Quality statement 7: Annual review of drug treatment

Quality statement

People with attention deficit hyperactivity disorder (ADHD) who are taking drug treatment have a specialist review at least annually to assess their need for continued treatment.

Rationale

There are a number of potential side effects associated with drug treatment for ADHD; therefore people taking drugs for ADHD need to be monitored regularly. Side effects from drugs to treat ADHD can reduce adherence to treatment. In addition, without regular monitoring there is a greater risk that drugs prescribed to treat ADHD will be misused.

Quality measures

Structure

Evidence of local arrangements to ensure that people with ADHD who are taking drug treatment have a specialist review at least annually.

Data source: Local data collection.

Process

Proportion of people with ADHD who are taking drug treatment who receive a specialist review at least annually.

Numerator – the number of people in the denominator receiving a specialist review with the last review date no more than 1 year after the previous review.

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

Data source: Local data collection. NICE clinical guideline 72 audit support tool, services for adults, criterion 13. Data are collected through the child and adolescent mental health services (CAMHS) secondary uses dataset on prescribed medication (global number 17302890).

Outcome

People with ADHD feel supported to manage their condition.

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, indicator 4.7: patient experience of community mental health services. The adult social care outcomes framework 2013–14 indicator 1B: proportion of people who use services who have control over their daily life.

What the quality statement means for service providers, healthcare practitioners, and commissioners

Service providers ensure that systems are in place for people with ADHD who are taking drug treatment to have a specialist review at least annually.

Healthcare practitioners ensure that people with ADHD who are taking drug treatment have a specialist review least annually.

Commissioners ensure that they commission services for people with ADHD who are taking drug treatment to have a specialist review at least annually.

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

People who are taking medication to treat ADHD have their medication reviewed by a specialist at least once a year.

Source guidance

Definitions of terms used in this quality statement

Specialist review should be undertaken either by an ADHD specialist or, if agreed by the person with ADHD and their specialist, in primary care under a locally agreed shared care arrangement after titration and dose stabilisation.

Annual specialist review of drug treatment should include a comprehensive assessment of the following:

  • Clinical need, benefits and side effects.

  • The views of the person and those of a parent, carer, teacher, spouse, partner and close friends as appropriate.

  • The effect of missed doses, planned dose reductions and brief periods of no treatment should be taken into account and the preferred pattern of use should also be reviewed.

  • Coexisting conditions should be reviewed, and the person treated or referred if necessary.

The need for psychological, social and occupational support for the person and their parents or carers (as appropriate) should be assessed.

Equality and diversity considerations

All information and advice about treatment should be culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. People with ADHD should have access to an interpreter or advocate if needed.