Protocolo clínico para o Transtorno de Déficit de Atenção e Hiperatividade em crianças e adolescentes: saberes e práticas dos prescritores

Abstract

Attention deficit hyperactivity disorder (ADHD) is one of the main disorders to affect children and adolescents. It is associated with important co-morbidities and it has increasingly been acknowledged. Clinical protocols may be used as instruments of intervention for the diagnosis and treatment of ADHD. The aim of this study is to analyse the knowledge and routine of prescribers doctors on clinical protocols and herapeutic guidelines for children and adolescents with ADHD in the child-juvenile public health system of Fortaleza-CE. It is a descriptive study with a quantitative approach, conducted between September of 2017 to January 2018 with 115 medical prescribers. The data was, collected through a semi open questionnaire and Epi Info version 3.5.1 was used for analysis. It was found that out of the 115 prescribers that fitted the inclusion criteria, there was a predominance in the feminine sex (67,0%), middle aged adults, public sector workers, long time working for the system (average of 10,9 years), with the majority having medical residency and speciality (mainly in paediatrics and family health). Great part of the prescribers (93,9%) are familiar with the clinical protocols, however, only 14,8% use this instrument for the intervention of the diagnosis and treatment of children and adolescents with ADHD. The main reasons for using this instrument were: increase in the precision of diagnosis, better choice of treatment and other benefits. Most of the prescribers (44,3%) consider the implementation of a clinical protocol for ADHD extremely important. The professionals assigned to assist the diagnosis of ADHD are: specialty medical doctors (neurologist, neuro paediatrician, psychiatrist and paediatrician), psychologists and occupational therapists. The criteria used for diagnosis were: evaluation of clinical symptoms (44,3%) and family history (23,7%). The main therapeutic approaches adopted were: psychological behavioural therapy and, in a lower percentage scale, pharmacological. The first choice of therapy was methylphenidate (28,7%), followed by lisdexamphetamine (3,5%). The minimum prescription age of methylphenidate was six years (13.9%). For the most part, the prescribers participating in the study were interested in the proposed development and future implementation of a clinical protocol for ADHD in the city of Fortaleza - CE. Thus, it is concluded that it is necessary to reflect these professionals as to their knowledge and practices for the use of clinical protocols as an intervention tool for the care of children and adolescents diagnosed with ADHD in work routines, as a means of improving quality of the service, privileging the individuality, performing safer and more effective diagnoses and optimizing the care to these patients.