GP-led adult ADHD care hindered by lack of training and funding, University of Queensland study finds

The research by the University of Queensland was conducted nearly a year after GPs were given the power to diagnose and prescribe medication for adults with attention deficit hyperactivity disorder, a condition marked by symptoms of inattention, hyperactivity and impulsivity. Queensland was the first Australian jurisdiction to embrace the expansion but, unlike other states, GPs aren’t required to undertake mandatory ADHD-specific training.

PhD candidate Benjamin Johnson, from UQ’s National Centre for Youth Substance Use Research, said Queensland doctors needed better training to avoid misdiagnosis. “Even though many GPs have experience with treating childhood ADHD, adult ADHD can be quite tricky to diagnose, which is why there needs to be more education and compulsory training,” Johnson said. He noted that someone experiencing burnout can present with similar impairments to ADHD, such as inattention and forgetfulness, but their treatments are very different. “That’s why it’s really important to be able to differentiate between situational factors and a long-term developmental disorder,” he said.

Best practice ADHD diagnosis typically requires two to three hours over several sessions to cover developmental history, collateral reports, screening for co-occurring health conditions and shared decision-making. Before the expansion into GP-led care, adults seeking diagnosis had to visit a specialist, usually a psychiatrist. Such appointments could cost upwards of $1000 and incur waiting periods of up to a year, making care inaccessible for many people.

While expanding GP authority had relieved strain on the system, Johnson’s research found current Medicare funding arrangements do not support longer consultations, and rebates should be reviewed to ensure GPs are not financially penalised for providing comprehensive care.

Assistant Professor Dr Sidd Sarmah, a Gold Coast-based GP and practice owner, and chair of AMA Queensland’s General Practice Committee, agreed with the need for current Medicare funding arrangements to be reviewed, but said doctors are well-placed to provide adult ADHD care and didn’t necessarily need compulsory training. “I support training and GPs should have access to good education [and] shared care pathways with psychiatrists and paediatricians,” Sarmah said. “GPs have been able to take on this new challenge very well, primarily because our fellowship involves rigorous specialist training, and we manage quite a few complex chronic conditions, and most adult mental health problems.”

Sarmah described the expansion as “a breath of fresh air” because the real alternative was actually no care, noting access for adults seeking ADHD assessment was a big problem at that point. He noted GPs have been managing ADHD for children between the age of four and 17 since 2017, and said some have chosen not to broaden their services to adults since the changes came into effect in December last year. “I do a lot of skin cancer work, a few GPs [at my practice] do mental health work,” he said. “They wouldn’t necessarily want to get involved from an interest point of view in ADHD management because it is a very complex condition [and] Medicare rebates do not reward long and complex consultations, which is a paradox.”