Experiences of the Medication Use Process by People with Intellectual Disabilities. What a Pharmacist Should Know!

Flood, Bernadette; Henman, Martin

doi:10.3390/pharmacy9010024

Cited by 5 publications

(9 citation statements)

References 51 publications

(77 reference statements)

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“…Medication adherence has been defined as ‘the extent to which patients take medications as prescribed by their healthcare providers’, 71 while its measurement is the process of systematically assigning numbers or words to tangible and intangible characteristics so that they can be defined, quantified and differentiated. In our review of 59 PROMs, these self-reported measures aimed at quantifying medication adherence based on the responses from a nominal or Likert-point scale and assigning categories to the total scores.…”

Section: Discussionmentioning

confidence: 99%

“…Examples of diseases or statuses explored were asthma, 61 diabetes, AIDS, 58 hypertension, 57 68 chronic diseases, acute osteoporosis, eye-related conditions, 16 cardiovascular, and organ transplant recipients. 27 59 DISCUSSION Quantification of adherence and non-adherence Medication adherence has been defined as 'the extent to which patients take medications as prescribed by their healthcare providers', 71 while its measurement is the process of systematically assigning numbers or words to tangible and intangible characteristics so that they can be defined, quantified and differentiated. In our review of 59 PROMs, these self-reported measures aimed at quantifying medication adherence based on the responses from a nominal or Likert-point scale and assigning categories to the total scores.…”

Section: Extent Of Non-adherencementioning

confidence: 99%

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Patient-reported outcome measures to detect intentional, mixed, or unintentional non-adherence to medication: a systematic review

et al. 2022

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ObjectiveTo categorise patient-reported outcome measures (PROMs) into their propensity to detect intentional and/or unintentional non-adherence to medication, and synthesise their psychometric properties.DesignSystematic review and regression analysis.EligibilityMedication adherence levels studied at primary, secondary and tertiary care settings. Self-reported measures with scoring methods were included. Studies without proxy measures were excluded.Data sourcesUsing detailed searches with key concepts including questionnaires, reliability and validity, and restricted to English, MEDLINE, EMBASE, CINAHL, International Pharmaceutical Abstracts, and Cochrane Library were searched until 01 March 2022. Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA-2020) checklist was used.Data analysisRisk of bias was assessed via COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN-2018) guidelines. Narrative synthesis aided by graphical figures and statistical analyses.Outcome measuresProcess domains [behaviour (e.g., self-efficacy), barrier (e.g., impaired dexterity) or belief (e.g., perception)], and overall outcome domains of either intentional (I), unintentional (UI), or mixed non-adherence.ResultsPaper summarises evidence from 59 studies of PROMs, validated among patients aged 18–88 years in America, the United Kingdom, Europe, Middle East, and Australasia. PROMs detected outcome domains: intentional non-adherence, n=44 (I=491 criterion items), mixed intentionality, n=13 (I=79/UI=50), and unintentional, n=2 (UI=5). Process domains detected include belief (383 criterion items), barrier (192) and behaviour (165). Criterion validity assessment used proxy measures (biomarkers, e-monitors), and scoring was ordinal, dichotomised, or used Visual Analogue Scale. Heterogeneity was revealed across psychometric properties (consistency, construct, reliability, discrimination ability). Intentionality correlated positively with negative beliefs (r(57)=0.88) and barriers (r(57)=0.59). For every belief or barrier criterion-item, PROMs’ aptitude to detect intentional non-adherence increased by β=0.79 and β=0.34 units, respectively (R2=0.94). Primary care versus specialised care predicted intentional non-adherence (OR 1.9; CI 1.01 to 2.66).ConclusionsTen PROMs had adequate psychometric properties. Of the ten, eight PROMs were able to detect total, and two PROMs were able to detect partial intentionality to medication default. Fortification of patients’ knowledge and illness perception, as opposed to daily reminders alone, is most imperative at primary care levels.

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Section: Discussionmentioning

confidence: 99%

Section: Extent Of Non-adherencementioning

confidence: 99%

Patient-reported outcome measures to detect intentional, mixed, or unintentional non-adherence to medication: a systematic review

et al. 2022

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“…Straetmans et al (2007) have shown that the high number of prescriptions to people with intellectual disabilities is a consequence of more frequent contacts with GPs, even though people with ID are less likely to receive a prescription during a doctor's appointment. Another reason possibly explaining the differences in the use of medicines between people with ID and the control group is that people with ID are less likely to assess or decide for themselves whether they want to take the medicines prescribed to them (Flood & Henman 2021). Because register data do not provide an answer, further research on the subject is needed.…”

Section: Discussionmentioning

confidence: 99%

Medicine use in people with intellectual disabilities: a Finnish nationwide register study

