Who cares for patients with attention-deficit/hyperactivity disorder (ADHD)? Insights from Nordbaden (Germany) on administrative prevalence and physician involvement in health care provision.
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.
Schlander
Michael
M
Institute for Innovation and Valuation in Health Care, Eschborn, Germany. michael.schlander@innoval-hc.com
Schwarz
Oliver
O
Trott
Goetz-Erik
GE
Viapiano
Michael
M
Bonauer
Norbert
N
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