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An Audit of Transitional care for adolescents with ADHD in a North West England District

An Audit of Transitional care for adolescents with ADHD in a North West England District. Warrington PCT, CDC. Michael Ogundele, IL Omenaka. Transitional care for adolescents with ADHD in a North West England District. Introduction Methods Results Conclusion Learning Points. INTRODUCTION.

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An Audit of Transitional care for adolescents with ADHD in a North West England District

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  1. An Audit of Transitional care for adolescents with ADHD in a North West England District Warrington PCT, CDC Michael Ogundele, IL Omenaka

  2. Transitional care for adolescents with ADHD in a North West England District • Introduction • Methods • Results • Conclusion • Learning Points

  3. INTRODUCTION • ADHD is a clinically recognised behavioural syndrome characterised by inattention, hyperactivity and impulsivity. • ADHD affects approx 3-7% of school age children • ADHD is now considered to be a chronic neuro-developmental disorder that persists from childhood into adolescence and adulthood. • some adolescents and young adults are known to prematurely stop their treatment for ADHD.

  4. INTRODUCTION • Transition is “a multi-faceted, active process that attends to the medical, psychosocial and educational/vocational needs of adolescents as they move from child to adult centred care” • A key element of adolescent health care • A challenging period for carers, patients and professionals • Increasing numbers of young people with ADHD are diagnosed in childhood and continue to require care in adulthood.

  5. Effective Transitional Care • Starts early • Young person centred • Inclusive of parents/care-givers • Multi-disciplinary /Inter-agency • comprehensive, flexible, responsive • holistic –medical, psychosocial and educational/vocational aspects • comprehensive, flexible, responsive • age and developmentally appropriate

  6. Methods • We analysed the data on transition of adolescents diagnosed with ADHD in childhood into adult specialist ADHD services in Warrington district. • Patients were diagnosed with ADHD using the standard DSM-IV criteria. • Adolescents who were eligible for transition to adult ADHD services were identified from a community paediatric service database.

  7. Methods • Patients who reached the age of 16 years over a period of two years consecutively (July 2009 to June 2011) were studied retrospectively using the clinical records. • Data analysis performed with MS Access and OpenStat

  8. Epidemiology • From a total of 504 patients on the specialist ADHD database, 104 adolescents were eligible for transitional to adult services over the study period. • M:F 83:21 (80%:20%) • The estimated prevalence of ADHD among school children (4 to 16yrs) in Warrington is 504/30803 (1.64%). • Age at diagnosis varied between 3 years and 12 years with a median of 7 years.

  9. Results • 68 adolescents (65%) were discharged from the paediatric services before transition: • often due to voluntary discontinuation of medications and • self-discharge due to non-attendance at follow-up clinics • 2 patients who moved out of the area.

  10. Results • 19 patients (18%) were referred to CAMHS • (5 of them already discharged). • Only 16 patients (15%) were successfully referred to the specialist adult ADHD services • (3 of them already discharged). • Only one patient still remained under the community paediatric services.

  11. Conclusions • There is a high rate of discontinuation of medications, loss to follow-up and a remarkably low rate of successful transition to locally commissioned adult ADHD services among adolescents diagnosed with ADHD in childhood. • A total of 73% of eligible patients were either discharged or lost to follow-up.

  12. Learning Points • Establishing a formal transitional process early from the age of 13 years among patients with childhood ADHD may help minimise high rate of attrition. • Multi-disciplinary team approach providing holistic care for patients may improve the rate of follow-up and successful transition.

  13. Learning Points • There must be some flexibility in the referral pathway to the adult ADHD services. • Adolescents previously lost to follow-up could be re-referred by other primary or secondary care healthcare professionals if the need arises in the future. • Neither simple transfer to adult doctors nor allowing adolescents to “drop out” of medical care is now acceptable quality care for young people with chronic illness

  14. References • National Institute for Health and Clinical Excellence. Attention deficit hyperactivity disorder. Diagnosis and management of ADHD in children, young people and adults. September 2008. Available at: http://www.nice.org.uk/nicemedia/pdf/CG72NiceGuidelinev3.pdf • Wong I C K, Asherson P, Bilbow A, Clifford S, Coghill D, DeSoysa R, et al. Cessation of attention deficit hyperactivity disorder drugs in the young (CADDY) - a pharmacoepidemiological and qualitative study. Health Technol Assess 2009;13(50).

  15. Thank You

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