Evaluation of an interdisciplinary review committee managing the use of psychotropic medication with people with intellectual disabilities

Jauernig, Roland; Hudson, Alan R.

doi:10.1080/07263869500035431

Cited by 10 publications

(29 citation statements)

References 5 publications

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“…Jauernig and Hudson (1995) report a reduction on regularly prescribed psychotropic medication by an average of 51 per cent and reduction in poly-pharmacy from 52 to 24 per cent. These reductions were brought about through the regular meetings of a review committee involving caregivers, psychologists, medical professionals and pharmacists who met fortnightly over a period of two years.…”

Section: Resultsmentioning

confidence: 96%

Use of PRN medication in people with intellectual disabilities

Delafon

Kiani

Barrett

et al. 2013

Advances in Mental Health and Intellectual Disabilities

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all are based at Leicestershire Partnership NHS Trust, Leicester, UK. AbstractPurpose -The purpose of this paper is to identify psychotropic medication being prescribed for people with intellectual disability "as and when required" (PRN); the indications, frequency of use, rate of poly-pharmacy and contribution of PRN medication towards this. The paper also aimed to identify individual and environmental factors associated with PRN medication prescribing. Design/methodology/approach -Data were collected from nursing and medical records for the 119 service users in the acute assessment and treatment unit and NHS residential care settings managed by specialist intellectual disability services covering Leicester, Leicestershire and Rutland over a month period. Data were analysed using descriptive statistics and logistic regression to calculate adjusted odds ratios for predictor variables. Findings -In total, 72 per cent of the service users were prescribed and 25 per cent were administered PRN medication over the study period. The most common indications for PRN prescribing were aggression and agitation. Lorazepam and chlorpromazine were the most frequently prescribed PRN medications. The rate of poly-pharmacy was 41 and 38 per cent of this was attributable to PRN medication. Male gender and history of challenging behaviour were found to be significant factors associated with PRN medication prescribing. Originality/value -PRN medications are commonly prescribed in people with intellectual disabilities and contribute to poly-pharmacy. Whilst PRN medication continues to remain an effective therapeutic option in situations where environmental and behavioural approaches are proving insufficient, their use should always be in conjunction with effective review mechanisms.

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Section: Resultsmentioning

confidence: 96%

Use of PRN medication in people with intellectual disabilities

Delafon

Kiani

Barrett

et al. 2013

Advances in Mental Health and Intellectual Disabilities

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“…Ten studies describe the outcome of reduction or discontinuation of antipsychotic medication as the proportion of the intervention group who were maintained on a lower dose or achieved drug discontinuation at follow-up (ranging from 3 months to over 10 years). 32,38,[40][41][42][43][44][45][46][47] The proportion of participants maintained on a reduced dose was between 19% and 83%, discontinuation of antipsychotics ranged from 4% to 74%, the proportion unsuccessful in attempts to reduce or discontinue antipsychotics was between 0% and 96% (table 2). In several cases, reporting of the study is such that it is not possible to distinguish three groups accurately.…”

Section: Success Of Attempts To Reduce or Discontinue Antipsychotic Mmentioning

confidence: 99%

“…Six studies report the effect of antipsychotic reduction or discontinuation on participant behaviour. 32,39,43,44,47,48 Behavioural outcome measures ranged from validated instruments to colloquial reports (Appendix C).…”

Section: Effect Of Reduction or Discontinuation Of Antipsychotics On mentioning

confidence: 99%

Reduction or discontinuation of antipsychotics for challenging behaviour in adults with intellectual disability: a systematic review

Sheehan

Hassiotis

2017

The Lancet Psychiatry

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The use of antipsychotics to manage challenging behaviour in adults with intellectual disability is widespread but controversial, and evidence is scarce. There is a perception that antipsychotics used in this context can be reduced or discontinued, and this has been a major focus of recent national policy. However, such an intervention risks harm as well as having potential benefits. We reviewed the available evidence and found that antipsychotics can be reduced or discontinued in a substantial proportion of adults who use them for challenging behaviour, although not always without adverse effects. There is a group which displays behavioural deterioration on antipsychotic reduction that prevents discontinuation; predictors of poor response could not be reliably identified. In view of the relatively scarce data and methodological limitations of the available studies, we cannot draw firm conclusions to inform a population level approach to this issue. Antipsychotic medication used for behaviour should be reviewed regularly and an individualised approach taken to treatment.

