The UK psychiatrists' experience of rationalising antipsychotics in adults with intellectual disabilities: A qualitative data analysis of free‐text questionnaire responses

Abstract

Background: Overprescribing of off-licence psychotropic medications, particularly antipsychotics, for challenging behaviours in people with intellectual disabilities without a psychiatric disorder is a significant public health concern. In the United Kingdom, the National Health Service England launched an initiative in 2016, 'STopping Over-Medication of People with learning disabilities, autism or both (STOMP)', to address this concern. STOMP is supposed to encourage psychiatrists in the United Kingdom and elsewhere to rationalise psychotropic medication use in people with intellectual disabilities. The current study aims to gather UK psychiatrists' views and experience of implementing the STOMP initiative.Methods: An online questionnaire was sent to all UK psychiatrists working in the field of intellectual disabilities (estimated 225). Two open-ended questions allowed participants to write comments in response to these questions in the free text boxes.One question asked about the challenges psychiatrists faced locally to implement STOMP, and the other asked for examples of successes and positive experiences from the process. The free text data were analysed using a qualitative method with the help of the NVivo 12 plus software.Results: Eighty-eight (estimated 39%) psychiatrists returned the completed questionnaire. The qualitative analysis of free-text data has shown variation within services in the experience and views of the psychiatrists. In areas with good support for STOMP implementation provided through adequate resources, psychiatrists reported satisfaction in the process with successful antipsychotic rationalisation, better local multidisciplinary and multi-agency working, and increased awareness of STOMP issues among the stakeholders such as people with intellectual disabilities and their caregivers and multidisciplinary teams, and improved quality of life caused by reduced medication-related adverse events in people with intellectual disabilities. However, where resource utilisation is not optimum, psychiatrists seemed dissatisfied with the process with little success in medication rationalisation.

Stakeholder experiences of deprescribing psychotropic medicines for challenging behaviour in people with intellectual disabilities

“…We only found two papers through database searching (Kleijwegt et al , 2019; Deb et al , 2020). We found one additional paper through citation searching (Wrein, 2019) and an additional three more via direct author contact (de Kuijper et al , 2022b; de Kuijper et al , 2022a; Deb et al , 2023). Two papers reported results from the same study, one reporting quantitative data (Deb et al , 2020) and the other reporting qualitative data (Deb et al , 2023).…”

“…Collaborative involvement of diverse health-care and social care professionals is essential for effective deprescribing in individuals with intellectual disabilities and challenging behaviour, emphasising the importance of collective psychotropic deprescribing decisions (Deb et al, 2020(Deb et al, , 2023. In addition to secondary care health-care professionals, primary care practitioners, including GPs and non-medical prescribers, have a significant role in the prescribing and deprescribing of psychotropic medicines in people with intellectual disabilities who display challenging behaviour.…”

“…In addition to secondary care health-care professionals, primary care practitioners, including GPs and non-medical prescribers, have a significant role in the prescribing and deprescribing of psychotropic medicines in people with intellectual disabilities who display challenging behaviour. However, inadequate resources can hinder effective deprescribing review (Deb et al, 2023(Deb et al, , 2020de Kuijper et al, 2022b). Commentaries by Deb and colleagues (Deb, 2007;Deb et al, 2009) further emphasise the significance of the team approach in implementing psychotropic deprescribing.…”

“…Due to the low number of studies included in this review, the impact of our findings is limited, and therefore it is important to exercise caution in interpreting these findings. The quality appraisal process identified potential bias associated with sampling and recruitment methods across studies, such as direct approaches (de Kuijper et al, 2022b;Deb et al, 2023Deb et al, , 2020, convenience sampling (Kleijwegt et al, 2019) and recruitment by physicians (de Kuijper et al, 2022a).…”

“…The belief that resources can play a significant role in achieving successful psychotropic deprescribing outcomes was reported in one study (Deb et al, 2023(Deb et al, , 2020, where positive behaviour support (PBS) plans were seen as a facilitator to deprescribing. The lack of time, absence of appropriate PBS plans, lack of non-pharmacological interventions for challenging behaviour and inadequate social care provision were reported as barriers to achieving successful deprescribing (de Kuijper et al, 2022b;Deb et al, 2023).…”