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Improving the care of people with learning disabilities in pharmacy

There are about 1.2 million people in England with a learning disability. A number of recent studies have highlighted concern about the widespread prescribing of psychotropic drugs for people with a learning disability. The Stopping Over-Medication of People with Learning Disabilities campaign aims to reduce the use of inappropriate psychotropic medicines, by ensuring that they are reviewed at appropriate intervals.

However, in order to optimise medicines effectively, practitioners need to aim to understand the patient’s experience. And for successful medicines optimisation to take place, a relationship between the professional and the patient is key.

In July 2016, Health Education England (HEE) published a new learning disabilities core skills education and training framework. The framework has been developed in partnership by HEE, Skills for Health and Skills for Care. It sets out the core skills and knowledge that are common and transferable across health and care staff.

Pharmacy professionals have a key role to play in enabling this transformation and we have some way to go before we consistently provide excellent care and support for people with learning disabilities and their families and carers. The learning disabilities community report mixed interactions with pharmacy professionals. Some were positive, others not so.

Jubraj et al. have investigated practical ways to improve pharmacy consultations. They held a discussion with a group of adults with Down’s syndrome and identified that their experience was that pharmacists often spoke to their carers during consultations instead of them. They reported that adults with Down’s syndrome would like the pharmacist to talk to them directly and give them more accessible information about their medicines.

Pharmacy professionals often have the misconception that people with learning disabilities want long consultations and worry about getting it wrong. So what can pharmacy professionals do to better engage with people who have a learning disability? Simple basics like smiling, saying “hello” and introducing yourself by your name and role are as important as in any other consultations.

People who have a learning disability are individuals with diverse needs, you will need to listen and observe body language to check if your communication approach is working. A clear consultation structure will be more important to a person who has a learning disability than it is to other people. It can be helpful to set out the structure of the consultation at the start, so they know what to expect.

When you are gathering information talk directly to the person, bring the carer into the conversation with the person’s permission when clarification is necessary. Ask the person what they want to get from your conversation today.

Prioritise the information that you give. It is better to limit the amount of information given in one session and be successful than to overwhelm the patient. Be prepared to explain something several times and do this without being condescending or patronising. Keep your explanations clear and concise using only one or two information words per sentence.

When summarising key actions when you are closing the consultation, it might be appropriate to write down information using simple language and it can be helpful to use pictures even if your drawing is not good.

While adapting your practice might seem daunting, there are examples of good practice to draw on, for example, the award winning Community Pharmacy West Yorkshire’s (CPWY) ‘Making time’ project, which aims to ensure people with learning disabilities get the best service possible from their pharmacy.

Later this month the Centre for Pharmacy Postgraduate Education (CPPE) will launch a learning disabilities open learning programme. This learning programme will enable pharmacy professionals in England to work towards achieving the competencies in the HEE Learning disabilities core skills education and training framework. In spring 2017, CPPE will deliver a national learning campaign focussing on pharmacy’s role in transforming care for people with learning disabilities. To keep up to date with our development plans register your email address at www.cppe.ac.uk.

Emma Anderson

CPPE tutor, East Midlands region

Centre for Pharmacy Postgraduate Education

 

Citation: Clinical Pharmacist DOI: 10.1211/CP.2016.20201566

Readers' comments (1)

  • In the population with intellectual/learning disabilities compared to the general population, the multi-morbidity burden is greater, occurs at much earlier age, and the profile of health conditions differs [1].

    People with intellectual disabilities use multiple medications and may have been taking them for many years.

    Extreme care in required when de- prescribing many medications in this population group.

    The principles of good de-prescribing during medication review in the population with intellectual/learning disabilities, based on the British Pharmacological Society’s Principles for Good Prescribing 2010, provide a template for quality de-prescribing in this population group.

    Principles of Good De-prescribing during Medication Review in the Population with Intellectual Disabilities and Behaviour Disorders. Based on the British Pharmacological Society’s Principles for Good Prescribing 2010

    1. Be clear about the reasons for de-prescribing.
    2. Take into account the patient with intellectual disabilities and behaviour disorders medication history before de-prescribing.
    3. Take into account other factors that might alter the benefits and risks of de-prescribing treatment in the patient with intellectual disability and behaviour disorders.
    4. Take into account the patient’s/carer’s/families/advocates ideas, concerns, and expectations.
    5. Ensure all medicines are effective, safe, cost-effective in appropriate form individualised for the patient with intellectual disability, behaviour disorders and other conditions such as dysphagia, autism.
    6. Adhere to national guidelines and local formularies where appropriate. Use caution where the population with intellectual disability have not been considered in the guideline development process.
    7. Write unambiguous correct documentation detailing reason for de-prescribing.
    8. Monitor the beneficial and adverse effects of de-prescribing medicines and any effects on behaviour.
    9. Communicate and document all de-prescribing decisions and the reasons for them such as transferred to appropriate personnel such as GP, pharmacist, psychiatrist, epileptologist, carer and patient.
    10. De - prescribe within the limitations of your knowledge, skills and experience of the population with intellectual disabilities and behaviour disorders.

    Prepared by: Bernadette Flood PhD MPSI


    1. Cooper S-A, McLean G, Guthrie B, et al. Multiple physical and mental health comorbidity in adults with intellectual disabilities: population-based cross-sectional analysis. BMC Family Practice. 2015;16:110. doi:10.1186/s12875-015-0329-3.

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