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Open Access Research

Management of adult attention deficit hyperactivity disorder in UK primary care: a survey of general practitioners

Suzanne McCarthy12*, Lynda Wilton3, Macey Murray3, Paul Hodgkins4, Philip Asherson5 and Ian CK Wong36

Author Affiliations

1 School of Pharmacy, University College Cork, Cork, Ireland

2 Pharmacy Department, Cork University Hospital, Cork, Ireland

3 Centre for Paediatric Pharmacy Research, School of Pharmacy, University College London, London, UK

4 Shire Pharmaceuticals LLC, Wayne, Pennsylvania, USA

5 MRC Social Genetic and Developmental Psychiatry, King’s College London, Institute of Psychiatry, London, UK

6 Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong

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Health and Quality of Life Outcomes 2013, 11:22  doi:10.1186/1477-7525-11-22

Published: 22 February 2013

Abstract

Background

Compared to existing literature on childhood attention deficit hyperactivity disorder (ADHD), little published adult data are available, particularly outside of the United States. Using General Practitioner (GP) questionnaires from the United Kingdom, this study aimed to examine a number of issues related to ADHD in adults, across three cohorts of patients, adults who received ADHD drug treatment in childhood/adolescence but stopped prior to adulthood; adults who received ADHD drug treatment in childhood/adolescence and continued treatment into adulthood and adults who started ADHD drug treatment in adulthood.

Methods

Patients with a diagnosis of ADHD and prescribed methylphenidate, dexamfetamine or atomoxetine were identified using data from The Health Improvement Network (THIN). Dates when these drugs started and stopped were used to classify patients into the three cohorts. From each cohort, 50 patients were randomly selected and questionnaires were sent via THIN to their GPs.

GPs returned completed questionnaires to THIN who forwarded anonymised copies to the researchers. Datasets were analysed using descriptive statistics.

Results

Overall response rate was 89% (133/150). GPs stated that in 19 cases, the patient did not meet the criteria of that group; the number of valid questionnaires returned was 114 (76%). The following broad trends were observed: 1) GPs were not aware of the reason for treatment cessation in 43% of cases, 2) patient choice was the most common reason for discontinuation (56%), 3) 7% of patients who stopped pharmacological treatment subsequently reported experiencing ADHD symptoms, 4) 58% of patients who started pharmacological treatment for ADHD in adulthood received pharmacological treatment for other mental health conditions prior to the ADHD being diagnosed.

Conclusion

This study presents some key findings relating to ADHD; GPs were often not aware of the reason for patients stopping ADHD treatment in childhood or adolescence. Patient choice was identified as the most common reason for treatment cessation. For patients who started pharmacological treatment in adulthood, many patients received pharmacological treatment for comorbidities before a diagnosis of ADHD was made.

Keywords:
Attention deficit hyperactivity disorder; Adult; Stimulant; Primary care; General practitioner