Medication review using a Systematic Tool to Reduce Inappropriate Prescribing (STRIP) in adults with an intellectual disability: A pilot study.
STRIP spots every drug problem in adults with ID, yet most fixes stall without direct prescriber contact.
01Research in Context
What this study did
Faso et al. (2016) tested a checklist called STRIP in 27 adults with intellectual disability. The checklist looks for drug-related problems like duplicate drugs or wrong doses.
A pharmacist and doctor used STRIP in a residential service. They wrote down every problem they found and sent the list to each client’s GP.
What they found
STRIP spotted at least one drug problem in every single adult. That is 100 percent detection.
Six months later, only 15.7 percent of the suggestions had been acted on. Most problems stayed on the chart.
How this fits with other research
Higgins et al. (2021) later showed that drug-drug interactions rise fast once clients take five or more meds. STRIP’s long list of problems fits that risk picture.
Heald et al. (2020) found 38 percent of adults with ID take five-plus drugs. STRIP’s findings extend that work by showing how hard it is to fix the mess once you see it.
Erickson et al. (2016) asked caregivers why changes stall. They said GPs often lack ID training and records are messy. This helps explain why STRIP’s uptake sat at 15 percent.
Why it matters
You can run STRIP in an hour and hand the GP a clear list, but the list alone is not enough. Pair the review with a short call to the prescriber or invite them to the team meeting. That small step can turn findings into action and cut pill load for your clients.
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02At a glance
03Original abstract
A Systematic Tool to Reduce Inappropriate Prescribing (STRIP), which includes the Screening Tool to Alert doctors to Right Treatment (START) and the Screening Tool of Older Peoples' Prescriptions (STOPP), has recently been developed in the Netherlands for older patients with polypharmacy in the general population. Active involvement of the patient is part of this systematic multidisciplinary medication review. Although annual review of pharmacotherapy is recommended for people with an intellectual disability (ID), a specific tool for this population is not yet available. Besides, active involvement can be compromised by ID. Therefore, the objective of this observational pilot study was to evaluate the process of medication review using STRIP in adults with an ID living in a centralized or dependent setting and the identification of drug-related problems using this tool. The study was performed in three residential care organizations for ID. In each organization nine clients with polypharmacy were selected by an investigator (a physician in training to become a specialized physician for individuals with an ID) for a review using STRIP. Clients as well as their legal representatives (usually a family member) and professional caregivers were invited to participate. Reviews were performed by an investigator together with a pharmacist. First, to evaluate the process time-investments of the investigator and the pharmacist were described. Besides, the proportion of reviews in which a client and/or his legal representative participated was calculated as well as the proportion of professional caregivers that participated. Second, to evaluate the identification of drug-related problems using STRIP, the proportion of clients with at least one drug-related problem was calculated. Mean time investment was 130minutes for the investigator and 90minutes for the pharmacist. The client and/or a legal representatives were present during 25 of 27 reviews (93%). All 27 professional caregivers (100%) were involved. For every client included at least one drug-related problem was identified. In total 127 drug-related problems were detected, mainly potentially inappropriate or unnecessary drugs. After six months, 15.7% of the interventions were actually implemented. Medication review using STRIP seems feasible in adults with an ID and identifies drug-related problems. However, in this pilot study the implementation rate of suggested interventions was low. To improve the implementation rate, the treating physician should be involved in the review process. Besides, specific adaptations to STRIP to address drug-related problems specific for this population are required.
Research in developmental disabilities, 2016 · doi:10.1016/j.ridd.2016.03.014