Dr Amol Vaze General Adult Psychiatrist with expertise in Adult ADHD 8 th March 2017

Transcription

1 Dr Amol Vaze General Adult Psychiatrist with expertise in Adult ADHD 8 th March 2017

2 Context how big an issue Brief overview of service models for Adult ADHD History and overview of Leicestershire model Rough numbers/referral rates etc Future proposals

3 Anxiety >5% Dementia 1-2 % Bipolar 1-3% Depression 4% PD 5-7% Substance ASD misuse 1-3 % Schizophrenia 1% Adult ADHD 2-4% Learning Disabilities 1-2 %

4 Total adult population about 600, 000 International prevalence 2-4 % Assuming lowest figure we should have about adults with ADHD We have detected about 1500 (<15%)

5 Autism ADHD Substance misuse( alcohol, heroine, nicotine) Bipolar affective disorders (70%) Schizophrenia Alzheimer s disease OCD Anxiety/ Unipolar disorder Anorexia Substance misuse (Cannabis/hallucinogens)

6 USA -$36-52b $67-112b Alzheimer s $91b LD $51b Anxiety $47b Autism $35b Michael Ganz 2006 Schizophrenia $33b

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9 Co-morbidity is the rule 60-80% have at least one other Psychiatric diagnosis. Mean 3 diagnoses. Depression 19-37% Anxiety disorders 25-50% Alcohol misuse 32-53% Substance misuse 08-32% Personality disorders 10-20% Antisocial Behaviour 18-28% Autistic spectrum 10% Learning disability 15-25%

10 Fairly easy to start and titrate Fairly safe...mostly no need for baseline tests Clean.usually few troubling side effects No long term side effects..can be continued in primary care Very few medical contraindications( can be combined with most other meds) Contrary to myth. Medication not widely misused or abused

11 Tertiary care model (completely separate service)- Maudsley, Bristol Secondary care model (delivered by generic CMHTs/equivalent)- Sheffield, Manchester Combined secondary care and tertiary care (Small tertiary team but close liason and formal agreement with secondary care)- Leicester Psychologist led model- Northampton

12 Models Domains Quality of Ass and treatment MDT involvement Tertiary Secondary Combined High Inconsistent High Assured depending on funding Possible but not of trained staff Assured depending on funding Waiting lists Usually long Same as other referrals Continuity of care Monitoring during treatment Fragmentation likely Assured Can be managed effectively Assured Assured Inconsistent Assured

13 Models Domains Tertiary Secondary Combined Throughput Backlog likely Backlog likely Throughput assured Training of other professionals Sustainability/cos t effectiveness Continuity of care Difficult unless special interest Not likely due to above reasons Fragmentation likely Difficult unless special interest Assured Assured Assured Assured Assured

14 Lead by Dr Arif Started as special interest of Lead clinician while in Pakistan Initial pilot clinic and special interest clinic in 2002 Funding arrangements, formal policy ratification and start Started with 2 consultant clinic sessions and admin support

15 Referrals through and retained by generic services if necessary Only transitional patients directly referred Standard Protocol for assessment Formal shared care arrangements with GPs Formal policy agreements with generic teams So far approximately 25 senior clinicians (consultants and SpRs) have worked in the clinic

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18 Approximately 100 referrals per year but funded for about 40 per year Still functioning with 2 consultant clinic sessions and admin Data regarding co-morbidity, prevalence and treatment was comparable with sci literature Data Analysis (and bending backwards..) helped increase funding 5-6 fold in 2013.

19 REF SOURCE CAMHS/COMM PEDS OTHER SERVICES GEN PSYCHIATRY PRIMARY CARE TOTAL PATIENTS ASSESSED PATIENTS NOT ASSESSED TOTAL

20 35% 30% Psychiatric co-morbidties 30% Number of Psychiatric Co-morbidities 25% 24% 20% 3% 15% 10% 5% 11% 11% 9% 10% 4% 4% % of Patients 20% 52% 25% 1 DIAGNOSIS 2 DIAGNOSES 3 DIAGNOSES 4 DIAGNOSES 0%

21 Number of patients reporting impairment before medication Number of patients reporting improvement after medication

22 Referral rates exponentially increased (from 100 per year to approx 800 per year in 2016) RTT targets were agreed in 2014 to bring waiting lists down from 18 months ADHD Nurse appointed in 2015 Increase in admin support (1.5 WTE) Currently 1 full time Consultant and 7 additional Clinic sessions

23 Waiting lists down to under 3 months (for first appointments) However 2 nd assessment appointments not available for a long time Average assessments taking 3-6 months No follow ups available, titration takes 6-9 months Fragmentation of care Admin support never enough

24 East midlands Adult ADHD commissioning group Wealth of experience with 2 established services and experienced professionals Local professionals have national links (UKAAN) Potential research ideas. Will reduce postcode lottery for patients.

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