Introduction

  • This document outlines the terms of engagement for patients registered with Psychiatry UK’s Titration Service. 
  • Its purpose is to ensure efficient and effective management of the titration process, to clarify what is required of patients and prioritise their safety and care. 

What is Titration?

  • Titration is the process that introduces new medication safely in line with NICE guidelines. Patients are allocated to a member of Psychiatry UK’s specialist ADHD prescribing team to initiate a personalised treatment plan recommended by their doctor. 
  • Treatment is carried out remotely via the MedQare patient portal. Patients are requested to submit weekly readings of their blood pressure, pulse and weight for prescriber review, reporting any side effects and scoring any improvements. 
  • This information is essential for the prescriber to safely monitor the patient’s response to medication. The prescriber will adjust the dose, and (if required) the medication, to achieve dose optimisation; that is: to alleviate ADHD symptoms with the minimum possible side effects.  
  • The Psychiatry UK titration model takes up to 12 weeks. 
  • Information about ADHD medications can be found on the Choice and Medication website. 

Waiting List Management

  • Psychiatry UK currently operates a wait list for titration. Estimated wait times are available here. 
  • Patients receive regular communication while on the wait list, including monthly wellbeing checks and supportive resources. 

Preparation for Titration

  • Medical Investigations: The results of any medical investigations (if applicable) requested by the patient’s Psychiatry UK doctor should be submitted to the Titration Admin Team before reaching the top of the wait list. 
  • Pre-Titration Checklist: 28 days before reaching the top of the titration wait list, patients are requested to complete a checklist of tasks, known as the ‘Pre-Titration Checklist’. This must be completed within 28 days to ensure swift allocation of a prescriber and avoid any delay in starting treatment. 
  • Patients are required to give their consent to start treatment and to agree to Psychiatry UK’s titration monitoring schedule. Weekly readings (blood pressure, pulse and weight) are required throughout the titration period to facilitate safe monitoring of the patient’s response to medication. 

Starting Titration

  • Prescriber allocation: Once a prescriber has been allocated, they will review the patient record and request a new set of readings to check there have been no changes. Additional investigations or tests may be requested if indicated by the readings. 
  • Treatment plan: If the prescriber is satisfied that it is safe for the patient to start titration, they will confirm the treatment plan and issue the first prescription. 

Monitoring Information

  • Throughout the titration period (up to 12 weeks), the patient is required to submit weekly readings of their blood pressure, pulse and weight, record any side effects and score any improvements. 
  • The prescriber will review the patient’s response to treatment and any side effects. Where appropriate, they will discuss any alternative treatment options or adjust the medication dose. 
  • After the third week of treatment, the patient is requested to complete an ASRS (Adult Self-Report Scale) Form. The prescriber will review progress with the patient and prepare their next prescription. 
  • This progress review will repeat every three weeks until the completion of titration. 
  • The patient’s new prescription cannot be ordered without this information to ensure their safety. 

Terms of Engagement

  • Patients will need to be in the UK throughout the titration period; Psychiatry UK is unable to treat or deliver medication to patients outside the UK. They will need to have frequent access to a blood pressure monitor, computer or phone and the internet to submit monitoring forms. 
  • If a patient is unable to commit to weekly monitoring for the full 12 weeks of titration, they should make their prescriber aware before starting treatment, as only one pause can be built into an episode of treatment. It may be appropriate to delay initiating treatment to a later stage. 
  • If patients are aware of any reason that they may not be able to submit any of their weekly monitoring forms (e.g. they have a holiday or surgical procedure planned), they should let their prescriber know in advance so that it can be planned into the process. 
  • If the patient is experiencing any IT problems, these should be reported at the earliest opportunity.  
  • For help resetting your password, click here. 
  • To reset two-factor authentication (2FA), click here.  
  • For all other IT issues, please contact our Live Chat service. 
  • Patients should inform their prescriber if they are already accessing or have received ADHD treatment from another service. 

Appointment Preparation

  • Identification: Patients are to present valid identification during their first appointment to verify their identity.
  • Technology Requirements: Patients require access to the internet and a device (e.g., computer, laptop, tablet or smartphone). 
  • Psychiatry UK uses the MS Teams platform for video appointments
  • Patients choosing to attend their video appointments via a laptop or computer can access the MS Teams Platform using their internet browser. 
  • Service users choosing to attend their video appointments via a mobile phone or tablet will need to download the MS Teams app to their device. 
  • Technical assistance is available by making contact using our web chat function or creating a support ticket on our website IT Support. Service Users can also make contact via phone to our contact centre on 0330 124 1980 (Mon-Fri: 8am-6pm).
  • Patients should inform their prescriber if: 
    • They become pregnant while taking their ADHD medication; 
    • They are prescribed new medication for other conditions while in titration. 

End of Titration

  • End of Titration: The patient is invited to an End of Titration Review when dose optimisation has been achieved; that is, the patient is experiencing reduced symptoms and improvements in managing daily living activities, with tolerable side effects.  
  • Shared Care: The prescriber will review the patient’s progress. If the patient and prescriber are satisfied with the new prescription, Psychiatry UK will write to the patient’s GP to ask for their agreement to enter a Shared Care Agreement. This means that future prescriptions would be issued by the GP surgery. 
  • If the GP accepts Shared Care, they will be requested to arrange a medication review appointment after six months. 
  • Psychiatry UK will contact the patient after 12 months to attend an Annual Review with Psychiatry UK. 
  • If the GP declines a Shared Care Agreement, Psychiatry UK will continue to prescribe medication. 

Early Discharge

  • Psychiatry UK is required to adhere to a set timeline for titration to ensure the safety of patients both in titration and on the wait list.  
  • If the Titration Service does not hear from a patient under their care within the requested timeframes, or if a weekly monitoring form is missed on three occasions, a clinical review of their case will be undertaken. This may result in the patient being discharged back to the care of their GP. 
  • If the decision is made to discharge a patient from the Titration Service, the patient will be fully informed about how to safely discontinue treatment and seek a re-referral, if this is something they would like to pursue. 
  • If the patient is re-referred to the service, they will be required to attend a review appointment with their doctor. If it is felt that treatment would still be appropriate, they will be re-allocated to the titration wait list. 

If you have any questions not covered in the above policy please check our FAQ section or use our ‘Live Webchat‘ to chat with one of our agents.