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Determinants of inter-practice variation in ADHD diagnosis and stimulant prescribing: cross-sectional database study of a national surveillance network
- Source :
- BMJ Evidence-Based Medicine
- Publication Year :
- 2019
- Publisher :
- BMJ Publishing Group, 2019.
-
Abstract
- Early recognition, identification and treatment of children with attention deficit hyperactivity disorder (ADHD) can reduce detrimental outcomes and redirect their developmental trajectory. We aimed to describe variations in age of ADHD diagnosis and stimulant prescribing among general practitioner practices in a nationwide network and identify child, parental, household and general practice factors that might account for these variations. Cross-sectional study of children aged under 19 years registered within a general practice in the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network in 2016, RCGP RSC has a household key allowing parent and child details to be linked. Data from 158 general practices and 353 774 children under 19 were included. The mean age of first ADHD diagnosis was 10.5 years (95% CI 10.1 to 10.9, median 10, IQR 9.0–11.9) and the mean percentage of children with ADHD prescribed stimulant medications among RCGP RSC practices was 41.2% (95% CI 38.7 to 43.6). There was wide inter-practice variation in the prevalence of diagnosis of ADHD, the age of diagnosis and stimulant prescribing. ADHD diagnosis is more likely to be made later in households with a greater number of children and with a larger age difference between adults and children. Stimulant prescribing for children with ADHD was higher in less deprived practices. Older parents and families with more children fail to recognise ADHD and may need more support. Practices in areas of higher socio-economic status are associated with greater prescribing of stimulants for children with ADHD.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
Databases, Factual
medicine.medical_treatment
primary care
03 medical and health sciences
0302 clinical medicine
030225 pediatrics
medicine
Humans
Attention deficit hyperactivity disorder
030212 general & internal medicine
Practice Patterns, Physicians'
Child
Psychiatry
Age differences
business.industry
Database study
Mean age
General Medicine
Original EBM Research
medicine.disease
Mental health
United Kingdom
3. Good health
Stimulant
Cross-Sectional Studies
Developmental trajectory
Attention Deficit Disorder with Hyperactivity
Child, Preschool
General practice
Central Nervous System Stimulants
Female
business
mental health
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- BMJ Evidence-Based Medicine
- Accession number :
- edsair.doi.dedup.....44565e2171264a0d35e79576c0ee14d3