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ADHD Plus > Titration Engagement Policy

Titration Engagement Policy

1 Purpose and Scope

This policy sets out the engagement terms for all patients enrolled in Psychiatry UK’s ADHD Titration Service. Its goal is to ensure safe, efficient, and well-managed titration, clarify patient responsibilities, and prioritise safety throughout treatment.

2 Understanding Titration

Titration is a careful process for introducing ADHD medication, in line with NICE guidelines, to find the most effective dose with minimal side effects.

  1. Each patient is assigned a specialist ADHD prescriber who develops a personalised treatment plan recommended by their doctor.
  2. The process is delivered remotely via the MedQare patient portal.
  3. Patients must regularly submit blood pressure, pulse, and weight readings, report any side effects, and score symptom improvements.
  4. The prescriber reviews these updates to adjust medication type or dosage as needed to achieve dose optimisation.
  5. Psychiatry UK’s titration process typically takes up to 12 weeks.
  6. Further information on ADHD medication can be found via the Choice and Medication website.

3 Waiting List and Pre-Titration Requirements

  1. Psychiatry UK operates a waiting list for titration, with estimated wait times provided online.
  2. While waiting, patients receive bi-monthly wellbeing checks and supportive resources.
  3. Medical Investigations: Any requested test results must be sent to the Titration Admin Team before the patient reaches the top of the list.
  4. Pre-Titration Checklist: Issued 28 days before allocation, this must be completed within the timeframe to prevent delays. It includes providing consent for treatment and agreeing to the monitoring schedule.

4 Starting Titration

  1. Once assigned, the prescriber will review patient records and request updated readings to confirm there have been no changes.
  2. Additional investigations may be required if any concerns arise.
  3. The treatment plan is confirmed, and the first prescription issued once safety is assured.

5 Monitoring During Titration

  1. Over the 12-week period, patients must submit all required health readings, log side effects, and score improvements.
  2. After six weeks, patients complete the ASRS (Adult Self-Report Scale), which informs the next prescription.
  3. Medication cannot be prescribed without this monitoring data.

6 Patient Commitments and Conditions

  1. Patients must remain in the UK for the entire titration period. Psychiatry UK cannot deliver medication abroad.
  2. Access to a blood pressure monitor, internet, and a suitable device is essential.
  3. Only one pause is permitted in the treatment period; patients unable to commit should notify their prescriber before starting.
  4. Holidays, medical procedures, or other absences must be reported in advance.
  5. IT issues should be reported immediately; support is available via Live Chat, password reset links, and two-factor authentication help.
  6. Patients must disclose if they are already receiving ADHD treatment elsewhere.

7 Appointment Requirements

  1. Identification: Valid ID must be shown at the first appointment.
  2. Technology: Appointments are via MS Teams, accessible through a browser (desktop/laptop) or the app (mobile/tablet).
  3. Technical support is available through web chat, support tickets, or by calling 0330 124 1980 (Mon–Fri, 8am–6pm).
  4. Prescribers must be informed immediately if:
    • The patient becomes pregnant while on medication.
    • New medication for other conditions is prescribed during titration.

8 End of Titration and Shared Care

  1. When symptoms improve and side effects remain tolerable, the patient attends an End of Titration Review.
  2. If agreed, Psychiatry UK will ask the patient’s GP to take over prescribing under a Shared Care Agreement.
  3. The GP will schedule a six-month review, while Psychiatry UK will follow up annually.
  4. If the GP declines, Psychiatry UK will continue prescribing.

9 Early Discharge

  1. Adherence to timelines is vital for patient safety and service efficiency.
  2. Missing three monitoring forms or failing to respond within agreed timeframes will trigger a clinical review and may result in discharge to GP care.
  3. Discharged patients will be advised on safe medication discontinuation and can be re-referred for future treatment, subject to review and wait list allocation.