Medication review using a Systematic Tool to Reduce Inappropriate Prescribing (STRIP) in adults with an intellectual disability: A pilot study

Zaal, Rianne J.; Ebbers, S.J.; Borms, M; Koning, Bart de; Mombarg, Erna; Ooms, Piet; Vollaard, Hans; Bemt, Patricia M. L. A. van den; Evenhuis, Heleen M.

doi:10.1016/j.ridd.2016.03.014

Cited by 23 publications

(55 citation statements)

References 31 publications

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“…These are methods not depending on the ability of the patient, and should thus be possible to use also among people with ID. However, medication reviews have been found feasible to perform among people with ID [ 44 , 45 ]. Hence, higher prescription rate of PIMs, such as that found in the present study, should be avoidable.…”

Section: Discussionmentioning

confidence: 99%

Prescription of potentially inappropriate medications among older people with intellectual disability: a register study

Axmon

Sandberg

Ahlström

et al. 2017

BMC Pharmacol Toxicol

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BackgroundOlder people have a greater disease burden and are more likely than younger to be prescribed medications. They are also more sensitive to adverse effects. With this in mind, a range of medications have been suggested inappropriate in this population. People with intellectual disability (ID) have a higher disease burden than the general population, putting them at even greater risk of prescription of such medications. The aim of this study was to describe prescription of potentially inappropriate medications among older people with ID in relation to prescriptions among their age peers in the general population.MethodsWe established an administrative cohort of people with ID (ID cohort; n = 7936), using a Swedish national register. A referent cohort from the general population (gPop) was matched one-to-one by sex and year of birth. Data regarding prescription of potentially inappropriate medications were collected from the Swedish prescribed drug register for the years 2006–2012.ResultsPeople with ID were more likely than the general population to be prescribed medications with anticholinergic effects, intermediate- or long-acting benzodiazepines, and antipsychotics at least once during the study period, and also had more number of years with prescription. Except for benzodiazepines, those in the ID cohort with at least one prescription had larger amounts prescribed than those in the gPop cohort. People in the ID cohort were less likely than the general population to be prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Among those with at least one prescription of NSAIDs, those in the ID cohort had prescriptions during fewer years and in lower amounts than those in the gPop cohort.ConclusionsAlthough prescription of potentially inappropriate medications overall is more common among people with ID than in the general population, the opposite pattern is found for medications for pain management. This may be a result of pain being under-recognized and under-treated in this population. Thus, there is a need for training as well as increased knowledge and awareness among care and health care professionals regarding signs of adverse effects and the need of continuous evaluation of treatment in this vulnerable group.

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Section: Discussionmentioning

confidence: 99%

Prescription of potentially inappropriate medications among older people with intellectual disability: a register study

Axmon

Sandberg

Ahlström

et al. 2017

BMC Pharmacol Toxicol

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“…Feedback has enabled us to identify aspects of the HT-SMR which require development to improve utility and enhance the potential for benefits of the intervention. The advantages of this mediation review were that it is relatively quick, self-explanatory and can be completed in a single patient contact, making it easier to integrate into the current models of care than other published medication review methods that are multistage and multiprofessional and more likely to encounter implementation barriers 31 32. Being conducted by the psychiatrist, who is also the prescriber, the method avoids the pitfalls of non-prescriber-directed medication reviews in which as few as one-third of recommendations are actioned 33…”

Section: Discussionmentioning

confidence: 99%

A structured medication review tool to promote psychotropic medication optimisation for adults with intellectual disability: feasibility study

