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

Rory Sheehan; André Strydom; Louise Marston; Nicola Morant; Federico Fiori; Paramala Santosh; Angela Hassiotis

doi:10.1136/bmjopen-2019-033827

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

BMJ Open. 2019 Dec 15;9(12):e033827. doi: 10.1136/bmjopen-2019-033827.

Authors

Rory Sheehan¹, André Strydom², Louise Marston³, Nicola Morant⁴, Federico Fiori⁵, Paramala Santosh⁶, Angela Hassiotis⁴

Affiliations

¹ Division of Psychiatry, University College London, London, UK r.sheehan@ucl.ac.uk.
² Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
³ Research Department of Primary Care and Population Health, University College London, London, UK.
⁴ Division of Psychiatry, University College London, London, UK.
⁵ Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
⁶ Department of Child and Adolescent Psychiatry, King's College London, London, UK.

Abstract

Objectives: To investigate the feasibility of delivering structured psychotropic medication review in community services for adults with intellectual disability (ID).

Design: Single-arm feasibility study conducted over a 6-month period.

Setting: Specialist community ID teams in England.

Participants: Psychiatrists working with adults with ID and adults with ID who had been prescribed psychotropic medication.

Intervention: A 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 measures: Feasibility 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.

Results: Fifteen 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.

Conclusions: Structured 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.

Keywords: feasibility study; intellectual disability; medication optimisation; medication review; psychotropic medication.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Decision Making, Shared*
England
Feasibility Studies
Female
Humans
Intellectual Disability*
Male
Medication Adherence
Medication Therapy Management*
Middle Aged
Patient Acceptance of Health Care
Patient Participation
Psychotropic Drugs / adverse effects
Psychotropic Drugs / therapeutic use*
Young Adult

Substances

Psychotropic Drugs

Abstract

Publication types

MeSH terms

Substances

Grants and funding