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Interdisciplinary medication review to improve pharmacotherapy for patients with intellectual disabilities

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Abstract

Background Patients with intellectual disabilities is an underserved patient group that have poor abilities to express their health complaints. Objective The aim of this study was to improve pharmacotherapy in patients with intellectual disability, by the use of medication reviews and interdisciplinary case conferences. Setting Patients with intellectual disabilities receiving home care services in Oslo, Norway. Method Patients receiving home care services were recruited by a nurse. A clinical pharmacist conducted medication reviews, and thereafter, the patients’ general practitioner, nurse/social educator and clinical pharmacist discussed the pharmacotherapy at an interdisciplinary case conference. Patient demographics, prescribed drugs (strength, dose, indication) and drug-related problems (DRPs) were recorded. Main outcome measure Patient outcomes and actions taken to resolve DRPs 6 weeks after the case conference. Results Forty patients (34–77 years) with intellectual disabilities consented to medication reviews. They used on average 12 different drugs (range 5–23). The most commonly prescribed drugs were CNS-active drugs: analgesics (25 patients), antiepileptics (23 patients) and anxiolytics (21 patients). In total, 27 patients used between 3 and 7 different CNS-active drugs. The clinical pharmacist identified 178 DRPs in 39/40 patients (average 4.5 DRPs, range 0–13). DRPs for 30% of all prescribed drugs were resolved (145/481). Overall, 11% of drugs were deprescribed, 8% required therapeutic monitoring/follow-up, and either the dosage, formulation or route of administration were changed for 7% of the drugs. Conclusions Patients with intellectual disabilities receiving home care services were prescribed many unnecessary drugs and needed adjustment of pharmacotherapy for about one third of their prescribed drugs. The interdisciplinary case conferences improved pharmacotherapy for this vulnerable patient group.

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References

  1. Buszewicz M, Welch C, Horsfall L, Nazareth I, Osborn D, Hassiotis A, et al. Assessment of an incentivised scheme to provide annual health checks in primary care for adults with intellectual disability: a longitudinal cohort study. Lancet Psychiat. 2014;1(7):522–30.

    Article  Google Scholar 

  2. Kidd SA, Lachiewicz A, Barbouth D, Blitz RK, Delahunty C, McBrien D, et al. Fragile X syndrome: a review of associated medical problems. Pediatrics. 2014;134(5):995–1005.

    Article  Google Scholar 

  3. Chitty K, Evans E, Torr JJ, Iacono T, Brodaty H, Sachdev P, et al. Central nervous system medication use in older adults with intellectual disability: results from the successful ageing in intellectual disability study. Aust N Z J Psychiatry. 2016;50(4):352–62.

    Article  Google Scholar 

  4. O'Dwyer M, Peklar J, McCarron M, McCallion P, Henman M. Prevalence, patterns and factors associated with polypharmacy and excessive polypharmacy in an ageing population with intellectual disability in Ireland. Irish J Med Sci. 2013;182:S210.

    Google Scholar 

  5. O'Dwyer M, Peklar J, Mulryan N, McCallion P, McCarron M, Henman M. Patterns of antiepileptic drug use in an ageing population with epilepsy and intellectual disability. Int J Clin Pharm. 2016;38(2):589.

    Google Scholar 

  6. Smith C, Kerr M, Felce D, Baxter H, Lowe K, Meek A. Exploring the evaluation of antiepileptic drug change in people with intellectual disabilities and high-frequency epileptic seizures: seizure control and sustained responsiveness to the environment. Epilepsy Behav. 2004;5(1):58–66.

    Article  Google Scholar 

  7. Davis SR, Durvasula S, Merhi D, Young PM, Traini D, Bosnic Anticevich SZ. Knowledge that people with intellectual disabilities have of their inhaled asthma medications: messages for pharmacists. Int J Clin Pharm. 2016;38(1):135–43.

    Article  CAS  Google Scholar 

  8. Henderson CM, Robinson LM, Davidson PW, Haveman M, Janicki MP, Albertini G. Overweight status, obesity, and risk factors for coronary heart disease in adults with intellectual disability. J Policy Pract Intellect. 2008;5(3):174–7.

    Article  Google Scholar 

  9. Sandberg M, Ahlstrom G, Kristensson J. Patterns of somatic diagnoses in older people with intellectual disability: a Swedish eleven year case-control study of inpatient data. J Appl Res Intellect Disabil. 2017;30(1):157–71.

    Article  Google Scholar 

  10. Ji NY, Findling RL. Pharmacotherapy for mental health problems in people with intellectual disability. Curr Opin Psychiatry. 2016;29(2):103–25.