Nurminen

Rättö

Arvio

et al. 2022

J intellect Disabil Res

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Background People with intellectual disability (ID) are a vulnerable group in our society; many of them depend on other people for assistance in their everyday lives. Compared with the general population, people with ID have poorer general health and, therefore, need more healthcare services and use more medicines. The aim of this study is to define the population of all Finnish people with ID using administrative data and to compare their medicine use and expenditure on medicines to those of the age-matched and sex-matched controls. Methods People with ID and their age-matched and sex-matched controls (1:1) were extracted from nationwide healthcare and social allowance registers. Administrative register data on all prescription medicine purchases in 2019 were used to determine the prevalence of medicine use in both groups on a general level and by medicine categories. The differences in the prevalence of medicine use between the two groups were analysed using the logistic regression model. In addition, we studied the total expenditure on reimbursable medicine purchases covered by the National Health Insurance between people with ID and control group. ResultsThe subpopulation of people with ID consisted 37 196 individuals, of whom 82.7% purchased prescription medicines in 2019. The corresponding share of individuals purchasing prescription medicines in the control group was 70.3%. The differences in the prevalence of medicine use between the two populations were highest in the younger age groups (0-6, 7-12 and 13-17). In the study population, 28.1% (OR = 12.28; 95% CI: 11.54-13.07) of the people used antipsychotics, making it the most used medicine category in people with ID. In the control group, 3.3% of people used antipsychotics. Compared with the control group, the use of antiepileptics, drugs for constipation, mineral supplements and anxiolytics was four to seven times higher among people with ID. Furthermore, the median expenditure on medicine use among people with ID was four times higher than in the control group. Conclusions Compared with the control group, people with ID used more medicines, especially

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“…During osteoporosis evaluations the experience may pose difficulties due to the lack of reasonable adjustments and challenges with equipment, or individuals may simply be scared. People with ID have had complications in the past getting tested for osteoporosis because of the nature of the DXA test that may seem frightening or challenging for this population [38][39][40]. In frequent patient-physician interactions, the diagnosis itself proves to be more challenging because those with ID are often unable to express their symptoms or frightened by the DXA assessment [41].…”

Section: Introductionmentioning

confidence: 99%

“…Recent research has shown that the use of the GE Lunar Achilles quantitative Ultrasound (QUS) has the potential to be a much better alternative to the DXA for people with IDs, allowing for the undiagnosed and untested population to be more adequately monitored [6]. Nonetheless, after being diagnosed, some individuals have difficulty following through on their treatment plans and may find it challenging to adhere to physical therapy regimes, medications such as bisphosphonates or understanding the importance of the treatment due to lack of reasonable adjustments [37][38][39][40]. As mentioned above, osteoporosis is not a topic associated with men with intellectual disability, further exacerbating the demand for more attention.…”

Section: Introductionmentioning

confidence: 99%

Men's Bones Matter Too, a Cross Sectional Study Examining Bone Health among Men with Intellectual Disability in Ireland.

Burke¹,

Carroll²,

Ding³

et al. 2021

obm geriatr

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Globally between 30-40% of all osteoporotic fractures occur among men, with a quarter of all hip fractures, the most serious complication of osteoporosis, occurring in men. Among men of 50 years of age or older, osteoporotic fracture risk reaches an alarming 20%. What is of great concern is that associated mortality is greater among men when compared with women. For hip fractures specifically, mortality for men is two to three times that in women which may be attributed to the fact that osteoporosis is often considered a “women’s disease”. Of great concern is that there is a paucity of bone health investigation among men with intellectual disability. In the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing, objective bone status of 244 men was measured using a quantitative ultrasound. Participant’s also self-reported doctor’s diagnosis of health conditions including osteoporosis, medication and fracture history with the assistance of key workers/family. Ethical approval for the study was obtained from the Faculty of Health Sciences Trinity College and all participating service providers. Overall, 70.9% of men presented with poor bone health, with 57.8% taking at least one medication that contributed to osteoporosis/osteopenia. Men had a high prevalence of fracture (21.7%) despite this less than 18% had attended bone health screening. In light of these findings, it is time for the spotlight to focus on men’s bone health and for healthcare professionals to realise how ‘at risk’ of osteoporosis are men with intellectual disability. Projections place men on a trajectory of continuous increased risk of fracture in comparison to women.

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Experiences of the Medication Use Process by People with Intellectual Disabilities. What a Pharmacist Should Know!

Cited by 5 publications

References 51 publications

Patient-reported outcome measures to detect intentional, mixed, or unintentional non-adherence to medication: a systematic review

Patient-reported outcome measures to detect intentional, mixed, or unintentional non-adherence to medication: a systematic review

Medicine use in people with intellectual disabilities: a Finnish nationwide register study

Men's Bones Matter Too, a Cross Sectional Study Examining Bone Health among Men with Intellectual Disability in Ireland.

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