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International Journal of Clinical Pharmacy

, Volume 37, Issue 4, pp 566–578 | Cite as

Pharmacists’ medicines-related interventions for people with intellectual disabilities: a narrative review

  • Máire O’DwyerEmail author
  • Arijana Meštrović
  • Martin Henman
Review Article

Abstract

BackgroundPeople with intellectual disabilities (ID) have complex pharmaceutical care needs due to a high prevalence of multimorbidity, a notable degree of polypharmacy and a high risk of adverse drug reactions. Despite this, people with ID often experience significant health disparities compared to the general population. In most developed countries, increasing emphasis on deinstitutionalisation and community integration also means greater utilisation of primary health care services where general practitioners, pharmacists and carers may lack appropriate information about the pharmaceutical needs of this population. Aim of the review To explore what type of pharmaceutical care interventions were being undertaken for people with ID and how pharmacists’ contributed to the care of people with ID as part of multidisciplinary teams. Method Systematic searches of the following electronic databases were carried out; CINAHL, Pubmed, Medline, Embase, Cochrane library, Science Direct and International Pharmaceutical Abstracts. Results were limited to the period 1994–2014 using search terms ‘learning disabilities’, ‘intellectual disabilities’, ‘mental retardation’, ‘developmental disabilities’, ‘learning difficulties’ and ‘pharmacist intervention’, ‘pharmaceutical care’, ‘primary care', ‘pharmacy' “pharmacists” “pharmacy technicians”. Agreement on studies to be included was arrived at by consensus and by using a pre-determined set of inclusion criteria. Due to the heterogeneous nature of the study aims, methods and presentation of study outcomes found, a narrative review was considered appropriate. Results In total, after removal of duplicates, 70 abstracts were identified and screened from the initial search. After screening and consensus agreement, eight articles which met the inclusion criteria were included in the review and were analysed under the following three themes; pharmacist interventions, pharmacists collaboration in provision of care, qualitative studies relating to patient, carers, and pharmacist views on care of people with ID. Conclusions The limited evidence available in the literature suggests that pharmacists can make positive interventions in relation to the quality of the medication use process, in collaboration with other healthcare professionals, carers and patients with ID. However, further research will be required to increase the evidence base with regard to the benefits of providing pharmaceutical care to patients with intellectual disability and to inform future policy and planning.

Keywords

Pharmaceutical care Intellectual disability Pharmacist Pharmacist interventions Clinical pharmacy 

Notes

Acknowledgments

MO’D would like to acknowledge funding received from a Trinity College Dublin Studentship.

Conflicts of interest

None.

Funding

None.

Supplementary material

11096_2015_113_MOESM1_ESM.pdf (311 kb)
Supplementary material 1 (PDF 311 kb)

