Pilot Program Cuts ADHD Diagnosis, Treatment Times

With long wait times for behavioral healthcare delaying diagnosis and treatment of adult attention-deficit/hyperactivity disorder (ADHD), an approach in primary care could fast-track care for patients.

The Methodist Hospital Family Medicine Residency Program at the University of Minnesota in St. Louis Park, Minnesota, implemented a pair of screening tools that reduced complaint-to-treatment times for uncomplicated adult ADHD by up to 96% compared with behavioral health referrals.

The outcomes of the intervention were recently published in Annals of Family Medicine.

Medical residents at the Park Nicollet Clinic—Creekside, St. Louis Park, Minnesota, observed an increase in adult patients at the facility concerned about possibly having ADHD. Patients referred to specialists at the clinic could wait up to a year for diagnosis and possible treatment, said Deborah M. Mullen, PhD, a former research scientist at Park Nicollet and now an associate professor of healthcare management at the University of Tennessee at Chattanooga and lead author of the article.

The seven residents consulted with psychologists and psychiatrists within the system to create a way to better screen patients in primary care with the goal of decreasing wait times for diagnosis.

During the first visit, patients completed one six-question questionnaire, which asked about comorbidities such as anxiety or depression. If the resident suspected ADHD, patients were given a DIVA-5 Diagnostic Interview on a follow-up visit.

In the pilot program, 80% of the 48 patients who took the second diagnostic were diagnosed with ADHD.

The implementation of the screening tools addressed a growing need in primary care settings to manage the increasing prevalence of ADHD concerns among adults. An ADHD diagnosis often begins with a conversation.

An estimated 11 million adults in the United States have ADHD, the second most common psychiatric disorder in the nation. Diagnosis in both children and adults has trended upward in recent years, with better awareness of the condition leading to more patients asking if they have the condition.

Teresa Lovins, MD, the owner of a direct primary care practice in Columbus, Indiana, recommended asking patients about how recently potential ADHD symptoms developed and what the patient was like as a child.

Lovins said she screens for ADHD, and if a patient’s answers indicate the disorder, Lovins first treats possible underlying conditions such as anxiety or depression. If a patient has simple adult ADHD, a milder form of the disorder with little hyperactivity, she often recommends cognitive behavioral therapy or prescribes stimulant or nonstimulant medications.

Lovins said a referral to a behavioralist can take several weeks or months. According to the Health Resources Services Administration, more than half the US population lives in a Mental Health Professional Shortage Area.

Lovins said questions inquiring if a patient has trouble finishing projects and queries designed to uncover comorbidities, such as bipolar disorder, sleep apnea, and substance abuse, are effective.

“It really pulls in the diagnostic criteria much more eloquently than the screener that I’ve been using,” said Lovins, who is also a member of the board of directors of the American Academy of Family Physicians.

The pilot at Park Nicollet is ongoing. Mullen said the residents plan to perform chart audits starting in January to examine what steps patients diagnosed with ADHD took, such as behavioral therapy or medication.

The authors reported no conflicts of interest.

No further disclosures.