ADHD Diagnosis and Treatment: A Shifting Landscape in New Zealand's Healthcare
A controversial shift is coming to NewHCare's approach to ADHD. From February 1st, General Practitioners (GPs) will be able to diagnose and prescribe medication for Attention-Deficit/Hyperactivity Disorder (ADHD), a role previously exclusive to psychiatrists and psychologists. But will this expansion of GPs' responsibilities be a game-changer or a burden?
Imagine being told you're a distraction to others and yourself throughout your school years. That's what Christchurch resident Pamela experienced, only to discover in 2020, during her university days, that she might have ADHD. Obtaining a diagnosis was straightforward but costly. After contacting private psychologists, she found one offering assessments, costing around $340-$350 for the appointment and an additional $300 for the report. Pamela considers herself fortunate, as the demand for ADHD assessments has since skyrocketed, with some paying over $1,000 for a diagnosis.
The standard process for adult ADHD diagnosis involves assessments by clinical psychologists or psychiatrists, with pediatricians handling children's cases. The public system's waiting lists are notoriously long, pushing those who can afford it towards private practitioners, who often have lengthy wait times as well. Only psychiatrists and pediatricians can initiate ADHD medication prescriptions, but GPs and nurse practitioners (NPs) can continue prescribing with written recommendations from the initiating specialist.
The upcoming change will empower GPs and NPs to assess, diagnose, and prescribe ADHD medication directly. However, GPs caution that this won't be an overnight solution. Angus Chambers, a GP and chair of the General Practice Owners Association, emphasizes that it will be a gradual process, not a magic bullet. With general practices already overwhelmed by patients with complex, chronic conditions, ADHD assessments will add to their workload.
But here's where it gets controversial: Dr. Ben Beaglehole, a psychiatrist and University of Otago lecturer, highlights the tenfold increase in ADHD prescriptions for adults between 2006 and 2022. This surge in demand is particularly notable among previously neglected groups, such as women and girls. However, the demographic data suggests that only those who can afford private assessments are getting treated, leaving many without the help they need.
The recreational potential of ADHD medications adds another layer of complexity. Pamela recalls friends jokingly asking if she'd sell her pills, highlighting the street value of these medications. Dr. Beaglehole stresses the need for tight oversight to prevent misuse.
The direct involvement of GPs in prescribing ADHD medication offers easier access, but it's not without challenges. Dr. Beaglehole expresses concern about the thoroughness of assessments and the potential for misdiagnoses or patient pressure for specific medications. The service is unfunded, meaning patients will bear the full cost of GP appointments for ADHD diagnoses.
Even with a correct diagnosis, medication isn't an instant solution. Pamela had to experiment with different dosages and types of medication throughout 2021 and 2022, experiencing side effects like loss of appetite and sleep disturbances. The global shortage of ADHD medication further complicates matters, with Pharmac delaying prescribing changes until 2026.
The demand for ADHD treatment has skyrocketed globally as awareness grows. Many adults are realizing they might have ADHD, while others with the inattentive form may struggle with time management and organization. Dr. Chambers believes the change in prescribers is a bureaucratic move, shifting the burden rather than solving the problem, especially with global drug supply chain constraints.
In conclusion, while expanding GPs' role in ADHD diagnosis and treatment may improve access, it's not a panacea. The private system may remain the go-to for those who can afford it, and long waiting lists could persist in the public sector. The question remains: Will this shift truly address the growing demand for ADHD care, or is it merely a temporary fix in a complex healthcare landscape?