References

  1. 1.
    American Association on Intellectual and Developmental Disabilities. Definition of intellectual disability 2011. http://aaidd.org/intellectual-disability/definition#.VL-LRnu3G4c.
  2. 2.
    Haveman M, Heller T, Lee L, Maaskant M, Shooshtari S, Strydom A. Major health risks in aging persons with intellectual disabilities: an overview of recent studies. J Policy Pract Intellect Disabil. 2010;7(1):59–69.CrossRefGoogle Scholar
  3. 3.
    Haveman M, Perry J, Salvador-Carulla L, Walsh PN, Kerr M, Van Schrojenstein LV, et al. Ageing and health status in adults with intellectual disabilities: results of the European POMONA II study. J Intellect Dev Disabil. 2011;36(1):49–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Heslop P, Blair PS, Fleming P, Hoghton M, Marriott A, Russ L. The confidential inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study. Lancet. 2013;383(9920):889–895.Google Scholar
  5. 5.
    Lavin KE, McGuire BE, Hogan MJ. Age at death of people with an intellectual disability in Ireland. J Intellect Disabil. 2006;10(2):155–64.PubMedCrossRefGoogle Scholar
  6. 6.
    Taylor D, Paton C, Kapur S. The Maudsley prescribing guidelines in psychiatry: Wiley. com; 2012.Google Scholar
  7. 7.
    McCarron M, O’Dwyer M, Burke E, McGlinchey E, McCallion P. Epidemiology of epilepsy in older adults with an intellectual disability in Ireland: associations and service implications. Am J Intellect Dev Disabil. 2014;119(3):253–60.PubMedCrossRefGoogle Scholar
  8. 8.
    Cooper S-A, Smiley E, Morrison J, Williamson A, Allan L. Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. Br J Psychiatry. 2007;190(1):27–35.PubMedCrossRefGoogle Scholar
  9. 9.
    van Schrojenstein Lantman-De HM, Metsemakers JF, Haveman MJ, Crebolder HF. Health problems in people with intellectual disability in general practice: a comparative study. Fam Pract. 2000;17(5):405–7.CrossRefGoogle Scholar
  10. 10.
    Mac Giolla Phadraig C, el-Helaali R, Burke E, McCallion P, McGlinchey E, McCarron M, et al. National levels of reported difficulty in tooth and denture cleaning among an ageing population with intellectual disabilities in Ireland. J Disabil Oral Health. 2014;15(2):48–53.Google Scholar
  11. 11.
    McCarron M, Swinburne J, Burke E, McGlinchey E, Carroll R, McCallion P. Patterns of multimorbidity in an older population of persons with an intellectual disability: results from the intellectual disability supplement to the Irish longitudinal study on aging (IDS-TILDA). Res Dev Disabil. 2013;34(1):521–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Townsend CE. Developing a comprehensive research agenda for people with intellectual disability to inform policy development and reform. J Policy Pract Intellect Disabil. 2011;8(2):113–24.CrossRefGoogle Scholar
  13. 13.
    Lindsey M. Comprehensive health care services for people with learning disabilities. Adv Psychiatry Treat. 2002;8(2):138–47.CrossRefGoogle Scholar
  14. 14.
    Robertson J, Emerson E, Pinkney L, Caesar E, Felce D, Meek A, et al. Treatment and management of challenging behaviours in congregate and noncongregate community-based supported accommodation. J Intellect Disabil Res. 2005;49(1):63–72.PubMedCrossRefGoogle Scholar
  15. 15.
    Robertson J, Emerson E, Gregory N, Hatton C, Kessissoglou S, Hallam A. Receipt of psychotropic medication by people with intellectual disability in residential settings. J Intellect Disabil Res. 2000;44(6):666–76.PubMedCrossRefGoogle Scholar
  16. 16.
    Kiernan C, Reeves D, Alborz A. The use of anti-psychotic drugs with adults with learning disabilities and challenging behaviour. J Intellect Disabil Res. 1995;39(4):263–74.PubMedCrossRefGoogle Scholar
  17. 17.
    Branford D. A study of the prescribing for people with learning disabilities living in the community and in national health service care. J Intellect Disabil Res. 1994;38(6):577–86.PubMedCrossRefGoogle Scholar
  18. 18.
    Matson JL, Fodstad JC, Neal D, Dempsey T, Rivet TT. Risk factors for tardive dyskinesia in adults with intellectual disability, comorbid psychopathology, and long-term psychotropic use. Res Dev Disabil. 2010;31(1):108–16.PubMedCrossRefGoogle Scholar
  19. 19.
    Einfeld SL. Systematic management approach to pharmacotherapy for people with learning disabilities. Adv Psychiatry Treat. 2001;7(1):43–9.CrossRefGoogle Scholar
  20. 20.
    Straetmans JM, van Schrojenstein Lantman-de HM, Schellevis FG, Dinant G-J. Health problems of people with intellectual disabilities: the impact for general practice. Br J Gen Pract. 2007;57(534):64–6.PubMedCentralPubMedGoogle Scholar
  21. 21.
    Roberts MS, Stokes JA, King MA, Lynne TA, Purdie DM, Glasziou PP, et al. Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. Br J Clin Pharmacol. 2001;51(3):257–65.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Lemay RA. Deinstitutionalization of people with developmental disabilities: a review of the literature. Can J Community Ment Health. 2009;28(1):181–94.CrossRefGoogle Scholar
  23. 23.
    Barton J. Pharmacist support for people with learning disabilities. Pharm J. 1999;263(7072):826–31.Google Scholar
  24. 24.
    Allemann SS, van Mil JF, Botermann L, Berger K, Griese N, Hersberger KE. Pharmaceutical care: the PCNE definition 2013. Int J Clin Pharm. 2014;36(3):544–55.PubMedCrossRefGoogle Scholar
  25. 25.
    Oliver P, Piachaud J, Done J, Regan A, Cooray S, Tyrer P. Difficulties in conducting a randomized controlled trial of health service interventions in intellectual disability: implications for evidence-based practice. J Intellect Disabil Res. 2002;46(4):340–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Clarke DJ, Pickles K. Lithium treatment for people with learning disability: patients ‘and carers’ knowledge of hazards and attitudes to treatment. J Intellect Disabil Res. 1994;38(2):187–94.PubMedCrossRefGoogle Scholar