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“… 23 , 24 Four studies were cluster RCTs (n = 712 participants) 23 , 24 , 25 , 26 , 27 and the remaining 22 were before-after study designs (n = 7844 participants). 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 Studies were conducted in North America (15 studies), 28 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 39 , 42 , 43 , 46 , 47 , 48 , 49 Europe (10 studies) 23 , 25 , 26 , 27 , 29 , 38 , 40 , 41 , 44 , 45 and Australasia (1 study). 34 A total of 19 studies 23 , 26 , 27 , 28 ,…”

Section: Resultsmentioning

confidence: 99%

“… 34 A total of 19 studies 23 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 39 , 40 , 41 , 43 , 46 , 47 , 48 were conducted in institutional settings and reported psychotropic medication review of people with intellectual disability (9 studies; 1054 participants) 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 or those with dementia (6 studies; 3664 participants). 23 , 37 , 38 , 39 , 40 , 41 Meta-analysis included 3 studies 28 , 30 , 34 (n = 652 participants).…”

Section: Resultsmentioning

confidence: 99%

Association of Focused Medication Review With Optimization of Psychotropic Drug Prescribing

et al. 2018

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Importance Medication review has been proposed to achieve improved use of psychotropic drugs, but benefits have not been confirmed. Objective To synthesize evidence for focused psychotropic medication review in medication optimization. Data Sources Medline, PsycINFO, EMBASE, and CINAHL Plus were searched from inception to February 2018 using the index terms “drug utilization review” and “psychotropic drugs” and synonyms. Additional articles were retrieved using citation tracking and reference checking. Study Selection Full-length, peer-reviewed articles that reported focused psychotropic medication review were included. Inclusion was determined against prespecified criteria and assessed independently. Data Extraction and Synthesis Study quality was assessed using National Institutes for Health appraisal tools and informed a structured synthesis of results. Meta-analysis using a random effects model was conducted. Main Outcomes and Measures Change in the number or dosage of psychotropic medications, change in clinical parameters, change in patient-reported outcomes, and economic data were collected. Results A total of 26 studies met the inclusion criteria. Four studies were randomized clinical trials (n = 712 participants), while the remainder were before-after studies (n = 7844 participants). Most studies were conducted in elderly individuals, people with dementia, and adults with intellectual disability. Focused psychotropic medication review is a complex intervention; the professional(s) involved, target drug, degree of integration with usual care, and participant involvement varied greatly among the studies. Meta-analysis included 3 studies (n = 652 participants). Psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs compared with control (pooled odds ratio, 0.24; 95% CI, 0.14-0.39) in elderly participants with cognitive impairment living in nursing homes. Before-after studies consistently reported a change in psychotropic drug prescribing after medication review, regardless of the population. Studies that reported the effects of psychotropic medication review on clinical outcomes failed to demonstrate benefit. Economic implications of focused psychotropic medication review were not adequately assessed. The quality of evidence is poor and studies are at risk of bias. Conclusions and Relevance Focused psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs, but has not been shown to improve clinical outcomes or to provide economic benefit. More robust evidence is needed before programs of focused psychotropic medication review can be recommended as part of routine care for any patient group.

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Evaluation of an interdisciplinary review committee managing the use of psychotropic medication with people with intellectual disabilities

Cited by 10 publications

References 5 publications

Use of PRN medication in people with intellectual disabilities

Use of PRN medication in people with intellectual disabilities

Reduction or discontinuation of antipsychotics for challenging behaviour in adults with intellectual disability: a systematic review

Association of Focused Medication Review With Optimization of Psychotropic Drug Prescribing

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