Here’s how the process of titration works at ProblemShared:
1) Treatment Planning Session
If you decide to trial ADHD medication, you will be invited to attend a Treatment Planning Session, where your medication options will be fully explained to you by a prescriber.
This will be a 30-minute session via video call and is an opportunity for you to meet with one of our prescribers to discuss your medication options.
Please note that if the appointment is for a child/young person, they will need to be in attendance at the Treatment Planning Session, in order for the clinician to consider prescribing.
A link to access this appointment will be sent to you by email once the appointment is booked.
2) Remember your forms
Before your Treatment Planning Session can be booked, we will need to receive a summary of your medical record. This is a short version of your medical history containing your NHS number and any relevant medical conditions, medication history and allergies, and you can request it from your GP.
Once you have received it, you can submit it to us by uploading it to your client dashboard. If you need help with this, you can email support@problemshared.net and a member of our team will help you.
In addition to your medical record, we also need you to complete 2 extra forms before we can schedule your Treatment Planning Session: the Medical Assessment Tool (which captures some important health information from you), and either the ASRS form for adult clients, or the SNAP-IV form for child clients.
You may have completed one of these forms earlier in your client journey, however, it is important for your clinician to have the most up-to-date information possible when prescribing, and so you will need to complete both of them again.
Links to both of these forms can be found in our ADHD Medication Guide, which sits on the medication page of your client dashboard.
3) Provide your measurements
You will need to provide an up-to-date reading of your blood pressure, pulse, height, and weight in your Medical Assessment Tool. Most ADHD treatments lead to a slight increase in both blood pressure and pulse, which your prescribing team need to monitor. This is an important part of finding the right medication for you, and we cannot issue prescriptions without it.
This information must be sent to us before we can schedule your Treatment Planning Session. As your appointments are carried out remotely, we require that you take your own blood pressure and pulse readings. This can often be done for free at a GP surgery or pharmacy, or you can purchase a blood pressure monitor of your own and take the measurements yourself at home. You can buy blood pressure monitors from local pharmacies, or you can find them online.
4) How to take your blood pressure and pulse readings at home
If you choose to take your blood pressure readings yourself, it’s important to make sure you use equipment that has been clinically validated.
Ensure that you use an age-adapted cuff size with your blood pressure monitor, otherwise you may not get an accurate reading.
Some individuals require a larger cuff size if the cuff supplied does not adjust to fit. These are generally available, but may need purchasing separately.
Ideally, you should sit down for 10-15 minutes before taking the reading, and take the reading on your left arm if possible.
Take 3 blood pressure and pulse rate readings.
To accurately document your blood pressure and pulse readings on the Medical Assessment Tool, please follow these steps regarding where to locate the numbers on your blood pressure monitor:
1. Blood Pressure:
Look for two values, such as "120/80 mm Hg" on your monitor display.
The higher number is the systolic pressure (top number), and the lower number is the diastolic pressure (bottom number).
Ensure the readings are in millimetres of mercury (mm Hg).
Please include both numbers on the form.
2. Pulse:
Locate the pulse rate, usually displayed in beats per minute (BPM) on your monitor.
It may appear as "Pulse" or simply "BPM."
Record the lowest blood pressure and pulse reading of the 3 taken each day.
Ongoing medication review appointments during your titration period.
Following the initial Treatment Planning Session, your prescribing team will arrange review appointments every 3-4 weeks, to review the dose of the medication and to issue your next prescription.
Your prescribing team will also require an up-to-date blood pressure, weight and pulse reading from you prior to every review appointment whilst the medication is being titrated.
Once you have started medication you should take your blood pressure and heart rate at least 2 hours after taking a dose.
Without these measurements we cannot issue a prescription, and your treatment will be delayed.
No repeat prescriptions can be given unless you attend your review appointments, due to the NICE prescribing guidelines around issuing prescriptions for controlled drugs. Missing appointments may lead to breaks in your medication treatment or the treatment needing to be retitrated.
If you miss your appointment, an email will be sent to inform you of this and to request that you contact us within 7 days to arrange another appointment.
5) Prescriptions
Your prescribing team will send each prescription to a pharmacy. The process for receiving your medication will be explained by your prescribing team. Please note that if your medication is a controlled drug, the pharmacy must receive the original prescription in the post before they can dispense the medication, and this usually takes up to 5 working days.
You will receive a prescription valid for 28 days for a supply of medication to last you 30 days.
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