应与其他常见精神健康疾病的护理途径保持一致，包括由初级保健中适当合格的临床医生开始治疗，并将更复杂的病例转介到二级精神健康或三级服务。NHS的长期计划，使用初级保健网络方法，提供更多的联合和灵活的服务，可以投资于开发共享的ADHD专家资源。将成人ADHD诊断、治疗和监测下放到专科三级和二级服务与其高患病率和慢性病程不一致。为了实现所需的成本效益和大规模获得ADHD治疗，必须赋予一般成人心理健康和初级保健在为ADHD成人提供优质服务方面发挥关键作用。
ADHD in adults is a common and debilitating neurodevelopmental mental health condition. Yet, diagnosis, clinical management and monitoring are frequently constrained by scarce resources, low capacity in specialist services and limited awareness or training in both primary and secondary care. As a result, many people with ADHD experience serious barriers in accessing the care they need. Professionals across primary, secondary, and tertiary care met to discuss adult ADHD clinical care in the United Kingdom. Discussions identified constraints in service provision, and service delivery models with potential to improve healthcare access and delivery. The group aimed to provide a roadmap for improving access to ADHD treatment, identifying avenues for improving provision under current constraints, and innovating provision in the longer-term. National Institute for Health and Care Excellence (NICE) guidelines were used as a benchmark in discussions. The group identified three interrelated constraints. First, inconsistent interpretation of what constitutes a ‘specialist’ in the context of delivering ADHD care. Second, restriction of service delivery to limited capacity secondary or tertiary care services. Third, financial limitations or conflicts which reduce capacity and render transfer of care between healthcare sectors difficult. The group recommended the development of ADHD specialism within primary care, along with the transfer of routine and straightforward treatment monitoring to primary care services. Longer term, ADHD care pathways should be brought into line with those for other common mental health disorders, including treatment initiation by appropriately qualified clinicians in primary care, and referral to secondary mental health or tertiary services for more complex cases. Long-term plans in the NHS for more joined up and flexible provision, using a primary care network approach, could invest in developing shared ADHD specialist resources. The relegation of adult ADHD diagnosis, treatment and monitoring to specialist tertiary and secondary services is at odds with its high prevalence and chronic course. To enable the cost-effective and at-scale access to ADHD treatment that is needed, general adult mental health and primary care must be empowered to play a key role in the delivery of quality services for adults with ADHD.
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