  27. 27.
    Brahm NC, Brown RC. Clinical pharmacology services: a pharmacist-based consulting service for the developmentally disabled. Am J Health Syst Pharm. 2004;61(5):487.PubMedGoogle Scholar
  28. 28.
    Schmidt EV, Byars JR, Flamuth DH, Schott JJ, Sever CM. Prevalence of low bone-mineral density among mentally retarded and developmentally disabled residents in intermediate care. Consult Pharm. 2004;19(1):45–51.PubMedCrossRefGoogle Scholar
  29. 29.
    Parkes C, Samuels S, Hassiotis A, Lynggaard H, Hall I. Incorporating the views of service users in the development of an integrated psychiatric service for people with learning disabilities. Br J Learn Disabil. 2007;35(1):23–9.CrossRefGoogle Scholar
  30. 30.
    Strydom A, Forster M, Wilkie B, Edwards C, Hall I. Patient information leaflets for people with learning disabilities who take psychiatric medication. Br J Learn Disabil. 2001;29(2):72–6.CrossRefGoogle Scholar
  31. 31.
    Idzinga J, De Jong A, Van Den Bemt P. The effect of an intervention aimed at reducing errors when administering medication through enteral feeding tubes in an institution for individuals with intellectual disability. J Intellect Disabil Res. 2009;53(11):932–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Di Blasi A, Kendall S, Spark MJ. Perspectives on the role of the community pharmacist in the provision of healthcare to people with intellectual disabilities: exploration of the barriers and solutions. Int J Pharm Pract. 2006;14(4):263–9.CrossRefGoogle Scholar
  33. 33.
    Thomsen LA, Rossing C, Trier H, Faber M, Herborg H. Improving safety in the medicines use process for disabled persons in residential facilities. Results from a pilot study. J Biosafety Health Educ. 2014;2:114. doi: 10.4172/2332-0893.1000114
  34. 34.
    Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new medical research council guidance. BMJ. 2008;337:a1655. http://dx.doi.org/10.1136/bmj.a1655
  35. 35.
    McCarron M, Swinburne J, Burke E, McGlinchey E, Mulryan N, Andrews V, Foran S, McCallion, P. Growing older with an intellectual disability in Ireland 2011: first results from the intellectual disability supplement of the Irish longitudinal study on ageing school of nursing, Trinity College Dublin. 2011.Google Scholar
  36. 36.
    Ouellette-Kuntz HM, Lake JK, Wilton AS. 6 Medication use. Atlas on the primary care of adults with develop mental disabilities in Ontario. 2013;1:117.Google Scholar
  37. 37.
    Paton C, Flynn A, Shingleton-Smith A, McIntyre S, Bhaumik S, Rasmussen J, et al. Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services. J Intellect Disabil Res. 2011;55(7):665–74.PubMedCrossRefGoogle Scholar
  38. 38.
    Ellenor G, Frisk P. Pharmacist impact on drug use in an institution for the mentally retarded. Am J Health Syst Pharm. 1977;34(6):604–8.Google Scholar
  39. 39.
    Berchou RC. Effect of a consultant pharmacist on medication use in an institution for the mentally retarded. Am J Hosp Pharm. 1982;39(10):1671–4.PubMedGoogle Scholar
  40. 40.
    Inoue F. A clinical pharmacy service to reduce psychotropic medication use in an institution for mentally handicapped persons. Ment Retard. 1982;20(2):70–4.PubMedGoogle Scholar
  41. 41.
    Richardson TE, O’Reilly CL, Chen TF. A comprehensive review of the impact of clinical pharmacy services on patient outcomes in mental health. Int J Clin Pharm. 2014;36(2):222–32.PubMedCrossRefGoogle Scholar
  42. 42.
    Finley PR, Crismon ML, Rush AJ. Evaluating the impact of pharmacists in mental health: a systematic review. Pharmacother J Hum Pharm Drug Ther. 2003;23(12):1634–44.Google Scholar
  43. 43.
    Maidment ID, Lelliott P, Paton C. Medication errors in mental healthcare: a systematic review. Qual Saf Health Care. 2006;15(6):409–13.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Maidment ID, Fox C, Boustani M, Katona C. Medication management—The missing link in dementia interventions. Int J Geriatr Psychiatry. 2012;27(5):439–42.PubMedCrossRefGoogle Scholar
  45. 45.
    Zermansky AG, Alldred DP, Petty DR, Raynor DK, Freemantle N, Eastaugh J, et al. Clinical medication review by a pharmacist of elderly people living in care homes—Randomised controlled trial. Age Ageing. 2006;35(6):586–91.PubMedCrossRefGoogle Scholar
  46. 46.
    Krska J, Cromarty JA, Arris F, Jamieson D, Hansford D, Duffus PR, et al. Pharmacist-led medication review in patients over 65: a randomized, controlled trial in primary care. Age Ageing. 2001;30(3):205–11.PubMedCrossRefGoogle Scholar
  47. 47.
    Child A, Clarke A, Fox C, Maidment I. A pharmacy led program to review anti-psychotic prescribing for people with dementia. BMC Psychiatry. 2012;12(1):155.PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Brownlie K, Schneider C, Culliford R, Fox C, Boukouvalas A, Willan C, et al. Medication reconciliation by a pharmacy technician in a mental health assessment unit. Int J Clin Pharm. 2014;36(2):303–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Joos E, Mehuys E, Van Bocxlaer J, Remon JP, Van Winckel M, Boussery K. Medication management in Belgian residential care facilities for individuals with intellectual disability: an observational study. J Policy Pract Intellect Disabil. 2014;11(1):27–33.CrossRefGoogle Scholar
  50. 50.
    Flood B, Henman MC. Building quality indicators for medication use in people aging with intellectual disabilities and behaviour disorders. Int J Dev Disabil. 2015. Published online: 6 Feb 2015. doi:  10.1179/2047387714Y.0000000061.

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Máire O’Dwyer
    • 1
    Email author
  • Arijana Meštrović
    • 2
  • Martin Henman
    • 1
  1. 1.School of Pharmacy and Pharmaceutical SciencesTrinity College DublinDublinIreland
  2. 2.Study of PharmacyUniversity of Split School of MedicineSplitCroatia

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