Laxative use in adults with intellectual disabilities: development of prescribing guidelines.

Autor:	Bishop R; Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, Truro, UK; and CIDER, University of Plymouth Peninsula School of Medicine, Truro, UK., Laugharne R; CIDER, Cornwall Partnership NHS Foundation Trust, Truro, UK; and CIDER, University of Plymouth Peninsula School of Medicine, Truro, UK., Burrows L; Knowledge Spa Library, Royal Cornwall Hospital Trust, Truro, UK; and The Southwest Clinical School, University of Plymouth, Truro, UK., Ward S; Independent expert with lived experience, Truro, UK., Eustice S; CIDER, Cornwall Partnership NHS Foundation Trust, Truro, UK., Branford D; CIDER, University of Plymouth Peninsula School of Medicine, Truro, UK., Wilcock M; Royal Cornwall Hospital Trust, Truro, UK., Lamb K; CIDER, University of Plymouth Peninsula School of Medicine, Truro, UK., Tavare A; Health Innovation West of England, Bristol, UK., Annesley C; Learning Disability Liaison Service, North Middlesex University Hospital NHS Trust, London, UK., Lewis S; Gastroenterology Department, University Hospitals Plymouth NHS Trust, Plymouth, UK., Voulgaropoulos V; Pharmacy Department, Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK., Sleeman F; Bowden Derra Park, Launceston, UK., Sargent B; Bowden Derra Park, Launceston, UK., Shankar R; CIDER, Cornwall Partnership NHS Foundation Trust, Truro, UK; and CIDER, University of Plymouth Peninsula School of Medicine, Truro, UK.
Jazyk:	angličtina
Zdroj:	BJPsych open [BJPsych Open] 2024 Apr 18; Vol. 10 (3), pp. e84. Date of Electronic Publication: 2024 Apr 18.
DOI:	10.1192/bjo.2024.50
Abstrakt:	Background: Constipation is overrepresented in people with intellectual disabilities. Around 40% of people with intellectual disabilities who died prematurely were prescribed laxatives. A quarter of people with intellectual disabilities are said to be on laxatives. There are concerns that prescribing is not always effective and appropriate. There are currently no prescribing guidelines specific to this population. Aims: To develop guidelines to support clinicians with their decision-making when prescribing laxatives to people with intellectual disabilities. Method: A modified Delphi methodology, the RAND/UCLA Appropriateness Method, was used. Step 1 comprised development of a bespoke six-item, open-ended questionnaire from background literature and its external validation. Relevant stakeholders, including a range of clinical experts and experts by experience covering the full range of intellectual disability and constipation, were invited to participate in an expert panel. Panel members completed the questionnaire. Responses were divided into 'negative consensus' and 'positive consensus'. Members were then invited to two panel meetings, 2 weeks apart, held virtually over Microsoft Teams, to build consensus. The expert-by-experience group were included in a separate face-to-face meeting. Results: A total of 20 people (ten professional experts and ten experts by experience, of whom seven had intellectual disability) took part. There were five main areas of discussion to reach a consensus i.e. importance of diagnosis, the role of prescribing, practicalities of medication administration, importance of reviewing and monitoring, and communication. Conclusions: Laxative prescribing guidelines were developed by synthesising the knowledge of an expert panel including people with intellectual disabilities with the existing evidence base, to improve patient care.
Databáze:	MEDLINE
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