Attention-Deficit/Hyperactivity Disorder: knowledge and way to proceed of Primary Care paediatricians

Objective: to determine the diagnosis knowledge of attention-deficit/hyperactivity disorder (ADHD) in a group of Primary Care paediatricians from several Health Areas of Madrid; paediatricians way to proceed with children suspected to have ADHD; to determine if there is any association between paediatricians way to proceed and their knowledge of diagnosis; and if there are any differences between Primary Care paediatricians from different Health Areas of Madrid. Methods: a survey was conducted among 221 Primary Care paediatricians from the Areas 6, 8 and 9 of Madrid, in 2005. We consider these paediatricians had enough level in the knowledge of diagnosis of ADHD when they used standardized diagnostic criteria. Results: 104 paediatricians answered (47%). There were significant differences among the three areas in the type of professional qualification (MIR paediatrician or no MIR paediatrician or physician but not paediatrician), but not in the type of contract (temporary or permanent), or average of patients visited per day. 1. Knowledge of diagnosis: 86% have knowledge of three main symptoms of ADHD. 61% have knowledge of diagnostic criteria on DSM (Diagnostic and Statistical Manual of Mental Disorders) or ICE (International Classification of Disease), but only 41% of the participants use these criteria. 82% of the paediatricians that use diagnostic criteria prefer the DSM ones. There were no significant differences among the areas. 2. Way to proceed: when a suspected diagnosis, 52% of the participants send all patients to the neurologist or the psychiatrist. 72% never start medical treatment without previous consult to these specialists. To this respect a clear difference was found (p 0.0071) among the three areas: in the Areas 6 and 9, 81% never treat patients before consulting specialists, but only 42% in the Area 8. There were no significant differences among the Areas in the control of the evolution of patients with ADHD treated with medication: 17% of the participants only prescribe the medication, 61% controls the patients unsystematically, and only 22% controls the patients systematically. 3. Way to proceed according to the use or not of diagnostic criteria (DSM o ICE): Physicians using diagnostic criteria send less patients to the neurologist or the psychiatrist (p 0.0056), start with more frequency medical treatment without previous consult to these specialists (p 0.0009) and control patients under medical treatment more systematically (p 0.0005) than the physicians not using these criteria. Conclusions: 1. Only 41% of the Primary Care participant paediatricians have enough knowledge of diagnosis on ADHD. 2. Most of them send all or a lot of patients suspected of ADHD to the neurologist or psychiatrist. Never or very few times start medical treatment without previous consult to these specialist, and control unsystematically patients under medical treatment. 3. Primary Care paediatricians using diagnostic criteria DSM or ICE send less patients to the neurologist or the psychiatrist, start more frequently medical treatment without previous consult to these specialists, and control patients under medical treatment more systematically than those not using these criteria. 4. There were no significant differences among the three areas respect of the knowledge of diagnosis. There was significant difference, however, in the way to act: in the Area 8, participants send fewer patients to the specialists and specially start medical treatment more often without previous consultation than paediatricians in the Areas 6 and 9.