[Optimizing ADHD Treatment? Results of a Pilotstudy of the ADHD Selective Contract in Bremerhaven, Germany].
BACKGROUND
The attention deficit hyperactivity disorder (ADHD) is associated with substantial impairment and psychiatric comorbidities. Thus, an optimized treatment is essential. In 2011, a new multidisciplinary treatment strategy (so-called Versorgungsvertrag) was contracted for the model region of Bremerhaven, Germany. This manuscript describes the results of the feasibility testing, focusing on the effects of the Versorgungsvertrag on patients' ADHD symptoms and on the treatment satisfaction of patients' kins.


METHODS
Patients with ADHD (4-17 years) were assessed at baseline and at 9 months follow-up. Kins documented the current symptomatology using the FBB-ADHS questionnaire on both occasions, and rated their satisfaction with the Versorgungsvertrag at follow-up. The FBB-ADHS gives information on the severity of the ADHD core symptoms (0=normal, 3=very noticeable).


RESULTS
69 patients (77 kins) were included. At follow-up, data from 59 patients (67 kins) were available. FBB-ADHS data of both occasions was available for 44 patients. Improvements regarding the ADHD total score (1.27 at follow-up vs. 1.59 at baseline, p=0.003) and the subdomains inattention (1.42 vs. 1.81, p=0.001) and hyperactivity (0.96 vs. 1.22, p=0.032) were documented. In the subgroup of boys (n=34), inattention (p=0.001), impulsivity (p=0.019) and the ADHD total score (p=0.002) improved, while no changes were observed in the subgroup of girls (n=10). The majority of kins (52.4 to 68.4%) rated the treatment as helpful.


CONCLUSIONS
Our study shows improvements for the ADHD core symptoms after 9 months and a high satisfaction of kins with the treatment strategy. Due to the lack of a control group from routine care, no certain statement about the additional benefit of the treatment strategy can be made. The null effect in the subgroup of girls might be explained by the underrepresentation of girls, but the gender distribution observed in our study is commonly observed in patients with ADHD.


CONCLUSIONS
The positive effects during the observation period should be confirmed in further studies including a control group from routine care.
Institut für Allgemeinmedizin, Universität Duisburg-Essen, Universitätsklinikum Essen.
Christine
C
Kersting
HFH Hamburger Fernhochschule, Fachbereich Gesundheit und Pflege, Hamburg.
Christina
C
Lindemann
Helmholtz-Zentrum für Infektionsforschung, Epidemiologische und Statistische Methoden, Braunschweig.
Rafael
R
Mikolajczyk
Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS GmbH, Klinische Epidemiologie, Bremen.
Edeltraut
E
Garbe
Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS GmbH, Klinische Epidemiologie, Bremen.
Oliver
O
Riedel
D000293:Adolescent; D000553:Ambulatory Care; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D008297:Male; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D017060:Patient Satisfaction; D010865:Pilot Projects