Interdisciplinary medication review to improve pharmacotherapy for patients with intellectual disabilities

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.