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<\/p>\nIt’s been nearly eight months since GPs and nurse practitioners were given the authority to diagnose and prescribe medicine for attention-deficit hyperactivity disorder (ADHD) in adults.<\/p>\n
The February rule change was made to tackle the massive backlog of patients, who were sometimes waiting longer than a year for a diagnosis when only psychiatrists and paediatricians had that power.<\/p>\n
But with GP clinics already understaffed and overwhelmed with patients, there was concern about how GPs and nurse practitioners would manage the extra workload.<\/p>\n
At Family Health Matters in Auckland’s Glenn Innes, nurse practitioner Michal Noonan had a waitlist of patients wanting ADHD assessments months before she could start offering them.<\/p>\n
She began offering diagnoses in March, a month after the changes come into effect, and said since then there has been a steady flow of demand from both enrolled patients, and people outside the clinic.<\/p>\n
“People have been waiting a really long time to be assessed, they’ve often thought that they’ve got ADHD, but the cost in the past has been just out of reach for most people, now there is another option, while it is still costly, it’s significantly more accessible for more people, but people just want to get started and want to get cracking along.”<\/p>\n
GPs and nurse practitioners learning to balance the load<\/p>\n
Noonan said the past seven months have been a learning curve.<\/p>\n
She and the one other nurse practitioner offering the service at their clinic have had to think carefully about how to balance their workloads.<\/p>\n
“We kind of set up that we would do two to three ADHD things in a week per person, so that it didn’t have such a huge impact upon our enrolled population, and our other work that of course continues on and has been really busy because of winter and the flu season.”<\/p>\n
After finding their feet, they decided to bring in a psychologist and a psychology intern to help handle the paperwork and other admin that comes with an ADHD diagnosis.<\/p>\n
At Hobsonville Family Doctors, Dr Torrance Merkle is offering ADHD diagnoses alongside his normal duties. He also offers assessments at Beehyve, an online telehealth platform specialising in ADHD.<\/p>\n
Assessments typically take between 90 minutes and two hours of a health professional’s time.<\/p>\n
But that doesn’t take into account the paperwork and administrative steps, with patients first submitting a pre-assessment questionnaire that must be reviewed by someone in the clinic.<\/p>\n
Originally Merkle was doing four assessments per week, two at his Hobsonville Clinic, and two online via Beehyve.<\/p>\n
However he has now cut down to one assessment per week, to ensure workload is manageable.<\/p>\n
“I think in general practice we do want to help people but do you have to be really cautious of how much time and energy you spend each day with patients and you do have to save some for yourself because the whole health sector is under strain, particularly general practice.<\/p>\n
“I do feel guilty and it’s not ideal that my normal patients have to wait two weeks to see me at the moment, I wish I could see everyone within a day or two.”<\/p>\n
Despite the busy workload, Merkle said the changes he had seen an ADHD diagnosis make in patient’s lives had made the work more than worth it.<\/p>\n
“The improvements that people get and the amount of life changing that happens from sorting ADHD out, it’s one of the most impactful things we can do in medicine and it’s super rewarding.<\/p>\n
“You really do get that feeling of I’ve actually made a difference in this person and family’s life this week and that’s definitely one of the main motivators.”<\/p>\n
Wait times down, but cost remains a barrier<\/p>\n
Merkle and Noonan agree the changes seem to be cutting down the long wait times for assessments, with wait times at their clinics at no more than a few weeks.<\/p>\n
However, it’s the cost that remains a barrier for many patients.<\/p>\n
Due to the time a diagnosis takes, an assessment at Family Health Matters comes in around $1200.<\/p>\n
At Hobsonville Doctors a 90-120 minute assessment will set you back $800.<\/p>\n
Costs vary from clinic to clinic, but all come in well under the price of a psychiatry appointments, which can cost upwards of $2000.<\/p>\n
Despite the price of a GP or nurse practitioner being more affordable, Noonan said the bill still makes getting a diagnosis inaccessible for many.<\/p>\n
“That still doesn’t address the issue we have predominantly with our some of M\u0101ori and Pacific wh\u0101nau, that’s still out of reach for many wh\u0101nau. I think we need to maybe think about how we do that.”<\/p>\n
<\/p>\n
Dr Luke Bradford says the high cost of ADHD assessments is still an issue.<\/p>\n
Supplied<\/p>\n
Royal New Zealand College of GPs president Dr Luke Bradford said he was confident that as time went on, the backlog of patients waiting for a diagnosis would be solved with the February changes.<\/p>\n
“Before this change people were typically waiting six to twelve months for a private assessment, that is much shorter now, people are being seen much quicker so that’s good.”<\/p>\n
However, Bradford agreed that the high cost of assessments was still an issue.<\/p>\n
“The issue is accessibility and affordability. That’s a societal question, at what point is the payment for this diagnosis the responsibility of the individual versus the responsibility of society and therefore out of the health budget and that’s a different discussion.”<\/p>\n
How widely are ADHD assessments being offered by GPs and nurse practitioners?<\/p>\n
There’s no record of exactly how many GPs and nurse practitioners have opted into delivering ADHD assessments and prescriptions, with many patients left stumped in February, when they were turned away from their local GP clinic which was not choosing to offer the service.<\/p>\n