An Audit of Transitional care for adolescents with

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

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 l

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

INTRODUCTION l l ADHD is a clinically recognised behavioural syndrome characterised by inattention, hyperactivity

INTRODUCTION l l 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 neurodevelopmental disorder that persists from childhood into adolescence and adulthood. some adolescents and young adults are known to prematurely stop their treatment for ADHD.

INTRODUCTION l l Transition is “a multi-faceted, active process that attends to the medical,

INTRODUCTION l l 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 l l l l Starts early Young person centred Inclusive of

Effective Transitional Care l l l l 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

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

Methods l l Patients who reached the age of 16 years over a period

Methods l l 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 Open. Stat

Epidemiology l l From a total of 504 patients on the specialist ADHD database,

Epidemiology l l 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 16 yrs) in Warrington is 504/30803 (1. 64%). Age at diagnosis varied between 3 years and 12 years with a median of 7 years.

Results l 68 adolescents (65%) were discharged from the paediatric services before transition: Ø

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

Results • 19 patients (18%) were referred to CAMHS Ø (5 of them already

Results • 19 patients (18%) were referred to CAMHS Ø (5 of them already discharged). • Only 16 patients (15%) were successfully referred to the specialist adult ADHD services Ø (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

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. l A total of 73% of eligible patients were either discharged or lost to follow-up. l

Learning Points l l Establishing a formal transitional process early from the age of

Learning Points l l 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 l l l There must be some flexibility in the referral pathway

Learning Points l l l 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 l l National Institute for Health and Clinical Excellence. Attention deficit hyperactivity disorder.

References l l 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/CG 72 Nice. Guidel inev 3. pdf Wong I C K, Asherson P, Bilbow A, Clifford S, Coghill D, De. Soysa 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).

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