Primary care for people with an intellectual disability — what is prescribed? An analysis of medication recommendations from the BEACH dataset

Abstract

BackgroundPeople with intellectual disability (ID) experience a range of health disparities. Little is known about differential primary care prescribing patterns for people with and without ID.AimTo compare medications recommended by GPs at encounters where ID is recorded versus other encounters.Design & settingAnalysis of national Australian GP medication data from the Bettering the Evaluation and Care of Health (BEACH) programme, January 2003–December 2012 inclusive.MethodMedication recommendations made at encounters where an ID-defining problem was recorded as a reason for encounter (RFE) and/or as a problem managed, were allocated to the ‘ID group’ (n = 563). These encounters were compared with all other encounters (the ‘non-ID group’, n = 1 004 095) during the study period. Following age–sex standardisation of ID group encounters, significant differences were determined by non-overlapping 95% confidence intervals (CIs).ResultsAntipsychotics and anticonvulsants were recommended more frequently at ID group encounters than at non-ID group encounters. Antidepressant and anxiolytic recommendation rates did not differ between groups. Narcotic analgesic and antihypertensive recommendations were significantly lower at ID group encounters.ConclusionHigher rates of epilepsy and mental illness, and off-label use of some antipsychotics and anticonvulsants for behaviour management in people with ID, may have contributed to medication recommendations observed in this analysis. Lower narcotic analgesic recommendations at ID group encounters may relate to complex presentations and the nature of problems managed, while lower antihypertensive recommendations may indicate some potential omission of routine blood pressure measurement.

Adults with intellectual disabilities and mental health disorders in primary care: a scoping review

“… 4 , 74 , 75 In addition, a higher number of patients with ID are reported with psychotropic prescriptions than with recorded MHDs, indicating off-label prescription. 4 , 39 , 44 , 49 , 75 – 80 Behavioural problems are often described as an indication to start medication, 4 , 39 , 59 , 73 , 74 , 78 , 79 specifically in cases of limited access to alternative treatment strategies. 4 Prescribed medication is reported as predominantly long-term medication, 75 and a large proportion (62%–70%) is prescribed without a psychiatrist’s involvement.…”

“…50 Indications of inaccurate diagnoses 48,51 and underdiagnosis in primary care are frequently reported 4,31,41,42,48,49,[52][53][54][55][56] and may result in inappropriate care and progression of the disorder to a more severe stage that is less responsive to treatment. 23,52,[57][58][59] Overdiagnosis, however, occurs as well, leading to unnecessary prescriptions of medication. 53,57 Diagnostic failure is seen as related to communication problems, with patients with ID described as less able to label their feelings and communicate their needs, 44,53,57,[60][61][62] resulting in an atypical presentation of symptoms 29,43,44,57,[63][64][65] and a more complicated assessment.…”

“…43,50,65,83,110 Although guidelines and instruments are available to support GPs in applying a standardised approach in the general population, they are often not adapted to patients with ID. 40,43,44,72,73,80 Some publications covered specific guidelines for prescribing and/or monitoring medication for MHDs in patients with ID 39,47,49,54,59,65,67,73,82 and applicable tools for detecting unmet health needs in patients with ID. 31,40,49,60,69 It is suggested that GPs are insufficiently familiar with these ID-specific guidelines and tools.…”

Repurposing of Diagnostic Whole Exome Sequencing Data of 1,583 Individuals for Clinical Pharmacogenetics

“…More specifically, the individuals included in this study were originally sequenced to diagnose the cause of ID in the children. Several studies have shown that polypharmacy is more common among patients with ID . More important, patients with ID more often use antipsychotics, anticonvulsants, and/or antidepressants that frequently result in gene–drug interactions making the value of a PGx profile for this population even more meaningful.…”

“…Several studies have shown that polypharmacy is more common among patients with ID. [33][34][35] More important, patients with ID more often use antipsychotics, anticonvulsants, and/or antidepressants that frequently result in gene-drug interactions making the value of a PGx profile for this population even more meaningful. Unfortunately, many of these drugs are metabolized by either CYP2D6 or CYP2C19, both of which have shown to be difficult to determine based on existing WES data in our study.…”