    Article  Google Scholar 

  11. Axmon A, Sandberg M, Ahlström G, Midlöv P. Prescription of potentially inappropriate medications among older people with intellectual disability: a register study. BMC Pharmacol Toxicol. 2017;18:68.

    Article  Google Scholar 

  12. O'Dwyer M, Peklar J, McCallion P, McCarron M, Henman MC. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ Open. 2016;6(4):e010505.

    Article  Google Scholar 

  13. Sullivan WF, Berg JM, Bradley E, Cheetham T, Denton R, Heng J, et al. Primary care of adults with developmental disabilities Canadian consensus guidelines. Can Fam Phys. 2011;57(5):541–53.

    Google Scholar 

  14. Bell HT, Granas AG, Enmarker I, Omli R, Steinsbekk A. Nurses' and pharmacists' learning experiences from participating in interprofessional medication reviews for elderly in primary health care - a qualitative study. BMC Fam Pract. 2017;18(1):30.

    Article  CAS  Google Scholar 

  15. Zaal RJ, Ebbers S, Borms M, Koning BD, Mombarg E, Ooms P, et al. Medication review using a systematic tool to reduce inappropriate prescribing (STRIP) in adults with an intellectual disability: a pilot study. Res Dev Disabil. 2016;55:132–42.

    Article  Google Scholar 

  16. Flood B, Henman M. Multiple-medication use in people ageing with intellectual disability [PAWID] and behaviour disorders. Pharmacoepidemiol Drug Saf. 2013;22(6):674–5.

    Google Scholar 

  17. O'Dwyer M, Maidment ID, Bennett K, Peklar J, Mulryan N, McCallion P, et al. Association of anticholinergic burden with adverse effects in older people with intellectual disabilities: an observational cross-sectional study. Brit J Psychiat. 2016;209(6):504–10.

    Article  Google Scholar 

  18. Hatah E, Braund R, Tordoff J, Duffull SB. A systematic review and meta-analysis of pharmacist-led fee-for-services medication review. Br J Clin Pharmacol. 2014;77(1):102–15.

    Article  Google Scholar 

  19. O'Dwyer M, Mestrovic A, Henman M. Pharmacists' medicines-related interventions for people with intellectual disabilities: a narrative review. Int J Clin Pharm. 2015;37(4):566–78.

    Article  CAS  Google Scholar 

  20. van Mil JWF, Horvat N, Westerlund T. The PCNE Classification V 9.02019.

  21. Ruths S, Viktil KK, Blix HS. Classification of drug-related problems]. Tidsskr Nor Laegeforen. 2007;127(23):3073–6.

    PubMed  Google Scholar 

  22. Daaleman TP. Primary care of adults with intellectual and developmental disabilities. South Med J. 2016;109(1):12–6.

    Article  Google Scholar 

  23. Griffiths H, Halder N, Chaudhry N. Antipsychotic prescribing in people with intellectual disabilities: a clinical audit. Adv Ment Health Intellect Disabil. 2012;6(4):215–22.

    Article  Google Scholar 

  24. McGillivray JA, McCabe MP. Emerging trends in the use of drugs to manage the challenging behaviour of people with intellectual disability. J Appl Res Intellect. 2006;19(2):163–72.

    Article  Google Scholar 

  25. Matson JL, Neal D. Psychotropic medication use for challenging behaviors in persons with intellectual disabilities: an overview. Res Dev Disabil. 2009;30(3):572–86.

    Article  Google Scholar 

  26. Baftiu A, Feet SA, Larsson PG, Burns ML, Henning O, Saetre E, et al. Utilisation and polypharmacy aspects of antiepileptic drugs in elderly versus younger patients with epilepsy: a pharmacoepidemiological study of CNS-active drugs in Norway, 2004–2015. Epilepsy Res. 2018;139:35–42.

    Article  CAS  Google Scholar 

  27. Halvorsen KH, Johannessen Landmark C, Granas AG. Prevalence of different combinations of antiepileptic drugs and CNS Drugs in elderly home care service and nursing home patients in Norway. Epilepsy Res Treat. 2016;2016:8.

    Google Scholar 

  28. Johannessen Landmark C, Johannessen SI, Tomson T. Host factors affecting antiepileptic drug delivery-pharmacokinetic variability. Adv Drug Deliv Rev. 2012;64(10):896–910.

    Article  CAS  Google Scholar 

  29. Landmark CJ, Johannessen SI, Tomson T. Dosing strategies for antiepileptic drugs: from a standard dose for all to individualised treatment by implementation of therapeutic drug monitoring. Epileptic Disord. 2016;18(4):367–83.

    PubMed  Google Scholar 

  30. Kalachnik JE, Hanzel TE, Sevenich R, Harder SR. Benzodiazepine behavioral side effects: review and implications for individuals with mental retardation. Am J Ment Retard. 2002;107(5):376–410.

