Medication management in intellectual disability settings: A systematic review

Abstract

There is a high level of medication usage among people with intellectual disability due to the presence of significant morbidity and co-morbidities. This review sought to explore medication management and administration in intellectual disability settings, identifying frameworks for practice, analysing whether collaborative practice led to better outcomes, identifying key processes associated with practice, locating tools to support practice and describing metrics for outcome measurement. A systematic review was conducted with analysis of 64 sources which remained following screening and appraisal. Limited evidence was identified with some insight into the processes underpinning medication management and administration. No assessment tools were found, but two potential outcome measures, adherence and errors, were noted. The paucity of guidelines and frameworks is concerning as this is a complex area of practice. There is a need for further practice development and research to be undertaken that takes note of the unique issues that can present in intellectual disability settings.

Factors contributing to antihypertensive medication adherence among adults with intellectual and developmental disability

“…The innovation in this study is that we included all three conditions, intellectual and developmental disabilities, HTN, and MI, and examined whether adherence to psychotropic medication is a mediator in the pathway of residency type and antihypertensive medication adherence. Furthermore, a recent systematic review on the management of medication in intellectual disability settings found a lack of information on management, adherence, or compliance of medications (Sheerin et al, 2019). Of the 64 studies, two were related to the adherence of medication.…”

“…Adults with intellectual and developmental disabilities have 2–3 times higher rates of psychiatric disorders and higher rates of HTN compared to the general population (Ahrnsbrak et al, 2017; Buckles et al, 2013; Stevens et al, 2014); thus, individuals with a dual-diagnosis of intellectual and developmental disabilities and a psychiatric disorder are an important subgroup to target to improve medication adherence. Despite the knowledge that there are challenges for psychiatric and hypertension medication adherence, there are insufficient programs designed for the large group of home and community-based caregivers, outside of structured group homes and supervised apartments, about these issues (Sheerin et al, 2019; Tan et al, 2015). State disability agencies provide services such as case management and community support, including job coaching, day programs, and respite to families (Petner-Arrey and Copeland, 2015); however, there is little evidence that education and information is routinely provided to families.…”

“…For individuals with both MI and developmental disabilities, Tan and colleagues found that minority race/ethnicity, female gender, enrollment in a Medicaid capitated plan, and having gastroesophageal reflux disease were all associated with poor adherence to psychotropic medication (Tan et al, 2015). Further, a recent systematic review by Sheerin et al (2019) investigated medication management in intellectual disability settings, with one of their objects was to “describe potential metrics, outcome measures and performance indicators pertaining to medication management in intellectual disability settings.” Of the 64 articles found, only two focused on adherence, and none of the studies that examined adherence to antihypertensive medication in people with intellectual and developmental disabilities also considered those who were diagnosed with MI and prescribed MI medication. This is an important topic of study, and it is also clinically relevant because research in the general population suggests that there is greater non-adherence to medication in the presence of a dual diagnosis of MI (Bautista et al, 2012; Kretchy et al, 2014).…”

Rating scales to measure adverse effects of medications in people with intellectual disability: a scoping review

“…Relevant search terms (keywords) and controlled vocabulary related to the core concepts of the research question were developed with reference to relevant literature [ 43 , 44 ]. The core concepts were (1) people with ID, (2) medication adverse effects and (3) measures or specific rating scales.…”

Reasonable adjustments to application of the Medication Safety Standard for adult patients living with intellectual disability in Australian hospital settings

“…3,4 Specifically, people living with intellectual disability appear to endure unique barriers to safe medicine use across the entire medicine pathway from prescribing, dispensing, administration and adherence, and monitoring, resulting in their experience of relatively high rates of preventable adverse medication incidents. [5][6][7][8][9][10][11] To this end, the Commission recognises a requirement for the development of practical refinements to the application of all of its mainstream standards, called 'reasonable adjustments', to optimise the quality and safety of healthcare delivery for people living with intellectual disability. 12,13 Within health settings, reasonable adjustments have been interpreted to mean refinements to usual clinical processes and organisation intended to reduce barriers and improve access to, and participation of, people living with disabilities in healthcare.…”