Increasing Screening for Adult ADHD in Primary Care

Background: An estimated 70% of adults with ADHD are undiagnosed, which puts individuals at increased risk of medical and psychiatric comorbidities, suicide, accidental injury, and all-cause mortality. However, primary care is ideal for screening and identifying adults at risk of undiagnosed ADHD. Local Problem: No process had been established for identifying adults with ADHD, and screening was not a routine practice in a suburban VA primary care clinic in Salt Lake County. Methods: A pre-intervention survey was used as a needs assessment to determine staff knowledge deficits. The results were used to develop evidence-based resources for staff education and support eventual screening implementation. A post-intervention survey then collected data regarding increased knowledge, intent to use the provided resources, and staff perceptions of barriers and facilitators of screening. Interventions: Two staff-led discussion sessions were held to answer staff questions and concerns while introducing the provided resources. Results: A low pre-intervention survey response rate caused a shift in project objectives to focus more on education and the development of evidence-based recommendations to support the future implementation of a screening process. The completed pre-surveys showed low staff knowledge regarding diagnostic criteria, clinical presentation, and treatment of adult ADHD. These results led to the development of an evidence-based educational PowerPoint, a screening decision tool, and an adult ADHD fact sheet. Themes from the discussions included appreciation for the provided resources, increased knowledge regarding ADHD, and intent to use the resources and decision algorithm. The post-intervention survey showed increased staff knowledge, intent to use the resources, and no significant barriers to screening. Conclusion: Providing education on adult ADHD in the primary care setting can increase staff knowledge and support efforts to screen and identify adults with undiagnosed ADHD. The next steps include increasing the efficiency of the screening process and implementing adult ADHD screening in the VA primary care clinic, and evaluating the resources' usability, feasibility, and sustainability in another setting.