    Article  Google Scholar 

  31. Lewis MA, Lewis CE, Leake B, King BH, Lindemann R. The quality of health care for adults with developmental disabilities. Public Health Rep. 2002;117(2):174–84.

    Article  Google Scholar 

  32. Reimers A, Berg JA, Burns ML, Brodtkorb E, Johannessen SI, Johannessen Landmark C. Reference ranges for antiepileptic drugs revisited: a practical approach to establish national guidelines. Drug Des Devel Ther. 2018;12:271–80.

    Article  CAS  Google Scholar 

  33. Tobi H, Scheers T, Netjes KA, Mulder EJ, de Bildt A, Minderaa RB. Drug utilisation by children and adolescents with mental retardation: a population study. Eur J Clin Pharmacol. 2005;61(4):297–302.

    Article  CAS  Google Scholar 

  34. Charlot L, Abend S, Ravin P, Mastis K, Hunt A, Deutsch C. Non-psychiatric health problems among psychiatric inpatients with intellectual disabilities. J Intellect Disabil Res. 2011;55:199–209.

    Article  CAS  Google Scholar 

  35. Davis SR, Durvasula S, Merhi D, Young PM, Traini D, Bosnic-Anticevich SZ. Respiratory medication use in an Australian developmental disability clinic population: messages for health care professionals. Aust J Prim Health. 2014;20(3):278–84.

    Article  Google Scholar 

  36. Granas AG, Bakken MS, Ruths S, Taxis K. Deprescribing for frail older people—learning from the case of Mrs. Hansen. Res Soc Adm Pharm. 2018;14(6):612–6.

    Article  Google Scholar 

  37. O'Dwyer M, Peklar J, Mulryan N, McCallion P, McCarron M, Henman MC. Prevalence, patterns and factors associated with psychotropic use in older adults with intellectual disabilities in Ireland. J Intellect Disabil Res. 2017;61(10):969–83.

    Article  CAS  Google Scholar 

  38. Scheifes A, Egberts TC, Stolker JJ, Nijman HL, Heerdink ER. Structured medication review to improve pharmacotherapy in people with intellectual disability and behavioural problems. J Appl Res Intellect Disabil. 2016;29(4):346–55.

    Article  Google Scholar 

  39. Cocks E, Thomson A, Thoresen S, Parsons R, Rosenwax L. Health status and use of medications by adults with intellectual disability in Western Australia. J Intellect Dev Dis. 2016;41(2):87–96.

    Article  Google Scholar 

  40. Huneke NTM, Gupta R, Haider N, Chaudhry N. Difficult decisions: are intellectually disabled patients given enough information to consent to medical treatment? J Intellect Disabil. 2012;16(4):265–74.

    Article  Google Scholar 

  41. Fog AF, Kvalvaag G, Engedal K, Straand J. Drug-related problems and changes in drug utilization after medication reviews in nursing homes in Oslo. Norway Scand J Prim Health Care. 2017;35(4):329–35.

    Article  Google Scholar 

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Acknowledgement

We are grateful to Mrs. Sølvi Andersen and Mrs. Ingri Østensen, Nurses at the Centre for Development of Institutional and Home Care in Oslo, and Ms. Amani Mohammed (AM), master student in pharmacy for data collection.

Funding

No specific funding received. The Centre for Development of Institutional and Home Care in Oslo carried all expenses related to meetings and education material for health personnel involved.

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Authors and Affiliations

  1. Department of Pharmacy, University of Oslo, Blindern, Box 1068, 0316, Oslo, Norway

    Anne Gerd Granas

  2. Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsö, Norway

    Kjell Hermann Halvorsen

  3. Centre for Development of Institutional and Home Care in Oslo, Oslo, Norway

    Julie Wendelbo

  4. Programme for Pharmacy, Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway

    Cecilie Johannessen Landmark

  5. The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway

    Cecilie Johannessen Landmark

  6. Department of Pharmacology, Oslo University Hospital, Oslo, Norway

    Cecilie Johannessen Landmark

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  1. Anne Gerd Granas
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  2. Kjell Hermann Halvorsen
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  3. Julie Wendelbo
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  4. Cecilie Johannessen Landmark
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Correspondence to Anne Gerd Granas.

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Granas, A.G., Halvorsen, K.H., Wendelbo, J. et al. Interdisciplinary medication review to improve pharmacotherapy for patients with intellectual disabilities. Int J Clin Pharm 41, 1516–1525 (2019). https://doi.org/10.1007/s11096-019-00914-3

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  • DOI: https://doi.org/10.1007/s11096-019-00914-3

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