Assessment of physician practices in adult attention-deficit/hyperactivity disorder

Objective: Adult attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder, yet only 1 in 10 affected adults receives treatment. The study objective was to assess gaps in knowledge and describe current practice patterns of primary care physicians and psychiatrists in the United States in the management of adult patients with ADHD. Method: Primary care physicians and psychiatrists completed an Internet survey as a needs assessment of customary care related to management of adults with ADHD. Adult clinical case vignettes were followed by practice, confidence, and barrier questions. Survey data were collected from April 15, 2010, to August 22, 2010, and were deidentified and analyzed in aggregate to maintain confidentiality. χ2 and t tests were used to compare responses of primary care physicians with those of psychiatrists. Results: The survey was completed by 1,924 physicians: 1,216 primary care physicians and 708 psychiatrists. Fewer primary care physicians than psychiatrists were "extremely confident" in diagnosis (8% vs 28%, respectively, P<.001) and treatment (8% vs 27%, respectively, P<.001). Limited experience with ADHD diagnosis was more of a barrier in primary care than in psychiatry (44% vs 19%, respectively, P<.001). Mean scores on 12 evidence-based questions were lower for primary care physicians than for psychiatrists (6.1 vs 6.8 correct, respectively, P<.001). Awareness of adult ADHD prevalence was lower among primary care physicians than among psychiatrists (32% vs 47% correct, respectively, P<.001). Fewer primary care physicians than psychiatrists recognized comorbid substance use disorder (76% vs 82%, respectively, P=.002), but more primary care physicians than psychiatrists recognized eating disorders (35% vs 21%, respectively, P<.001). Conclusions: The self-assessment survey results indicate physician practices in primary care and psychiatry differ and show areas in which further education will be useful to improve care for adults with ADHD.