Medication reviews for people with developmental disability – a call to action!

To the Editor, Recent editorials in the March 2014 issue of this journal highlight the importance and effectiveness of medication management reviews such as the home medicines review, conducted in the community by accredited pharmacists. The Australian government established the Home Medicines Review Program in 2001, to help people living at home maximise medication benefits and prevent harmful consequences of medication misuse. According to the Program, predisposing factors for medication-related problems include taking five or more regular medications or more than 12 doses of medication daily, suspected noncompliance or inability tomanagemedication-related therapeutic devices, literacy or language difficulties, dexterity problems, impaired sight andconfusion/dementiaorother cognitive difficulties. A report commissioned by the Australian government in 2008 suggests that patient groups at highest risk of medication misadventure (immediately after hospital discharge, indigenous consumers, culturally and linguistically diverse (CALD) consumers, palliative care patients and non-compliant/non-adherent consumers) appear to have rarely received ahomemedicines review.Apotential subgroup of non-compliant consumers is people with developmental disabilities – ‘differences in neurologically based functions that have their onset before birth or during childhood, and are associated with significant long-term difficulties’. Developmental disabilities are usually associated with intellectual disability. Approximately 3% of the Australian population has an intellectual disability and the majority live independently, or in a group home (supported accommodation) of up to six people in the community. Cognitive, sensory andneurological deficits of thedevelopmentally disabled predispose them to medicationrelated problems. Comorbidities lead to a high level of medication use, including psychotropics, the side effects of which can have a significant impact on an individual's quality of life. Errors with prescriptions requiring a change of pharmacotherapy have been reported in older individuals with developmental disability. Australian therapeutic guidelines suggest six monthly medication reviews for peoplewithdevelopmental disability, acknowledging that patient communication difficulties may affect drug histories, for example why medications were prescribed initially, and articulation of adverse effects by thepatient.A literature search confirms that there is little published evidence – only one conference abstract – regarding medication reviews by pharmacists for people with developmental disability in the community. Thus, detailed information about the pharmaceutical care needs of people with intellectual disability in Australia is lacking. Also no validated tools for healthcare providers to assess medication management skills in people with intellectual disability appear to exist. In order to determine effective pharmacotherapeutic choices, pharmacists require insight and skills to effectively communicate with, and counsel people with intellectual disability; Australian pharmacists may not possess these skills. To the author's knowledge, there is no training in this area for pharmacists in Australia. A brief, communication-skills training session has been shown to positively impact the attitudes of undergraduate medical students in interactingwithpeoplewithdevelopmentaldisabilities. There is an urgent need to address training and exposure of pharmacists to people with intellectual disability, through pharmacy practice, education and research. Leadership and endorsement by pharmacy organisations, particularly in primary care, is vital.