RAtionalising Psychotropic medications for adults with Intellectual Disabilities: sCOPing (RAPID-COP)
Overmedication of people with learning (intellectual) disabilities, particularly due to off-label prescribing of psychotropic medications for behaviours that challenge, is a significant public health concern. In the UK, NHS England launched an initiative called STOMP to help reduce inappropriate overmedication. However, STOMP does not have a mechanism to implement its pledge.
One way of implementing the STOMP goals of reduction of overmedication of people with learning (intellectual) disabilities is by training people involved in the prescribing process.
There are two main protagonists in the prescribing process - the prescribers, primarily psychiatrists in the UK but also some nurse specialists and community pharmacists and the carers who ask for medication in the first place and are apprehensive about the psychotropic dose reduction/rationalisation.
For carers, we co-produced a training programme called 'Short-term Psycho Education for Carers To help Reduce the Over Medication of people with ID', SPECTROM.
There are no such programmes for prescribers. Therefore, we plan to develop a “StruCtured prOgramme of Psychotropic medication optimisation for pEople with intellectual disabilities (SCOPE).”
The SCOPE will develop an evidence and consensus based nationally agreed protocol for psychotropic medication optimisation in adults with intellectual disabilities supported by training resources aimed primarily at the prescribers. This will include prescribing as well as deprescribing where appropriate.
The aims of this project are:
(a) Assess whether the prescribers in the UK see the need for the SCOPE and agree to participate in its implementation in the future to assess the clinical and cost-effectiveness of SCOPE.
(b) To explore the current rate of psychotropic withdrawal, and what could be reasonably expected and feasible to achieve with the support of SCOPE?
Work Packages
1. Stakeholder workshop
One day workshop to assess the need for SCOPE and explore potential areas for module development.
2. Wider stakeholder consultation- online survey
An online questionnaire will be sent to all psychiatrists prescribing for adults with intellectual disabilities in community settings in the UK to assess the current state of clinical practice and collect examples of good practice case studies.
3. Longitudinal clinic-based audit
Several consultant psychiatrists across various regions of the UK will be asked to prospectively record psychotropic withdrawals and new prescriptions over six months to assess the current withdrawal rate, what could be reasonably achieved with the help of SCOPE and what resources may be needed to implement SCOPE locally.
4. Qualitative research involving interviews and focus groups
Interviews and focus groups will be conducted with a purposive sample of prescribers, health and social services managers, and multidisciplinary team members to explore positive and negative experiences of psychotropic optimisation to learn about its enablers and barriers.
5. Dissemination workshop with wider stakeholders
A workshop will be organised to disseminate the study findings and discuss the future activities involving the SCOPE.
