68 research outputs found
Young people with attention deficit hyperactivity disorder in transition from child to adult services: a qualitative study of the experiences of general practitioners in the UK
This is the final version. Available on open access from BMC via the DOI in this recordBackground
Many young people with Attention Deficit Hyperactivity Disorder (ADHD) have impairing symptoms that persist into adulthood, yet only a minority experience continuity of care into adult life. Despite growing emphasis on the primary care role in ADHD managementin NICE ADHD and transition guidance, little is known about GPsâ perspectives, which could hamper efforts to improve outcomes for young people leaving childrenâs services. This study aimed to understand GPsâ experiences of involvement with this group and explore their views on the roles and responsibilities of primary and secondary care in transition, to inform recommendations for policy and practice.
Method
Qualitative interview study with GPs across the UK. Semi-structured telephone interviews were carried out with 14 GPs recruited through a linked mapping study, social media, and snowballing; data were analysed using thematic analysis.
Results
In the absence of a smooth transition from child to adult services, many GPs became involved âby defaultâ. GPs reacted by trying to identify suitable specialist services, and were faced with the decision of whether to continue ADHD prescribing. Such decisions were strongly influenced by perceptions that prescribing carried risks, and concerns over responsibility, particularlywhere specialist services were lacking. Participants described variation inservice availability, and some highlighted tensions around how shared care works in practice.
Conclusion
Implementation of NICE guidance is highly variable, with implications for GPs and patients. Risk and responsibility for primary care ADHD prescribing are central concerns that need to be addressed, as is the inclusion of GPs in a planned transition process.National Institute for Health Research (NIHR)Health Education Englan
Prescribing of medication for attention deficit hyperactivity disorder among young people in the Clinical Practice Research Datalink 2005-2013: analysis of time to cessation
This is the author accepted manuscript. The final version is available from Springer Verlag via the DOI in this record.The aim of this study was to examine the time to cessation of ADHD medication amongst young people with ADHD aged 16 in the period 2005-2013. Previous studies of prescribing in primary care reported high rates of medication cessation amongst 16 and 17Â year olds with ADHD. The examination of trends since the introduction of new NICE guidance in 2008 will support service planning and improvement of outcomes over the vulnerable transition period from child to adult services. We used primary care records from the Clinical Practice Research Datalink and identified cases prescribed ADHD medication at the time of their 16th birthday during the study period. The outcome was time to medication cessation from the age of 16. Cessation of medication was defined as occurring at the beginning of a gap of over 6Â months in prescriptions. 1620 cases were included. The median time to cessation was 1.51Â years (95% CI 1.42-1.67).The estimated probability of remaining on medication was 0.63 (95% CI 0.61-0.65) at age 17 (i.e., at 1Â year) and 0.41 (95% CI 0.39-0.43) at age 18. Young people with ADHD remain at high risk of cessation of medication during the transition from child to adult services. Despite the restriction that only primary care prescribing data were available, the results suggest continuing disparity between expected levels of symptom persistence and continuation of medication.This research was funded as part of a Doctoral Research Fellowship from the National Institute for Health Research held by Tamsin Newlove-Delgado (Reference: DRF-2012-05-221). Tamsin Newlove-Delgado is currently funded by an NIHR Academic Clinical Lectureship. Ken Stein and Obioha C. Ukoumunne were funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula at Royal Devon and Exeter NHS Foundation Trust. This report is independent research and the views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health
Prescribing for young people with Attention Deficit Hyperactivity Disorder in UK primary care: analysis of data from the Clinical Practice Research Datalink
This is the author accepted manuscript. The final version is available from Springer via the DOI in this record.Background
Guidance on management of Attention Deficit Hyperactivity Disorder [ADHD] in the UK was issued
by the National Institute for Clinical Excellence [NICE] in 2008. No UK study has examined all
psychotropic prescribing in young people with ADHD since the introduction of the guidance; this is
especially relevant due to the high prevalence of psychiatric comorbidity in this population.
