Paediatricians back greater GP role in ADHD care

A public investigation looking at barriers to ADHD care has heard that different regulatory approaches to diagnosis, treatment and management across states and territories are negatively impacting patients.
 
Demand for ADHD care has exploded in recent years, prompting the Senate’s Community Affairs committee to open an inquiry into the issue.
 
The first round of public hearings, held on Thursday, featured a host of experts representing consumer groups, disability advocates and government departments.
 
It also heard from RACGP President Dr Nicole Higgins and Royal Australian College of Physicians representative Associate Professor Daryl Efron, who appeared together during an afternoon session and both called for GPs to play a more significant role in patient care.
 
‘We clearly need innovative models of care, which for paediatrics is going to need to involve paediatricians working alongside general practice,’ Associate Professor Efron, a developmental paediatrician, told the committee.
 
‘For example, an initial assessment by a paediatrician and then follow up monitoring by GPs with an interest who will refer back to specialists as required, or shared care models with alternating appointments [would be appropriate].
 
‘The fact that it needs to be, as a general rule across the country, a specialist who provides ongoing prescriptions … creates a lot of drama that just seems a bit silly.
 
‘There are lots of other medications that GPs can prescribe that have a higher risk profile than ADHD medicine.’
 
Dr Higgins likewise told the committee that access to ADHD management in Australia is ‘inadequate’, with multiple barriers including costs and access to specialist and allied health care, as well as a lack of clear referral pathways and coordination between services.
 
‘We wish for GPs to be supported to take on an expanded role with diagnosis and treatment of ADHD,’ she said.
 
‘We ask that there be investment … in shared care models, with GPs and other healthcare professionals working collaboratively together.
 
‘We also ask for increased investment, especially in longer GP consultations, so patients who require more time with their GP aren’t disadvantaged.’
 
She also said GPs need more support to undertake ADHD-related training, as well as simpler regulation that does not change across jurisdictions.
 
‘Medication and accessing a prescriber varies between state to state, so those regulatory settings are commonly the biggest barrier,’ she said.
 
‘As a regional GP, [I know] a lot of people have to travel interstate or have incurred significant costs to be able to access diagnostic care and ongoing care.
 
‘Seeing children and mental health is bread and butter general practice, and with ADHD being one of the [most] common things that GPs see, it’s certainly well within our scope.’
 
Ahead of the hearing, Dr Higgins called for action, saying timely reform is crucial.
 
‘Too many people with ADHD are not getting the help they need, when they need it,’ she said.
 
‘Unfortunately, access to care is limited, with many public sector mental health services not providing any ADHD services. What this means is that the burden falls on the private sector – leading to long wait lists and some missing out on care because they simply can’t afford it.
 
‘One GP recently told the college it would cost their patient over $700 for a telehealth ADHD diagnosis from a specialist.
 
‘Other media reports put the cost at around $3000, a huge sum particularly when you consider the high cost of living pressures squeezing many households across Australia.
 
‘We must cut red tape and enable GPs to play a more active role.’
 
Associate Professor Efron said GPs managing ongoing prescriptions with periodic or ‘as required’ review by paediatricians or psychiatrists ‘makes perfect sense’, but described the debate around diagnosis and prescription initiation within general practice as ‘nuanced’.
 
‘If a GP with an interest has dedicated training in the assessment of these patients, then I think it might be possible for GPs to initiate prescription and start treatment,’ he said.
 
‘But that that would be a big change and requires some careful thought about credentialing.’
 
But regardless of the model or regulatory changes that are adopted as a result of the inquiry, Dr Higgins said continuity of care must be a priority.
 
‘It’s a very complex system … we mustn’t fragmented care and have little bits of people and their diagnosis and their knowledge scattered around everywhere,’ she said.
 
‘It’s really important that we pull those threads together. People have much better health outcomes if we’ve got continuity of care.’
 
The committee is due to report back by 27 September.
 
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