Who cares for patients with attention-deficit/hyperactivity disorder (ADHD)? Insights from Nordbaden (Germany) on administrative prevalence and physician involvement in health care provision.

OBJECTIVE: To determine age and gender specific administrative prevalence of ADHD (hyperkinetic disorder, HKD, and hyperkinetic conduct disorder, HKCD, according to ICD-10-based coding) in Germany in 2003, and to assess physician involvement in medical care.

METHOD: Retrospective claims database analysis covering the insured population of Nordbaden, Germany (n = 2.238 million).

RESULTS: A total of 11,875 subjects with a diagnosis of HKD/HKCD were identified (overall 12-month prevalence rate 0.53%). Prevalence was highest among children age 7-12 years (5.0%; boys, 7.2%; girls, 2.7%). Among adults age 20 years and higher, prevalence was 0.04% (males, 0.04%; females, 0.03%). 36.0% (13.0%) of children and adolescents and 33.5% (12.5%) of adults with a diagnosis of ADHD were seen by a specialized physician at least once (four times) during the year. Physician involvement by discipline was highly skewed.

CONCLUSION: Diagnosis rates in children and adolescents exceeded those expected according to ICD-10 criteria, but matched DSM-IV-based estimates. In the adult population, ADHD was rarely detected. Most patients were not seen by a mental health specialist, and physician involvement was highly concentrated. Potential policy implications include a high need for expertise among pediatricians and general practitioners. The data indicate an urgent need for further research into health care utilization and quality.