Aim
To describe primary care prescribing of ADHD and other psychotropic medication for young people
with ADHD.
Design and setting
Analysis of records of patients with an ADHD diagnosis in the UK Clinical Practice Research
Datalink from 2005 to 2013.
Methods
Estimation of the prevalence of prescribing of ADHD and other psychotropic medication over 8 years
follow-up for cases aged 10 to 20 years in 2005.
Results
Of 9,390 ADHD cases, 61.6% (95% confidence interval (CI) = 60.6% to 62.5%) had a prescription at
some point for ADHD medication. Prescribing of other psychotropic medication was higher in girls
than boys (36.4% versus 22.7%; p<0.001). ADHD prescribing prevalence declined steeply between
the ages of 16 and 18 from 37.8% (95% CI 36.6 to 38.9) to 23.7% (95% CI: 22.7 to 24.6%). There
was a parallel increase in prescribing of other psychotropics from 3.8% (95% CI: 3.4% to 4.3%) to
6.6% (95% CI 6.0 to 7.3%).
Conclusion
There is scope to optimise the management of ADHD and psychiatric comorbidities in young people,
and a need for sustainable models of ADHD care for young adults, supported by appropriate training
and specialist services.National Institute for Health Research (NIHR
Resumption of Attention Deficit Hyperactivity Disorder medication in early adulthood: findings from a UK primary care prescribing study
This is the author accepted manuscript. The final version is available from Springer via the DOI in this record.This study aimed to examine resumption of Attention Deficit Hyperactivity Disorder (ADHD)
prescriptions in early adulthood in young people whose ADHD prescriptions stopped in adolescence.
Whilst prescribing studies indicate that the proportion of those with ADHD stopping treatment in late
adolescence remains in excess of the proportion expected to be symptom free, very few studies have
examined patterns of resumption amongst young adults previously prescribed medication.
Primary care records from the UK Clinical Practice Research Datalink from 2008 to 2013 were used
to examine the outcome of resumption of ADHD prescriptions from age 20 years in a sample of cases
with ADHD whose prescriptions stopped aged 14-18. A Cox regression model was fitted to explore
variables that could theoretically be associated with resumption of prescriptions.
Of 1,440 cases, 109 (7.6%) had their ADHD prescriptions resumed. Characteristics associated with an
increased probability of resumption included female gender, learning disability, referral to adult
mental health services, and prescription of antipsychotic medication.
In this study, only a small proportion of adolescents who stopped ADHD medication subsequently
resumed their prescriptions in primary care. Those that did resume were a more complex group. As
many vulnerable individuals with ongoing ADHD symptoms may not have the resources required to
surmount the barriers to re-enter services, the implication is that not all those who could benefit from
resuming medication are able to do so. The findings raise questions around whether current care
models are flexible enough and whether primary care are adequately supported in managing this
group
In transition with ADHD: the role of information, in facilitating or impeding young peopleâs transition into adult services
This is the final version. Available on open access from BMC via the DOI in this recordAvailability of data and materials:
The datasets generated and/or analysed during the current study are not publicly available as they are under embargo until the end of the CATCh-uS project (2019), but are available from the corresponding author on reasonable request. Data is currently stored securely by the University of Exeter College of Medicine and Health.Background
Many national and regional clinical guidelines emphasise the need for good communication of information to young people and their parent/carers about what to expect during transition into adult services. Recent research indicates only a minority of young people in need of transition for Attention Deficit Hyperactivity Disorder (ADHD) experience continuity of care into adulthood, with additional concerns about quality of transition. This qualitative study explored the role that information plays in experiences of transition from the perspectives of parent/carers and young people.
Methods
Participants were recruited from 10 National Health Service Trusts, located across England, with varying service configurations. Ninety two qualitative interviews were conducted: 64 with young people with ADHD at different stages relative to transition, and 28 with parent/carers. Thematic analysis of data was completed using the Framework Method.
