An intervention to facilitate deprescribing for people with intellectual disability

Intellectual disability (ID) affects approximately 1% of the population and is characterised by problems in intellectual and adaptive functioning with onset occurring during the developmental period(1). Compared with the general population, people with ID are more likely to have physical and mental health problems and are at risk of polypharmacy (prescribing of multiple medicines), particularly among older age groups(2). Whilst in many instances polypharmacy is appropriate, it increases the chances of patients being prescribed a medicine(s) with more risks than benefits, with adverse consequences to the persons quality of life, and an increased risk of adverse effects and medication non-adherence, as well as economic implications(3). People with ID may also be at heightened risk of ongoing adverse effects resulting from polypharmacy, as they may not be able to verbally communicate their adverse experiences, and may also be at risk of diagnostic overshadowing, described as ‘the misattribution of symptoms to an already diagnosed condition (ID)’(4).

Deprescribing is the process of identifying and discontinuing medicines with more risks than benefits and is a core component of good prescribing practice(5). However, there is burgeoning body of literature evidencing that deprescribing is not routine practice for healthcare professionals (HCPs) owing to a number of barriers including fear of adverse consequences, a perception that patients are attached to their medicines and it not being a priority. There is a need to develop an intervention to support HCPs to work with people with ID and their caregivers to deprescribe medicines with more risks than benefits.

Methods

This PhD programme of research will co-produce a theory and evidence based intervention to support deprescribing for people with ID. The research will be underpinned by behaviour change theory, follow the Medical Research Council’s framework for intervention development(6), and is likely to comprise of three projects:

 Project 1: A systematic review of healthcare professionals’ barriers and enablers to deprescribing for people with ID

Project 2: A mixed methods study, with active involvement of adults with ID and their carers, to contextualise, fully understand and prioritise for addressing in an intervention, the barriers and enablers from Project 1.

Project 3: Co-production of an intervention that addresses the prioritised barriers and enablers

The PhD Researcher will receive mixed methods, behavioural science and evidence synthesis methodological training and will thus finish the PhD with the required skillset to pursue their own independent programme of research.

Towards the end of the PhD, it is envisaged that the PhD Researcher will work with the supervisory team and wider collaborators to formulate a grant application to undertake a feasibility study and then a definitive trial to evaluate its effectiveness and cost-effectives.

Entry requirements:

Applicants are required to hold/or expect to obtain a Bachelor Degree 2:1 in a relevant subject area.

The University of Leicester English language requirements apply where applicable: https://le.ac.uk/study/research-degrees/entry-reqs/eng-lang-reqs/ielts-70

Application advice:

To apply please refer to: https://le.ac.uk/study/research-degrees/research-subjects/school-of-healthcare

With your application, please include:

• CV
• Personal statement explaining your interest in the project, your experience, why we should consider you in addition to confirmation of how you will pay your fees.
• Degree Certificates and Transcripts of study already completed and if possible transcript to date of study currently being undertaken
• Evidence of English language proficiency if applicable
• In the reference section please enter the contact details of your two academic referees in the boxes provided or upload letters of reference if already available.

In the proposal section please provide the name of the supervisors and project title (a proposal is not required)

Application and project queries to soh-pgr@le.ac.uk