title: Who cares for patients with attention-deficit/hyperactivity disorder (ADHD)? Insights from Nordbaden (Germany) on administrative prevalence and physician involvement in health care provision.
abstract: OBJECTIVE
  To determine age and gender specific administrative prevalence of ADHD (hyperkinetic disorder, HKD, and hyperkinetic conduct disorder, HKCD, according to ICD-10-based coding) in Germany in 2003, and to assess physician involvement in medical care.
  
  
  METHODS
  Retrospective claims database analysis covering the insured population of Nordbaden, Germany (n = 2.238 million).
  
  
  RESULTS
  A total of 11,875 subjects with a diagnosis of HKD/HKCD were identified (overall 12-month prevalence rate 0.53%). Prevalence was highest among children age 7-12 years (5.0%; boys, 7.2%; girls, 2.7%). Among adults age 20 years and higher, prevalence was 0.04% (males, 0.04%; females, 0.03%). 36.0% (13.0%) of children and adolescents and 33.5% (12.5%) of adults with a diagnosis of ADHD were seen by a specialized physician at least once (four times) during the year. Physician involvement by discipline was highly skewed.
  
  
  CONCLUSIONS
  Diagnosis rates in children and adolescents exceeded those expected according to ICD-10 criteria, but matched DSM-IV-based estimates. In the adult population, ADHD was rarely detected. Most patients were not seen by a mental health specialist, and physician involvement was highly concentrated. Potential policy implications include a high need for expertise among pediatricians and general practitioners. The data indicate an urgent need for further research into health care utilization and quality.
authors.affiliation: Institute for Innovation and Valuation in Health Care, Eschborn, Germany. michael.schlander@innoval-hc.com
authors.forename: Michael
authors.initials: M
authors.lastname: Schlander
authors.forename: Oliver
authors.initials: O
authors.lastname: Schwarz
authors.forename: Goetz-Erik
authors.initials: GE
authors.lastname: Trott
authors.forename: Michael
authors.initials: M
authors.lastname: Viapiano
authors.forename: Norbert
authors.initials: N
authors.lastname: Bonauer
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D002648:Child; D019955:Conduct Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D003695:Delivery of Health Care / Q000379:methods* / Q000458:organization & administration; D005260:Female; D005858:Germany / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D015995:Prevalence; D011364:Professional Practice / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D013038:Specialization