Improving patient care for attention deficit hyperactivity disorder in children by organizational redesign (Tornado program) and enhanced collaboration between psychiatry and general practice: a controlled before and after study

Implement Sci. 2014 Oct 30:9:155. doi: 10.1186/s13012-014-0155-3.


Background: Implementation of clinical guidelines for diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents is a challenge in practice due to insufficient availability of mental health specialists and lack of effective cooperation with primary care physicians. The Tornado program aims to reduce time between referral and start of treatment in eligible patients. This study aims to assess the effectiveness and efficiency of this program.

Methods/design: This is a non-randomized controlled before-after study involving 90 outpatients (6-18 years old) suspected of uncomplicated ADHD, which were recruited by ten mental health teams. The Tornado program, provided by three teams, combines accelerated-track diagnosis and treatment planning. This is followed by psychoeducation at a mental health center and pharmacological treatment by primary care physicians, who received an online e-learning module for this purpose. The control group consists of patients of seven other teams, who receive care as usual. Primary outcome is the patients' time between referral to the mental health or pediatric center and start of treatment. Secondary outcomes include severity of ADHD symptoms; functional status; health-related quality of life; treatment adherence; indicators of diagnostic procedures and treatments; patient, parent, and professional experiences and satisfaction with care; and an economic evaluation. The study is powered to detect a difference of 36 days.

Discussion: This study will provide insight into the effectiveness and efficiency of the Tornado program, an accelerated-track program in mental healthcare.

Trial registration: Netherlands Trial Register NTR2505.

Trial status: Active data collection.

Publication types

  • Controlled Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Attention Deficit Disorder with Hyperactivity / therapy*
  • Child
  • Controlled Before-After Studies
  • General Practice / methods
  • General Practice / standards*
  • Humans
  • Interprofessional Relations*
  • Mental Health Services / organization & administration
  • Mental Health Services / standards*
  • Netherlands
  • Patient Care / methods
  • Program Evaluation
  • Quality Improvement
  • Referral and Consultation / standards
  • Time-to-Treatment

Associated data

  • NTR/NTR2505