P170\u2005A study of irish trainee doctors prescribing knowledge for the different medication options for ADHD

Abstract

Introduction Attention-deficit/hyperactivity disorder (ADHD) is a common treatable childhood mental illness, with a prevalence of 7% in under 18 year olds. Functional impairment affects all environments and includes inattention impeding memory and learning, hyperactivity resulting in increased restlessness and movement, and impulsivity leading to poor judgement and risk taking behaviour. These impairments affect children’s social inclusion and ability to integrate and enjoy life, but also their ability to fulfil important educational goals. Children and adolescents with ADHD are more likely to have co-morbid medical conditions, which in turn likely impacts on engagement and recovery within medical treatment plans. Stimulants (e.g. methylphenidate) are first line licensed medications for ADHD, and selective norepinephine reuptake inhibitors (e.g. atomoxetine) and alpha-2A adrenergic receptor agonists (e.g. guanfacine) are second line. At least 85% of children respond to stimulants, and only require alternative medications due to poor tolerance profiles. European Union member states classify narcotics according to United Nation conventions, and stimulant medications are classified as controlled drugs. This means that they have strict prescribing rules, which if not adhered to results in delayed dispensing, continued impairment, and increased demands on already stretched clinical resources. In Ireland ADHD is treated by tertiary mental health services, however in many European countries, paediatricians take a lead role in ADHD treatment. Aim This study examines the knowledge of trainee doctors in Ireland of the prescribing restrictions of stimulant medications, and the alternative non controlled medications used to treat ADHD. Method A questionnaire was designed to capture the current knowledge and prescribing habits of Irish trainee doctors on the 4 commonly used ADHD medications i.e. methylphenidate based, amphetamine based, atomoxetine and guanfacine. The percentage of correct answers were calculated, and Chi squared testing used. Results 47 questionnaires were completed and returned with a response rate of 57.5%. The majority of doctors knew that stimulants were controlled and how to prescribe these, however only one third of doctors distinguished correctly that the other 2 drug classes were not controlled, and similarly did not know how to prescribe them. Conclusion There is a knowledge gap amongst trainee doctors around prescribing for ADHD. Mainly for the non-controlled medication options, but also on specific points around prescribing the controlled stimulant medications. We hope that this identified gap in knowledge can be filled with targeted teaching; supporting doctors to become informed, competent and comfortable in prescribing for this common childhood illness.