Authors:
Jerome, D; Jerome, L. Pages: 732 - 736 Abstract: ObjectiveTo provide primary care clinicians with an approach to the diagnosis and management of attention deficit hyperactivity disorder (ADHD) by reviewing and summarizing the relevant practice guidelines and recent evidence from the literature.Sources of informationPublished guidelines on the management of ADHD were reviewed. A PubMed search was conducted with the MeSH terms attention deficit disorder and family practice. Results were limited to articles published in English within the past 15 years.Main messageAttention deficit hyperactivity disorder is a common neurodevelopmental disorder. Guidelines agree that diagnosis and management of ADHD is appropriate within primary care. Attention deficit hyperactivity disorder is diagnosed by applying the criteria defined within the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, and is supplemented by validated rating scales. Behavioural management is first-line management in all patients, and stimulant medications are first-line management in patients 6 years of age and older. The Canadian ADHD Resource Alliance provides free resources to help clinicians care for patients with ADHD.ConclusionMost patients with ADHD can be managed by family physicians. It is a chronic condition that requires ongoing follow-up. Attention deficit hyperactivity disorder that is complicated by comorbidities might require referral to a specialist. PubDate: 2020-10-19T09:25:05-07:00 Issue No:Vol. 66, No. 10 (2020)
Authors:
Goldman; R. D. Pages: 737 - 738 Abstract: Question A 15-year-old boy in my practice returned for follow-up after having a spontaneous pneumothorax. He spent 6 hours in the emergency department and received oxygen. How common is this condition, and what needs to be considered regarding management and recurrence'Answer Primary spontaneous pneumothorax—penetration of air in the pleural space between the lung and the chest wall—in children is common, and the incidence seems to be on the rise. Emphysematous bleb, asthma, and tobacco use were the most common findings associated with the condition, and in young children pneumothorax might be associated with underlying congenital anomalies. Auscultation and observation of the chest with imaging are used to diagnose the condition, and recurrence in adolescents is common. Treatment includes supportive therapy (mostly rest and oxygen) for small pneumothorax or placing a chest tube or definitive surgical treatment for larger pneumothorax. PubDate: 2020-10-19T09:25:05-07:00 Issue No:Vol. 66, No. 10 (2020)
Authors:
Young, E; Green, L, Goldfarb, R, Hollamby, K, Milligan, K. Pages: 750 - 757 Abstract: ObjectiveTo inform a shared care model between developmental and behavioural (DB) and mental health specialists and primary care physicians by having members of primary care family health teams (FHTs) report on strengths of and barriers to providing care for children with DB disorders and mental health concerns.DesignQualitative study using semistructured focus groups.SettingAcademic and community-based FHTs in Toronto, Ont.ParticipantsPrimary care physicians, nurses, allied health professionals, and family medicine trainees within the participating FHTs.MethodsNine focus groups were conducted with FHT members, and transcripts were analyzed for key themes using an inductive thematic analysis approach.Main findingsEighty-four participants across 9 sites were interviewed. Six sites were academically affiliated and 3 were community based. Participants described their roles in the care of children with DB disorders as primarily "referral agent" but also as "long-term supporter" and "health care coordinator." Family health team members expressed the desire to "learn" and "do more" for these children but noted numerous barriers to providing care, captured in 4 overarching themes: limited training beyond how to screen, lack of service knowledge, limited time and communication, and cumbersome access to mental health and dual diagnosis services.ConclusionPrimary care physicians are in the unique position of being able to provide longitudinal care for children with DB and mental health disorders. However, they perceive barriers to providing care that can affect access to services, service quality, and health outcomes for these children and their families. The health system might benefit from addressing these barriers by providing more training for primary care physicians in the longitudinal care of children with mental health and DB disorders, and by improving communication between FHTs and DB and mental health specialists regarding service navigation and emerging comorbidities. A shared care model integrating DB and mental health specialists into primary care might be one approach that warrants implementation and research. PubDate: 2020-10-19T09:25:05-07:00 Issue No:Vol. 66, No. 10 (2020)
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