The Royal Australian College of General Practitioners (RACGP) says GPs could play a larger role in ADHD diagnosis and treatment to improve affordability and access to care for patients.
In a submission to the Senate's Barriers to consistent, timely and best practice assessment of attention deficit hyperactivity disorder (ADHD) inquiry, the RACGP calls for:
- support for an expanded role in the diagnosis and treatment of ADHD for GPs with an interest in this area
- consistent rules across all states and territories on which clinicians can diagnose and prescribe stimulant medications for patients
- funding to support effective shared models of care and appropriate funding for long consultations.
Long waits for specialists and high costs are a significant barrier for patients living with ADHD, particularly adult patients who do not have access to diagnosis via a paediatrician.
Most public sector mental health services do not provide ADHD services, resulting in an over-reliance on private sector care and services. Long wait times and high costs are typical, with one RACGP GP member telling the College it would cost their patient over $700 for a telehealth ADHD diagnosis from a specialist, though costs of around $3000 have been reported in the media.
Meanwhile, a 2019 Deloitte Access Economics study for the Australian ADHD Professionals Association estimated ADHD cost Australia $20.4 billion that year, comprising $12.8 billion in financial costs and $7.6 billion in wellbeing costs.
RACGP president Dr Nicole Higgins said too many patients are missing out on care, and GPs can increase their role in the diagnosis and management of ADHD to improve access.
"Access to ADHD diagnosis is inadequate and unaffordable for too many patients," she said.
"Costs potentially in the thousands of dollars, even interstate travel, for patients who may have ADHD show that not only is access too hard, but that people are desperate for healthcare in this area. The recently published ADHD clinical guidelines have given GPs a comprehensive, evidence-based resource to guide the diagnosis and management of ADHD.
"With appropriate support, GPs can step up to help patients, psychiatrists, and paediatricians to diagnose and manage ADHD. This will require appropriate training, funding, regulatory change for prescribing and the development of shared care arrangements between GPs and other health professionals."
More patients are seeking referrals to a specialist for ADHD diagnosis, with 78% respondents to an RACGP poll in March 2023 saying they had seen a substantial increase in the number of patient inquiries about referrals in the previous 12 months, and 16% reporting a small increase.
Dr Higgins said GPs can play a more active role, including in diagnosis of ADHD in shared care arrangements, but are hampered by rules on diagnosis and prescription of stimulant medication that vary by jurisdiction.
In Queensland, GPs can diagnose ADHD and initiate stimulant medication prescriptions for 4–18-year-olds; in NSW, GPs can diagnose and initiate prescription for 6–18-year-olds with permission from the state Ministry of Health. As discussed in the RACGP submission, trials and pilots where GPs work with paediatricians and psychiatrists to upskill in ADHD treatment – and diagnose and manage patients – are underway or proposed in Western Australia, Queensland, New South Wales, and Victoria, but each state operates under different rules. In its submission, the RACGP calls for the development of consistent rules that reflect scientific evidence and best practice.
"Some GPs have already taken on an increased role in diagnosing and treating ADHD, but more support and regulatory change is needed," Dr Higgins said.
"At the moment, it's a postcode lottery. Patients would benefit from consistent rules across all states and territories describing the clinicians that are authorised to diagnose and prescribe stimulant medications. This should include general practitioners. Local, state, and Commonwealth governments should coordinate funding for models of care which support shared care models and clear health pathways for patients.
"Higher patient rebates for relevant Medicare-subsidised services would also improve patients' ability to get support in managing their ADHD by reducing costs and give more people access to coordinated care between health professionals, including GP management plans, team care arrangements, GP mental health treatment plans and multidisciplinary case conferences.
"People living with ADHD also need lifelong and individualised support. More than two-thirds of people with ADHD have at least one other condition such as autism spectrum disorder, depression, anxiety, and sleep disorders. Chronic conditions shouldn't be treated in isolation, but as part of a comprehensive care plan which is regularly reviewed and has input from a multidisciplinary team stewarded by their usual GP. Ensuring that people are able to access allied health services like psychology, only 56% of which were bulk billed in 2021, will also improve patients' access to the services they need.".
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