In-home comprehensive medication reviews for adults with intellectual or developmental disability: A pilot study

Abstract

ObjectivesTo assess the feasibility of conducting in-home comprehensive medication reviews (CMRs) and to identify and intervene when appropriate for medication-related problems (MRPs) found in medication regimens taken by people with an intellectual or developmental disability. SettingCommunity-based group homes in southeast Michigan. Practice descriptionImplementation and evaluation of a pilot program conducting CMRs within community-based group homes. Practice innovationAn in-home CMR conducted by a clinical pharmacist. EvaluationIdentified MRPs, pharmacist recommendations, recommendation acceptance, time spent directly on intervention, and barriers to implementation. ResultsCMRs were conducted for 15 patients identified as receiving 5 or more medications by their community support agency. Thirty-six MRPs were identified (mean ± SD of 2.4 ± 1.5 per person). The most common MRPs were a medication that was being taken with no indication for its use (7 occurrences) and identification of an untreated medical problem (7). Other MRPs included wrong dose (5); patient or caregiver indicated that the medication was not working (4); wrong dosage form was being used or given (3); duplication of therapy (2); pharmacy error (2); extended release medications were being crushed before administration (2); and wrong administration time, drug ordered but not given, drug-disease potential interaction, and poor drug administration technique (1 for each). The interventions included sending information letters to the group home manager containing information to be discussed with the patient’s physician or telephone calls made directly to the prescriber or pharmacy. The interventions made by telephone calls to prescribers included 3 calls to physicians to discuss 5 MRPs, and 3 telephone calls for pharmacy-related MRPs, all of which were accepted. ConclusionThe results of this prospective pilot project provide justification to further explore the role of conducting independent CMRs for patients with an intellectual or developmental disability living in the community to ensure safe and effective use of their medications.