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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. Those providing direct care are the most important person in the life of an individual with intellectual disabilities and may have a direct influence on medication prescribed or de-prescribed, for problem behaviours etc.
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. A recent study highlights a health-promoting social network of people with ID as a prerequisite for change .
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 specialist and other pharmacists i...
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 specialist and other 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.
Strategies to reduce inequalities and inequities will require use of data to educate decision makers, including doctors and pharmacists, attention to and awareness of social determinants, and a life course model with emphasis on leveraging inclusion in mainstream services where possible.
Understanding the various elements in ‘the system’ that results in psychotropic medication being prescribed for each person with intellectual disability is vital. To optimise medication use we will require an understanding of the complex interactions and relationships that occur in the lives of people with intellectual disabilities.
General information :
All health-care professionals need to have an understanding of the nature of complexity in health care, as it is important for preventing adverse events. Health care is complex due to:
• the diversity of tasks involved in the delivery of patient care
• the dependency of health-care providers on one another
• the diversity of patients, clinicians and other staff
• the huge number of relationships between patients, carers, health-care providers, support
staff, administrators, family and community members
• the vulnerability of patients
• variations in the physical layout of clinical environments
• variability or lack of regulations
• implementation of new technology
• the diversity of care pathways and organizations involved
• increased specialization of health-care professionals—while specialization allows a wider
range of patient treatments and services, it also provides more opportunity for things to go
wrong and errors to occur.
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
2. Flood B. Safety of people with intellectual disabilities in hospital. What can the hospital pharmacist do to improve quality of care. Pharmacy (Basel)2017;5:44. doi:10.3390/pharmacy5030044 pmid:28970456CrossRefPubMedGoogle Scholar
3. O’Dwyer M, Meštrović A, Henman M. Pharmacists’ medicines-related interventions for people with intellectual disabilities: a narrative review. Int J Clin Pharm2015;37:566-78. . doi:10.1007/s11096-015-0113-4 pmid:25903938
4.Smith MVA, Adams D, Carr C, Mengoni SE . Do people with intellectual disabilities understand their prescription medication? A scoping review. J Appl Res Intellect Disabil2019;32:1375-88. . doi:10.1111/jar.12643 pmid:31338972CrossRefPubMedGoogle Scholar