Quality statement 6: Starting drug treatment

Quality statement

People with attention deficit hyperactivity disorder (ADHD) who are starting drug treatment have their initial drug dose adjusted and response assessed by an ADHD specialist.

Rationale

People starting drug treatment for ADHD should be closely monitored for side effects, particularly during the initial treatment period. Initial drug doses should be adjusted to ensure that any unwanted effects are minimised while optimising beneficial effects.

Quality measures

Structure

Evidence of local arrangements to ensure that people with ADHD who are starting drug treatment have their initial drug dose adjusted and response assessed by an ADHD specialist.

Data source: Local data collection.

Process

Proportion of people with ADHD who are starting drug treatment who have their initial drug dose adjusted and response assessed by an ADHD specialist.

Numerator – the number of people in the denominator who have their initial drug dose adjusted and response assessed by an ADHD specialist.

Denominator – the number of people with ADHD who are starting drug treatment.

Data source: Local data collection. Data are collected through the child and adolescent mental health services (CAMHS) secondary uses dataset on prescribed medication (global number 17302890).

Outcome

Rates of drug-related side effects in people starting drug treatment for ADHD.

Data source: Local data collection. Data will also be collected against NHS outcomes framework 2013–14 indicator 2.1: proportion of people feeling supported to manage their condition.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that systems are in place for people with ADHD who are starting drug treatment to have their initial drug dose adjusted and response assessed by an ADHD specialist.

Healthcare practitioners ensure that people with ADHD who are starting drug treatment have their initial drug dose adjusted and response assessed by an ADHD specialist.

Commissioners ensure that they commission services for people with ADHD who are starting drug treatment to have their initial drug dose adjusted and response assessed by an ADHD specialist.

What the quality statement means for patients, service users and carers

People with ADHD who are starting medication have their initial medication dose adjusted by an ADHD specialist, who should also check how well the medication is working.

Source guidance

Definitions of terms used in this quality statement

ADHD specialist A mental health specialist trained in the diagnosis and treatment of ADHD. This may include a specialist psychiatrist or, for children, a paediatrician. Drugs for the treatment of ADHD may also be prescribed by a nurse prescriber specialising in ADHD or other clinical prescribers with training in the diagnosis and management of ADHD.

NICE clinical guideline 72 recommendation 1.8.1.3 states that during the titration phase doses should be gradually increased until there is no further clinical improvement in ADHD (that is, symptom reduction, behaviour change, improvements in education and/or relationships) and side effects are tolerable.

Drug doses should be adjusted during the titration phase in accordance with the manufacturer's recommendations contained within the summaries of product characteristics and with reference to the 'British national formulary'.