Attention-deficit hyperactivity disorder. Management by family physicians
S. E. Moser and K. J. Kallail
Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita.
OBJECTIVE: To assess the evaluation and treatment practices of family
physicians in regard to attention-deficit hyperactivity disorder (ADHD).
DESIGN, SETTING, AND PARTICIPANTS: A 20-item survey was developed and
mailed to all 940 family and general physicians in Kansas. MAIN OUTCOME
MEASURES: Physician practices regarding ADHD. RESULTS: The 471 respondents
(50.1%) included 386 physicians in private clinical practice, who
constituted the study group. Ninety-eight percent of these physicians
regularly saw children and over half suspected four or more cases of ADHD
in the past year. When suspecting ADHD, 43% of the physicians referred for
diagnosis and treatment; 30% evaluated and treated by themselves; and 27%
referred for evaluation but did follow-up treatment themselves. There was
no significant difference in these ratios between rural and urban
physicians. Family physicians referred to a pediatric psychiatrist most
often, with no apparent difference in referral pattern by community size;
75% indicated they were comfortable with their current referral support. Of
the physicians who diagnosed and treated ADHD themselves, only 30.6%
routinely ordered laboratory work or other tests, only 28.7% used teacher
questionnaires, and only 20.4% used parent questionnaires. CONCLUSIONS: An
important amount of patient care for ADHD is managed by family physicians,
without significant differences between rural and urban practices. Most
family physicians are satisfied with their current level of referral
support. Physicians who treat ADHD themselves usually rely on clinical
evaluation rather than special tests or standardized questionnaires.
