UK Study Finds Regional Variation in Prescription, Referral Patterns for ADHD

A study published in the British Journal of Psychiatry found key regional differences in primary care prescribing of attention-deficit/hyperactivity disorder (ADHD) medication and referral of young people to adult mental health services in the United Kingdom. Young people with ADHD are at a higher risk for negative health, education, and employment outcomes; without consistent treatment these risks may increase.

The investigators used the Clinical Practice Research Datalink, a database of anonymous patient records including diagnoses, prescriptions, and referrals to secondary services. They identified patients with a diagnosis of ADHD aged 10 to 20 years in 2005 (study period 2005 to 2013). The first phase of analysis focused on changes in prescribing of ADHD medication through a defined transition period (aged 16 to 19 years).

There were 3476 patients in the cohort, with a mean age of termination or interruption of medication prescription of 16.6±2.63 years. Differences in the mean age at the end of ADHD prescription were statistically significant by region, with mean ages ranging from 15.8 to 17.4 years (P <.001). The percentage of patients with an ADHD prescription between the years of their 16th and 19th birthdays decreased by 19% for all patients (range 6% to 25%).

The percentage of patients with ADHD referred to an adult mental health service was approximately 11% in most regions (range 4% to 21%). Per region, the percentage averaged 9% when patients with a comorbid psychiatric diagnosis were excluded and 7% when patients with a prescription for other psychotropic medications were excluded.

Region and the age of cessation of ADHD prescription were marginally associated in the unadjusted model (P =.03). When referral to an adult mental health service was added, region was no longer a significant predictor and only referral to any service significantly predicted age of prescription cessation (P <.001).

The investigators noted that variations in prescribing and referrals by region may be related to differences in the availability of services for ADHD, and psychiatric comorbidities can affect the type of referral provided. They added that by focusing on patients with a childhood diagnosis of ADHD, they were unable to assess access to services for patients who present as adults. “This data can contribute to planning regional service development and provision and, ultimately, to addressing health inequalities in people with ADHD,” the researchers concluded.

Reference

Price A, Ford T, Janssens A, Williams AJ, Newlove-Delgado T. Regional analysis of UK primary care prescribing and adult service referrals for young people with attention-deficit hyperactivity disorder. BJPsych Open. 2020;6(1):e7.