Policy on Medication Prescribing and Ongoing Reviews

1. Introduction

ADHD Access is committed to providing safe, effective, and patient-centred medication prescribing and ongoing reviews for individuals with a confirmed ADHD diagnosis. This policy aligns with the National Institute for Health and Care Excellence (NICE) guideline NG87 on ADHD management to ensure best practice and regulatory compliance.

2. Scope

This policy applies to all healthcare professionals within ADHD Access involved in prescribing and monitoring ADHD medication for adults aged 18 and over. ADHD Access does not provide medication prescribing services for individuals under the age of 18.

3. Eligibility for Treatment

Patients accessing ADHD Access for medication prescribing and review services must:

Be aged 18 years or older.
Have a formal ADHD diagnosis confirmed by a qualified clinician in line with NICE NG87.
Provide documented evidence of their diagnosis from a recognised clinic.
Undergo an initial assessment by ADHD Access to determine suitability for medication management, including a comprehensive review of medical history, cardiovascular risk, and mental health status.

4. Medication Prescribing and Titration

Medication initiation, continuation, and adjustment will be guided by NICE recommendations:

First-line treatment:
- Adults (18+): Lisdexamfetamine is considered first-line, with methylphenidate as an alternative.
Alternative options: If first-line treatment is not tolerated or effective, other options such as dexamfetamine or atomoxetine may be considered.
Pre-treatment Assessments for Second-Line Treatment:
- Patients recommended for second-line treatment must undergo an electrocardiogram (ECG) and liver function tests (LFTs) before initiation.
- These tests can be conducted in-house at ADHD Access or externally, with the patient required to provide the results before treatment commencement.
Titration Process:
- Medication titration will be conducted over several weeks to determine the optimal dose for symptom control and side effect management.
- Patients will be reviewed every 2–4 weeks during titration to assess response and tolerability.

5. Ongoing Monitoring and Reviews

Regular monitoring is essential for optimising treatment and ensuring patient safety. ADHD Access will provide:

Initial Follow-up: Patients will have a follow-up appointment within 4 weeks of medication initiation to assess effectiveness and tolerability.
Routine Monitoring:
- Adults: At least annually or as required.
Physical Health Monitoring:
- Blood pressure and heart rate checks before and during treatment.
- Weight monitoring (if clinically indicated).
- Assessment of any emerging side effects or concerns.
Mental Health and Functional Assessment:
- Patients will be assessed for changes in mental health, including anxiety, depression, and risk of misuse.
- Functional outcomes, such as work performance and daily life impact, will be reviewed.
- Patients must complete and submit PHQ-9 (Patient Health Questionnaire) and GAD-7 (Generalised Anxiety Disorder) scores prior to each review to assess ongoing mental health status.
Specialist Monitoring for Second-Line Treatments:
- Patients on second-line treatments will require periodic ECG and LFT reassessments as clinically indicated.
Dose Adjustments: Medication doses will be reviewed and adjusted as necessary to maintain effectiveness and minimise adverse effects.

6. Shared Care Agreements and Communication

Shared Care Policy: ADHD Access aims to work collaboratively with GPs through shared care agreements where possible. Prescribing responsibility may be transferred to primary care providers after stabilisation, in line with local commissioning policies.
Information Sharing and Documentation:
- All patient consultations, medication prescriptions, and review outcomes will be fully documented and stored securely in accordance with General Data Protection Regulation (GDPR) guidelines.
- Patients’ GPs will be informed of their prescribed medication, titration process, and any dose adjustments to ensure continuity of care.
- Documentation will include rationale for prescribing decisions, monitoring outcomes, and any concerns regarding patient adherence or side effects.
Transparent and Collaborative Approach:
- ADHD Access is committed to maintaining a transparent prescribing service that keeps all healthcare providers informed.
- Patients will be encouraged to share their treatment plans with their GP and other relevant healthcare professionals to support holistic care.
- Any concerns raised by primary care providers will be addressed promptly, and collaborative decisions will be made regarding ongoing management.

7. Patient Education

Medication Information: Patients will receive comprehensive guidance on how to take their prescribed medication, potential side effects, and what to do in case of adverse reactions. This will be provided through printed leaflets, online resources, and direct clinician discussions during consultations.
Adherence to Treatment Plans: Patients will be educated on the importance of adhering to prescribed medication schedules and attending follow-up reviews to ensure continued efficacy and safety.
Lifestyle Modifications and Symptom Management: ADHD Access will offer tailored resources to support patients in managing their condition beyond medication, including guidance on sleep hygiene, nutrition, exercise, and behavioural strategies to improve focus and productivity.
Access to Information: Educational materials will be made available via:
- The ADHD Access website with downloadable guides and FAQs.
- In-clinic printed resources distributed at initial assessments and reviews.
- Email updates and digital newsletters containing research updates, coping strategies, and self-help tools.
Ongoing Support:
- Patients will be encouraged to email any questions regarding their treatment.
- If patients experience severe adverse events from taking medication, they will be directed to NHS 111 or their nearest A&E for immediate medical attention.
- Links to external support networks, including ADHD charities, patient forums, and community support groups, will be provided.

8. Treatment Adherence and Safeguarding

Patients must attend scheduled reviews to continue receiving prescriptions.
Medication will not be prescribed without appropriate clinical review.
Any signs of misuse, dependence, or diversion of medication will prompt immediate review and safeguarding measures where necessary.
Patients identified as at risk due to medication misuse or non-adherence will be referred to appropriate support services.

9. Review and Policy Compliance

This policy will be reviewed annually or as required to ensure continued alignment with NICE guidelines and best practice.
All prescribers within ADHD Access must adhere to this policy to maintain clinical governance and patient safety.
Any updates to NICE guidelines or regulatory requirements will be incorporated into practice promptly.