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Reducing antipsychotic medication in ID using QI methodology

Reducing antipsychotic medication in ID using QI methodology Research highlights that antipsychotic medications are prescribed more in people with Intellectual Disability (ID) without a diagnosis of severe mental illness. Despite non-pharmacological interventions recommended as alternatives, their application can be challenging due to heterogeneity of the patient group. The purpose of this paper is to discuss application of quality improvement (QI) methodology in adapting interventions, aiming to reduce challenging behaviour of people with ID, thereby reducing use of antipsychotic medication.Design/methodology/approachTwo interventions were introduced as “tests of change”; an “Attention-Deficit Hyperactivity Disorder (ADHD) clinic” and “Positive Behaviour Support (PBS) clinic”. Process (Clinical Global Impression (CGI) and Modified Overt Aggression Scale (MOAS)) and outcome measures (total antipsychotic use) were used to assess the interventions, with each being reviewed as per QI methodology guidelines.FindingsThere was an improvement in CGI scores for both interventions. MOAS scores reduced for those attending the ADHD clinic, resulting in reductions of antipsychotic medication. MOAS scores did not reduce for the PBS clinic, so there was no reduction in medication for this group.Originality/valueBased on the introduction of pilot clinics, this paper provides a commentary on how QI interventions can be used to evaluate and adapt evidence-based interventions, in managing the needs of patients with ID. It further highlights the importance of the diagnosis of ADHD in patients with ID and challenging behaviour. Although PBS is recommended to manage challenging behaviour, this paper demonstrates the importance of continuous evaluation of behavioural interventions. There is currently no existing literature investigating use of QI methodology to reduce challenging behaviour in ID populations, emphasising scope for future research and service evaluation. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Advances in Mental Health and Intellectual Disabilities Emerald Publishing

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Publisher
Emerald Publishing
Copyright
© Emerald Publishing Limited
ISSN
2044-1282
DOI
10.1108/amhid-11-2018-0046
Publisher site
See Article on Publisher Site

Abstract

Research highlights that antipsychotic medications are prescribed more in people with Intellectual Disability (ID) without a diagnosis of severe mental illness. Despite non-pharmacological interventions recommended as alternatives, their application can be challenging due to heterogeneity of the patient group. The purpose of this paper is to discuss application of quality improvement (QI) methodology in adapting interventions, aiming to reduce challenging behaviour of people with ID, thereby reducing use of antipsychotic medication.Design/methodology/approachTwo interventions were introduced as “tests of change”; an “Attention-Deficit Hyperactivity Disorder (ADHD) clinic” and “Positive Behaviour Support (PBS) clinic”. Process (Clinical Global Impression (CGI) and Modified Overt Aggression Scale (MOAS)) and outcome measures (total antipsychotic use) were used to assess the interventions, with each being reviewed as per QI methodology guidelines.FindingsThere was an improvement in CGI scores for both interventions. MOAS scores reduced for those attending the ADHD clinic, resulting in reductions of antipsychotic medication. MOAS scores did not reduce for the PBS clinic, so there was no reduction in medication for this group.Originality/valueBased on the introduction of pilot clinics, this paper provides a commentary on how QI interventions can be used to evaluate and adapt evidence-based interventions, in managing the needs of patients with ID. It further highlights the importance of the diagnosis of ADHD in patients with ID and challenging behaviour. Although PBS is recommended to manage challenging behaviour, this paper demonstrates the importance of continuous evaluation of behavioural interventions. There is currently no existing literature investigating use of QI methodology to reduce challenging behaviour in ID populations, emphasising scope for future research and service evaluation.

Journal

Advances in Mental Health and Intellectual DisabilitiesEmerald Publishing

Published: Jul 22, 2019

Keywords: Quality improvement; Intellectual disability; Challenging behaviour; ADHD; Positive behaviour support; Reducing antipsychotic medication

References