Psychotropic Medication Use in Population with Intellectual Disabilities: One Pharmacist’s perspective
Comment on: Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study
Inequalities and inequities in health and healthcare for people with intellectual disabilities have been of longstanding concern. Medication use is the major therapeutic intervention in this vulnerable population. The use of medication cannot be separated from the environment –physical and social – in which the person with intellectual disabilities lives and is supported. There is no ‘one size fits all’ regarding psychotropic medication use in this population group.
The social environment, the physical environment and societal preconditions, and their interconnectivity with one another and with individuals in the setting, play an important role in healthy settings for people with intellectual disabilities . Physical, mental, psychological and spiritual well being may all be influenced by the environment.
Pharmacists, as medication experts, in all healthcare environments can make positive contributions to the pharmaceutical care of patients with intellectual disabilities, in collaboration with other healthcare professionals, carers and patients themselves [2,3].
The expertise of pharmacists is often an untapped resource for the optimisation of medication use in this population group.
Research has shown that many people with intellectual disabilities who can make decisions about their daily life aren’t given clear information about their medication. Healthcare professionals such as pharmacists and doctors will have to spend longer explaining their medication, use different resources, and explain things ( prescribing and de-prescribing) in simpler language. The person with intellectual disability and their carer will need accessible appropriate information.
Strategies to reduce inequalities and inequities will require use of data to educate decision makers, including doctors and pharmacists, attention to social determinants, and a life course model with emphasis on leveraging inclusion in mainstream services where possible. Specialist pharmacists with expertise, interest and experience will be required to support generalist pharmacists in the community and other non specialist settings .
All pharmacists and others need to understand ‘the system’ that results in psychotropic medication being prescribed for each person with intellectual disability. There must be an understanding of the various elements at play in ‘the system’ around each person with intellectual disability .
To optimise medication use and understand prescribing patterns an understanding of the complex interactions and relationships that occur in the lives of people with intellectual disabilities is vital.
1.Kristel Vlot-van Anrooij, J Naaldenberg, T I M Hilgenkamp, L Vaandrager, K van der Velden, G L Leusink, Towards healthy settings for people with intellectual disabilities, Health Promotion International, Volume 35, Issue 4, August 2020, Pages 661–670, https://doi.org/10.1093/heapro/daz054
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