Results
Interviewees reported a range of experiences; however reliance on parent/carers to gather and translate key information, and negative experiences associated with poor communication of information, were universal. Three themes emerged: Navigating information with help from parents; Information on ADHD into adulthood; Information about the transition process. The first revealed the essential role of parent in the translation and application of information, the other two explored distinct types of information necessary for a smooth transition. Interviewees made recommendations for clinical practice similar to UK (United Kingdom) National Institute for Health and Care Excellence (NICE) guidelines, with an additional emphasis on providing nuanced information on ADHD as a potentially long term condition. It was important to interviewees that General Practitioners had a basic understanding of adult ADHD and also had access to information about service provision.
Conclusions
Our findings illustrate that the availability and communication of information to young people and their parent/carers is an essential component of the transition process between child and adult ADHD services. How and when it is provided may support or impede transition. This study constitutes a substantial contribution to the evidence base, drawing on interviews from a range of participants across England and from Trusts offering different types of services.National Institute for Health Research (NIHR
Transition between child and adult services for young people with ADHD: findings from a British national surveillance study
This is the author accepted manuscript. The final version is available from Cambridge University Press via the DOI in this record.Data Availability: Data is currently stored securely by the University of Exeter Medical School, under embargo until the end of the CATCh-uS project (2019).Background: Optimal transition involves continuity, joint care, planning meetings and information transfer. To plan services, commissioners and service providers need data on how many people require that service. Although Attention-Deficit/Hyperactivity Disorder (ADHD) frequently persists into adulthood, evidence is limited on transitions between child and adult services.
Aims: To estimate the national incidence of young people taking medication for ADHD that require and complete transition, and describe the proportion that experienced optimal transition.
Methods: Surveillance over twelve months using the British Paediatric Surveillance Unit and the Child and Adolescent Psychiatry Surveillance System, including baseline notification and follow up questionnaires.
Results: Questionnaire response was 79% at baseline and 82% at follow up. For cases aged 17-19, incident rate (range adjusted for non-response) of transition need was 202-511 per 100,000 people aged 17-19 per year, with successful transition of 38-96 per 100,000 people aged 17-19 per year. Cases were mostly male (77%) with a comorbid condition (62%). Half were referred to specialist adult ADHD and 25% to general adult mental health services; 64% had referral accepted but only 22% attended a first appointment. Only 6% met optimal transition criteria.
Conclusions: As inclusion criteria required eligible cases to be on medication, these estimates will represent the lower limit of the need for transition. Two critical points were apparent; referral acceptance and first appointment attendance. The low rate of successful transition and limited guideline adherence indicates significant need for commissioners and service providers to improve service transition experiences.National Institute for Health Research (NIHR
Healthy relationship education programmes for young people: systematic review of outcomes
This is the final version. Available on open access from Routledge via the DOI in this recordThe quality of romantic relationships is associated with mental health and wellbeing throughout the life course. A number of programmes have been developed to support young people in navigating healthy relationships, and a larger role for relationship education was recently formalised in statutory guidance in England. This study aimed to systematically review the evidence base for relationship education programmes. Evaluations of relationship education programmes for young people, including charting of outcome domains and measures, were reviewed, followed by a focussed synthesis of data from studies that included outcome domains of relevance to healthy relationships. Thirty-six studies of seven programmes were found that focussed on one or more outcomes relating to healthy relationship skills, knowledge and attitudes, none of which were assessed as high quality. All evaluated programmes were developed in the US, and only one evaluation was conducted in the UK. The evaluations had a diverse set of outcome domains and outcome measures, few had longitudinal measures. No evidence was found for young peopleâs involvement in programme or evaluation development. High-quality longitudinal evaluations and a core set of validated outcome measures are needed. This research also highlights the need to co-create programmes with young people, teachers and relationship experts that are feasible, acceptable and integrated into a mental health-informed curriculumWellcome Trus