Sheehan

Strydom²,

Marston

et al. 2019

BMJ Open

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ObjectivesTo investigate the feasibility of delivering structured psychotropic medication review in community services for adults with intellectual disability (ID).DesignSingle-arm feasibility study conducted over a 6-month period.SettingSpecialist community ID teams in England.ParticipantsPsychiatrists working with adults with ID and adults with ID who had been prescribed psychotropic medication.InterventionA structured web-based psychotropic medication review tool (the HealthTracker-based structured medication review) comprising measures of therapeutic benefit and adverse side-effects was made available for use by psychiatrists in routine clinic appointments. A summary measure of medication effectiveness was graphically presented to aid discussion and decision-making.Main outcome measuresFeasibility metrics including number of people with ID referred, eligible and recruited, and uptake of the medication review tool in naturalistic clinical settings. Psychiatrist and patient feedback was collected to assess acceptability of the intervention and suggestions for development.ResultsFifteen psychiatrists from five clinical teams took part. In total 94 potentially eligible people with ID were referred, of whom 79 (84%) were recruited and together underwent 97 medication reviews over the 6-month study period. Feedback from participants with ID was favourable. Psychiatrists indicated that the HealthTracker-based structured medication review was broadly acceptable and suggested adaptations to improve integration with existing information technology systems and to enhance patient involvement in the review.ConclusionsStructured psychotropic medication review can be used in community services for adults with ID as part of a programme of medication optimisation. It would be feasible to test clinical and patient outcomes of the HealthTracker-based medication review in a randomised clinical trial.

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“…Although there is a considerable ongoing research effort to develop criteria to assess medication appropriateness and optimization of anticholinergic burden drug prescription in the general elderly population in recent years [ 49 – 52 ], a specific tool for (older) adults with ID is not yet available. However, assessment of medication appropriateness included deprescribing of AC drugs in old age ID is beginning to attract research interest, with recent (pilot) studies considering the medication regimen as a whole [ 53 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

Anticholinergic burden in adult and elderly people with intellectual disabilities: Results from an Italian multicenter cross-sectional study

Vreese

Mantesso²,

Bastiani³

et al. 2018

PLoS ONE

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BackgroundAdults and older people with intellectual disabilities (ID) frequently receive anti-cholinergic drugs in chronic use, but no studies in Italy to date have investigated cumulative anticholinergic exposure and factors associated with high anticholinergic burden in this frail population.AimTo probe the cumulative exposure to anticholinergics and the demographic, social and clinical factors associated with high exposure.MethodsThe 2012 updated version of the Anticholinergic Burden Score (ACB) was calculated for a multicentre sample of 276 adult and older people over 40 years with ID and associations with factors assessed.ResultsOverall, antipsychotics, antiepileptics, anxiolytics, and antidepressants were the most frequent classes contributing to the total ACB score. People living in residential care were more likely exposed to high anticholinergic burden (an ACB score of 3+): both community housing (odds ratio [OR] 4.63, 95%CI 1.08–19.95) and nursing home facility ([OR] 9.99, 95%CI 2.32–43.04). There was also a significant association between an ACB score of 3+ and reporting mental health conditions ([OR] 25.56, 95% CI 8.08–80.89) or a neurological disease ([OR] 4.14, 95%CI 1.32–12.94). Neither demographic characteristics (age and gender) nor other clinical conditions (somatic comorbidity, levels and typology of ID) were associated with higher anticholinergic load. A high burden of anticholinergic was significantly more frequent in laxative users (22.6% ACB3+ vs. 5.1% ACB 0) (p = 0.003).ConclusionsPsychotropic drugs were the highest contributors to the anticholinergic burden in adult and old age ID, especially in those people living in institutional settings with mental health and/or neurological conditions. High anticholinergic load has shown to be associated with the use of laxatives.

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Medication review using a Systematic Tool to Reduce Inappropriate Prescribing (STRIP) in adults with an intellectual disability: A pilot study

Cited by 23 publications

References 31 publications

Prescription of potentially inappropriate medications among older people with intellectual disability: a register study

Prescription of potentially inappropriate medications among older people with intellectual disability: a register study

A structured medication review tool to promote psychotropic medication optimisation for adults with intellectual disability: feasibility study

Anticholinergic burden in adult and elderly people with intellectual disabilities: Results from an Italian multicenter cross-sectional study

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