Transcript Dr Michael Ogundele - An audit of transitional

An Audit of Transitional
care for adolescents with
ADHD in a North West
England District
Michael Ogundele, IL Omenaka
Warrington PCT, CDC
Transitional care for
adolescents with ADHD in a
North West England District
Introduction
 Methods
 Results
 Conclusion
 Learning Points
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INTRODUCTION
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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.
INTRODUCTION
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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.
Effective Transitional Care
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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
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.
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Methods
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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
Epidemiology
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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.
Results
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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.
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.
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.
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Learning Points
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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.
Learning Points
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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
References
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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/CG72NiceGuidel
inev3.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).
Thank You