The Cytotoxic T Lymphocyte Antigen-4+49A/G Single Nucleotide Polymorphism Association With Visceral Leishmaniasis
Background: Several lines of evidence approve that innate and adaptive immunity play key roles in the defense against visceral leishmaniasis (VL). The polymorphism within the cytotoxic T lymphocyte antigen 4 (CTLA-4) gene alters its expression. Objectives: The main aim of this study was to evaluate the polymorphism within the +49 position of the CTLA-4 gene of Iranian patients with VL in comparison with healthy controls. Materials and Methods: In this cross-sectional study, 88 patients with clinical presentations of VL, who were seropositive for Leishmania (group 1), 86 patients without clinical presentations but seropositive (group 2), and 115 healthy controls (group 3) were assessed with respect to the CTLA-4 +49A/G polymorphism, using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The anti-Leishmania antibody titration was evaluated using an immunofluorescence method. Results: Our results indicated that both CTLA-4 +49A/G polymorphisms were significantly associated with VL. Conclusions: According to the results, the polymorphisms within the +49 position of CTLA-4 can be associated with VL and may be considered as risk factors for the disease
Children and young peopleâs reported contact with professional services for mental health concerns: a secondary data analysis
This is the final version. Available on open access from Springer via the DOI in this recordData availability:
MHCYP 2017 survey data is available through data access request to NHS Englandâs DARS service, [email protected] and young peopleâs mental health services have been under increasing pressure following COVID-19. Understanding, for which channels help is sought from, will highlight services needing support. This study aims to explore the professional services that parents of children, and young people get help from when they have a concern for the childâs/their mental health. Secondary analysis of data is taken from Mental Health of Children and Young People in England Survey, 2017. 7608 reports of mental health-related contact with professional services from parents of 5â16 year-olds and self-reports from young people aged 17â19 were available. Service contact was reported by Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnosis, age, gender and ethnicity. Less than two-thirds of children and young people with a DSM-V diagnosis (63.5% (95% CI 58.6â68.1) aged 5â10, and 64.0% (95% CI 59.4â68.4) aged 11â16) reported contact with any professional services. The figure was lower for those aged 17â19; 50.1% (95% CI 42.8â58.2), pâ=â0.005. Children and young people aged 5â16 from Black (11.7%; 95% CI 2.4â41.4), Asian (55.1%; 95% CI 34.7â73.9) and Mixed (46.0%; 95% CI 32.4â60.3) ethnic groups reported less contact with professional services compared to those from the White group (66.9%; 95% CI 63.5â70.2). Patterns of service access during the three main educational stages aid with understanding service need during childhood. These lower levels of reported service access for young people aged 17â19 with a DSM-V diagnosis and those in ethnic minority groups demand further investigation.National Institute for Health and Care Research (NIHR)DHS
Experiences of help-seeking from professional services for a child or young personâs mental health concerns during the pandemic: A qualitative study
This is the final version. Available from Public Library of Science via the DOI in this record.âŻIntroduction
The immediate response to the Covid-19 pandemic saw school closures and a shift in provision to online health services for children and young people experiencing mental health concerns. This study provides mental health and referral services with an insight into difficulties experienced as well as recommendations on potential improvements.
Methods
Semi-structured interviews with 11 parents and six young people. Reflexive thematic analysis was used to analyse the data.
Results
Parents and young people reported mixed experiences on accessing mental health support. Priorities and pressures on health services impacted the likelihood of choosing to seek and being able to obtain help. Parents and young people had varying expectations and experiences in help-seeking during the pandemic which were also impacted by othersâ experiences and views. For many, the relationship with the professional they were in contact with impacted their mental health treatment. Provision was sometimes accessed via private services due to long waiting lists or problems that did not âmeet thresholdâ.
Conclusion
Understanding the experiences of seeking mental healthcare during the pandemic can inform improvements to access to services at a time when people are most vulnerable. Accessible provision other than private services needs to be made for those on waiting lists. For those who do not meet service threshold, intermediary support needs to be secured to prevent unnecessary exacerbation of symptoms and prolonged problems. If schools are to remain the hub for children and young peopleâs mental health services, they should be considered essential services at all times.UK Research and InnovationNational Institute for Health Researc
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