Maine Medical Center, Medical Education, Maine Medical Center Research Institute
Adult, Attention Deficit Disorder with Hyperactivity, Internal Medicine, Humans, Clinical Competence
Background: Patient complaints about ADHD in adulthood are on the rise, however primary care providers are not confident addressing this topic. Institutional guidelines on adult ADHD are lacking and those that exist tend to emphasize treatment with stimulants at the expense of alternative treatments that also have supportive evidence. To address this, we developed an adult ADHD toolkit for use in primary care offices that offers guidance on assessment and treatment. This project sought to establish whether implementation of the toolkit helped providers feel more confident responding to patient concerns. Methods: We administered an ADHD survey to providers at Maine Medical Center primary care offices immediately before the toolkit was introduced and again 5 months later. Participation was voluntary and anonymous. The survey was adapted with permission from the ADHD Questionnaire for Primary Care Providers, and used Likert-scale questions to address self-reported comfort and skill in different clinical domains related to adult ADHD. Results: The survey was completed by 77% (N=24) of participants at baseline and 64.5% (N=20) at 5 month follow-up. Most participants were MDs/DOs (70.4%), followed by LCSWs (22.7%), and NPs/PAs (6.8%). Participants reported significantly greater comfort on questions pertaining to assessment of adult ADHD 5 months after implementation of the toolkit (16.1 ± 5.3) compared to baseline (12.7 ± 5.0; p<0.05). While there were no significant changes from baseline to follow-up for questions pertaining to management, there were areas providers felt more or less comfortable with. For instance, participants were more comfortable with stimulants, and less with nonstimulants. In general, perceived skill in assessment and management of adult ADHD increased with higher self-reported comfort. Conclusions: Our study was limited in size, but serves as a preliminary attempt at establishing how primary care providers can be best supported in addressing ADHD in adulthood. The results are promising in that they demonstrate implementation of an adult ADHD toolkit can help providers feel more confident with assessment. This study also established provider strengths and weaknesses, which can be used to focus future efforts. More research is needed, including larger studies with greater power and those using measures of direct learning rather than perceptions of change.
Mallo, C Jason and Powers, Sara J., "A Clinical Toolkit Improves MMP Internal Medicine Provider Comfort and Perceived Skill with Assessment of Adult ADHD" (2020). Costas T. Lambrew Research Retreat 2020. 95.