Title: Optimising psychotropic medication for people with intellectual disability
Funder: Department of Health and Social Care

Abstract: Background People with intellectual disability (ID) do not always receive good healthcare and can suffer worse outcomes as a result. There is evidence that psychotropic medications are used inappropriately in this group. This is a topical and high-profile issue that has been recognised as a priority for improvement by NHS England. A programme of medicines optimisation to make sure that people receive the best from their medicines is needed, yet there is little evidence to guide this process. One important element of medicines optimisation is medication review, a systematic and comprehensive process undertaken in collaboration with service users that guides medication decisions.Aims To promote optimal use of psychotropic medication in people with ID by development of a structured psychotropic medication review tool that can be used in routine clinical consultations.Plan of investigationThe project has two stages. Stage 1 is to develop the psychotropic medication review tool and stage 2 is to test the feasibility of evaluating the tool in a clinical trial.Stage 1The medication review tool will be developed by combining available research evidence with stakeholder views. A systematic review will be conducted to explore the content, methods, and effectiveness of existing methods of structured psychotropic medication review drawing on evidence from studies conducted in other groups. Focus groups will be convened with service users (people with ID), family/informal carers, and paid carers, to explore attitudes towards psychotropic medication use and important issues that these groups think should be considered when medication decisions are made. The results of the systematic review and a thematic analysis of focus group discussions will be synthesised and form the basis of a Delphi consensus exercise that will be run with an expert panel of 15 clinicians. The Delphi process will be used to finalise the content and structure of the psychotropic medication review tool. The HealthTrackerTM system (an established secure web-based platform that hosts clinical information) will be used as the infrastructure that enables the psychotropic medication review tool to be delivered online.Stage 2The medication review tool will be made available to psychiatrists who will use it as part of their normal clinical work over a period of 12 weeks. Data will be gathered to indicate whether it is feasible to test the medication review tool in a large-scale clinical trial. Specifically, I will investigate:uptake, practical aspects, and subjective clinician feedback on the tool by online monitoring and a questionnaire sent to cliniciansacceptability to service users and their carers by conducting structured interviews and interpreting these with a structured thematic analysisservice user outcomes (the client satisfaction questionnaire) that may be used in a future clinical trial Summary of benefits to patients and the NHSThe psychotropic medication review tool will support optimisation of medication use in individuals with intellectual disability. This translates to better symptom control and reduced side-effect burden. The method of psychotropic medication review proposed in this project will encourage discussion between clinicians and service users. By promoting rational prescribing medication adherence is likely to improve and overall satisfaction with care will be enhanced. There are obvious benefits to the NHS, including resource savings generated by the delivery of more efficient and effective care.

Lay abstract: People with intellectual disability (also known as learning disability) often have high levels of healthcare need but might not always get the best treatment. A major concern is that people with intellectual disability sometimes use medication designed to treat mental health problems when they don't have a mental illness. This medication is called psychotropic medication. People with intellectual disability have also told us that they often feel that they aren't included when decisions about psychotropic medication are made. The aim of this research is to ensure that psychotropic medication is used in the best way possible in people with intellectual disability. To do this we will design a tool that can be used jointly by doctors and people with intellectual disability and their carers. The tool will be used during appointments to show the advantages and disadvantages of using psychotropic medication. This will help people to make informed choices about the medication they take and will hopefully make a positive difference to their lives. Our project has two stages. In the first stage we will design the psychotropic medication review tool. This will involve gathering the best available evidence that is already available, talking to people with intellectual disability and their carers, and seeking the views of professional experts. We will bring all of this information together to make the psychotropic medication review tool. In the second stage of the research we will evaluate if the tool is suitable for routine use and what people think about it. We will give the tool to a group of doctors and people with intellectual disability who take psychotropic medication and we will then collect their views about the tool. We will ask them how easy it was to use the tool and ways in which it could be improved. When this work is complete, we hope to start a bigger study that will tell us if regular use of the psychotropic medication review tool in appointments improves psychotropic medication use in people with intellectual disability.

Research activity codes: 6.3 MEDICAL DEVICES
Health categories: MENTAL HEALTH