Sheehan, Neil Rory;
(2020)
Psychotropic medication optimisation in adults with intellectual disability.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Background The need to improve the quality of psychotropic medication prescribing for adults with intellectual disability is reflected in Government policy. Medication optimisation is a multi-faceted approach that aims to ensure the safest, most effective, and least wasteful use of prescribed medication. Aim To investigate the application of medication optimisation to psychotropic medication prescribing for adults with intellectual disability. Methods 1) Multi-stakeholder qualitative study including adults with intellectual disability, paid and family carers, and psychiatrists. Data were collected in individual semi-structured interviews or focus groups and analysed using thematic analysis. 2) Systematic review and meta-analysis of peer-reviewed research reporting delivery and outcomes of psychotropic medication review. Studies were identified by searches of electronic databases, assessed independently, and appraised according to standard quality checklists. 3) Single-arm feasibility study of a structured web-based psychotropic medication review tool in community psychiatric services for adults with intellectual disability. Results 1) Psychotropic medication use can be a contentious topic. Collaborative medication decisions are achievable, but not always experienced by adults with intellectual disability and carers. Factors operating at individual, relational, and systems levels influence opportunities for stakeholder involvement in medication decision-making. 2) Psychotropic medication review is associated with reduction in medication prescribing but clinical, patient-reported, and economic benefit has not been consistently demonstrated. Quality of evidence is variable and studies are at risk of bias. 3) Feasibility metrics demonstrate that a definitive future trial of a medication review tool is possible. Participants made suggestions for future tool development. Conclusions Forms of shared decision-making can be further developed to ensure that adults with intellectual disability and their carers are involved in psychotropic medication discussions and decisions. Structured psychotropic medication review offers a potential practical means of improving the quality of psychotropic medication use and outcomes may be tested in a full-scale clinical trial.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Psychotropic medication optimisation in adults with intellectual disability |
| Event: | UCL (University College London) |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2020. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| Keywords: | intellectual disability, learning disability, psychotropic medication, medication optimisation, shared decision making, medication review |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10105826 |
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