Integrated model of primary and mental healthcare for the refugee population served by an academic medical centre.

Refugees are at increased risk for developing mental health concerns due to high rates of trauma exposure and postmigration stressors. Moreover, barriers to accessing mental health services result in ongoing suffering within this population. Integrated care-which combines primary healthcare and mental healthcare into one cohesive, collaborative setting-may improve refugees' access to comprehensive physical and mental health services to ultimately better support this uniquely vulnerable population. Although integrated care models can increase access to care by colocating multidisciplinary services, establishing an effective integrated care model brings unique logistic (eg, managing office space, delineating roles between multiple providers, establishing open communication practices between specialty roles) and financial (eg, coordinating across department-specific billing procedures) challenges. We therefore describe the model of integrated primary and mental healthcare used in the International Family Medicine Clinic at the University of Virginia, which includes family medicine providers, behavioural health specialists and psychiatrists. Further, based on our 20-year history of providing these integrated services to refugees within an academic medical centre, we offer potential solutions for addressing common challenges (eg, granting specialty providers necessary privileges to access visit notes entered by other specialty providers, creating a culture where communication between providers is the norm, establishing a standard that all providers ought to be CC'ed on most visit notes). We hope that our model and the lessons we have learned along the way can help other institutions that are interested in developing similar integrated care systems to support refugees' mental and physical health.

Comparison of On-Road Driving Between Young Adults With and Without ADHD.

OBJECTIVE: This study compared video recordings from routine driving of ADHD and non-ADHD young adults to identify differences in driving behaviors. METHOD: A matched sample of young adult drivers with and without ADHD are compared via blinded ratings of videoed g-force events recorded by DriveCam technology over 3 months of on-road driving. RESULTS: ADHD drivers were significantly more likely to have more crashes, minor events, and g-force events. G-force events for the ADHD drivers involved significantly more risky and illegal, hyperactive/impulsive, and distracted behaviors. The g-force events of non-ADHD drivers were due to evasive, defensive driving or lapses in attention. CONCLUSION: Increased risk for ADHD drivers may be the result of increased risk taking, increased hyperactivity/impulsivity or distraction behavior, and increased vulnerability to factors that interfere with driving in general, whereas the consequences of faulty driving were either higher or potentially higher in those drivers with ADHD.

Quantifying the relationship between perceived consequences of ADHD medication and its usage.

OBJECTIVE: To address a major barrier of medication noncompliance for individuals with ADHD, the authors present the ADHD Medication Attitude Scale (AMAS) with initial psychometric analyses and discriminant validity data. METHOD: The AMAS was posted on ADHD websites, along with questions about demographics and medication usage over a 6-month period. A total of 356 ADHD respondents qualified for data analysis (160 males, 196 females, mean age = 18.58, years range = 13-62 years, SD = 6.07). RESULTS: Factor analysis revealed two factors: one indicating positive and the other indicating negative attitude toward medication. The final refined 22-item scale demonstrated good reliability (α =.83). More positive and less negative attitude factor scores, as well as age (older than 19 years), independently predicted respondents' self-report of taking medication, χ(2) (1, N = 248) = 38.95, p < .001. CONCLUSION: The AMAS is a psychometrically sound means of assessing attitudes toward ADHD medication, which significantly relate to self-reported medication usage.

Long-acting methylphenidate reduces collision rates of young adult drivers with attention-deficit/hyperactivity disorder.

This study investigated whether methylphenidate delivered through a long-acting transdermal system (MTS) would reduce collision rates of young adult drivers with attention-deficit/hyperactivity disorder (ADHD).Seventeen young adults completing the study (mean [SD] age, 20.82 [2.40] years; 14 men and 13 white) met the following inclusion criteria: ADHD diagnoses but not routinely taking ADHD medication, previously responsive to ADHD medication, active drivers with more than 1 collision or citation in the past 2 years, and no significant comorbidities. In this open-labeled, crossover design drivers were randomly assigned either to the no-medication condition for 3 months and then MTS for 3 months or to the reverse sequence. In-car video monitoring of routine driving occurred during these 6 months. At baseline and after each condition, participants completed the Conners Adult ADHD Rating Scale and the Cox Assessment of Risky Driving Scale, and their blood pressure, heart rate, and body weight were monitored.Compared with the no-medication condition, participants in the MTS condition self-reported fewer total ADHD (P < 0.04) and inattentive symptoms (P = 0.014) and a trend for risky driving behaviors (P = 0.059) and had fewer video-recorded collisions (P < 0.005) and other problematic driving events. There were no significant changes in blood pressure, heart rate, or body weight across conditions or any significant skin reactions to the MTS patch.This is the first study demonstrating that long-acting methylphenidate improves activities of daily living among young adults with ADHD. Specifically, methylphenidate improved safety in routine driving while reducing ADHD symptoms with minimal adverse effects.