Mental Wellness First Practice- GP shared care Model for ADHD medication management:
In order to meet the increasing need for assessment and diagnostic clarity for patients with ADHD:
Aim and Purpose: 1) To provide assessment and Diagnostic clarification service for patients especially patients with ADHD who are often long undiagnosed, and desperate for diagnostic clarity.
2) Step 2: After the diagnostic assessment to assist with medication initiation and management through the GP shared care stimulant management system.
3) Education and Information to Gp’s and allied Health on ADHD/ ASD also known as Executive function dysregulation and co-morbidities and management including medications and other modalities
To provide an efficient service to each patient, given the huge need, given the paucity of psychiatrists diagnosing and treating ADHD.
The whole assessment for an ADHD diagnosis involves the following steps Screening for diagnoses of any other psychiatric disorders and a whole routine normal initial psychiatric assessment, plus score ADHD questionnaires, and explain treatments, treatment alternatives, and potential adverse effects, medication dosing and medication SFX, and take comprehensive notes and write letter of assessment and management recommendations to the GP.
Shared care - co-opting with skilled GPs the backbone of our health systems for stimulant medication management and monitoring to ensure Patient medication management is optimised as explained below:
Prescribing stimulant medication: The ways in which the stimulant medication The 1) Psychiatrist prescribes, 2)The GP prescribes with a letter from the psychiatrist. 3)The Psychiatrist initiates and the GP continues prescribing when the patient has stabilised.
Prior to taking the stimulant medication the patient needs a physical examination of the cardiovascular system from his GP, and an ECG, BP, weight and HR check.
To get baseline blood tests to rule out possible causes of symptoms. Such as Iron deficiency and electrolyte imbalances, hyper or hypo thyroidism.
Pharmacies required to confirm script validity with direct phone call with the prescribing doctor.
Safe-Script checks for abuse / mis use/ trafficking potential of medications.
Benefits the Patient - as follows
1) The cost benefit for the patient and reduced waiting times to see a general practitioner for a prescription. I have limited capacity and availability in my practice ADHD, to write the regulated scripts for every patient and to review and monitor the patient every one to two weeks, However, in a multi practitioner clinic, if the authorised GP is unavailable another Gp in the same practice can prescribe by law and regulation/ see VIC health regulation info below: to review and help minimise the disruption from running out of scripts and from not having timely access to prescriptions.
Vic Health Department of Drugs and Poisons information for Schedule 8 stimulant prescribing: Multi-practitioner clinics:
At multi-practitioner clinics, more than one medical practitioner might be involved in the management of some patients. For this reason, each practitioner is not required to obtain a permit, provided a valid permit is held by one practitioner at the clinic and the prescribing is consistent with and does not exceed the permit limits or conditions.
Note: To ensure compliance, details of permits, including maximum dosage plus expiry or cancellation dates, should be prominently displayed within patient records.
Permit applications by general practitioners
Attention Deficit Hyperactivity Disorder
The department’s policy is that specialist involvement is necessary for the diagnosis and ongoing management of all ADHD patients.
• General practitioners will generally only be issued with permits to prescribe dexamphetamine, lisdexamfetamine or methylphenidate where there is evidence of a specialist diagnosis and that a specialist review has taken place within a specified period.
Only specified if patients are being co-managed with the GP, and in this case, the GP must ask for a specialist review at least every 2 years
Strictly speaking, Victoria does not allow the specialist and GP to both have permits to prescribe at the same time but will allow co-managing which means that the permit to prescribe is transferred from the specialist to the
GP, and the GP can keep prescribing stimulants (after the permit has been approved) for up to 2 years before a specialist review is required to allow this to continue.
For more information on SafeScript visit the SafeScript website here. For more information including the required forms to manage routine stimulant prescribing and dispensing of Schedule 8 medications, visit the Stimulant Prescribing section of the medicines and poisons website.