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.

Outcome

People with ADHD feel supported to manage their condition.

Data source: Local data collection.

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.

Definitions of terms used in this quality statement

Specialist review

This 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

This should include a comprehensive assessment of the following:

  • preference of the child, young person or adult with ADHD (and their family or carers as appropriate)

  • benefits, including how well the current treatment is working throughout the day

  • adverse effects

  • clinical need and whether medication has been optimised

  • impact on education and employment

  • effects of missed doses, planned dose reductions and periods of no treatment

  • effect of medication on existing or new mental health, physical health or neurodevelopmental conditions

  • need for support and type of support (for example, psychological, educational, social) if medication has been optimised but ADHD symptoms continue to have a significant impact.

[NICE's guideline on attention deficit hyperactivity disorder, recommendation 1.10.1]

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.