Background Polypharmacy, a risk factor for inappropriate prescribing, is common in adults with intellectual disability (ID). For older patients with polypharmacy in the general population a Systematic Tool to Reduce Inappropriate Prescribing (STRIP)* has been developed recently. This patient review requires the active involvement of the patient, which can be complicated in adults with ID.
Purpose This pilot study was performed to evaluate whether STRIP can be used in adults with ID living in a centralised setting.
Material and methods This observational pilot study was performed in three care organisations. In each organisation nine clients with polypharmacy, defined as concomitant use of five or more drugs, were selected by their pharmacists and ID resident physician for a review using STRIP. Clients, their legal representatives and mentors were invited to participate. The primary outcome was the proportion of clients, legal representatives and mentors who participated. Secondary outcomes were the number of potentially appropriate indicated drugs (according to the START criteria) and the number of potentially inappropriate or unnecessary drugs identified (according to STOPP criteria).
Results 27 reviews were performed in this pilot study. During these 27 reviews, 24 clients (89%), 14 legal representatives (53%) and all 27 mentors (100%) participated.
Thirteen potentially appropriate indicated drugs and 44 potentially inappropriate or unnecessary drugs were identified, resulting in suggestions for changes in pharmacotherapy for 21 (78%) clients. Besides, 9 (33%) reviews revealed in total 21 drugs, mainly as required prescriptions, that were never used by the client.
Conclusion A Systematic Tool to Reduce Inappropriate Prescribing (STRIP) with the active involvement of adults with ID, their legal representatives and mentors can be used to identify drug-related problems in this population. The benefits in terms of reduction of patient harm as well as cost-effectiveness of this method should be assessed in this population in future studies.
The Dutch College of General Practitioners, Multidisciplinary Guideline Polypharmacy in the elderly, 2012
ReferenceNo conflict of interest.
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