2. Method
This project was classified and approved as a service evaluation by the Norfolk and Suffolk NHS Foundation Trust (NSFT) Research and Development Department. We utilised an outcome measure which was routinely used in the service, the Weiss Functional Impairment Rating Scale (WFIRS)16. Scores before and after titration onto ADHD medication were recorded and compared. As explained by Ramsay17, it can be useful to measure functional impairment in order to illustrate the effects of ADHD on one’s life and to justify the need for treatment, to track treatment progress and optimise treatments for adults with ADHD. The present study aimed to evaluate the efficacy of a specialist adult ADHD service, by assessing the difference (if any) in service users’ self-reported functional impairment before and after titration onto ADHD medication.
The WFIRS16 is a self-report scale, designed to assess ADHD-related functional impairment in seven domains that are clinically relevant to ADHD in adulthood, including home, self-concept, learning & work, activities of daily living (ADLs), social activities, and risky activities16,18,19. These domains are likely to represent the target for treatment, meaning the use of the scale before and after treatment can determine improvements in the service user’s ADHD, as well as whether functional difficulties have been alleviated19. In addition to this, the WFIRS demonstrates robust internal reliability, cross-informant agreement on par or superior to other measures of ADHD symptomatology and impairment, and concurrent validity19.
We monitored the case notes of service users who were seen by a Non-Medical Prescriber between 1st January 2019 and 31st March 2019, regardless to where they were in the titration process. Service users whom were already on ADHD medication at the time of their initial appointment (and therefore classed as annual medication reviews) were excluded from the sample. A total of 159 service users were seen by prescribers between 1stJanuary 2019 and 31st March 2019, with 46 of these being excluded as they were annual medication reviews. This left a sample of 113 service users for the evaluation.
Demographic information (age and gender) was collected, as well as their engagement status at the time of final data collection (30th August 2019). Mean scores were calculated for each domain of the WFIRS (18 Weiss 2000), pre- and post-titration to allow for comparison between domains and overall.