Primary care for people with an intellectual disability - What is prescribed? An analysis of medication recommendations from the BEACH dataset

Abstract

Background: People with intellectual disability (ID) experience a range of health disparities. Little is known about differential primary care prescribing patterns for people with and without ID. Aim: To compare medications recommended by GPs at encounters where ID is recorded versus other encounters. Design & setting: Analysis of national Australian GP medication data from the Bettering the Evaluation and Care of Health (BEACH) programme, January 2003-December 2012 inclusive. Method: Medication recommendations made at encounters where an ID-defining problem was recorded as a reason for encounter (RFE) and/or as a problem managed, were allocated to the 'ID group' (n = 563). These encounters were compared with all other encounters (the 'non-ID group', n = 1 004 095) during the study period. Following age-sex standardisation of ID group encounters, significant differences were determined by non-overlapping 95% confidence intervals (CIs). Results: Antipsychotics and anticonvulsants were recommended more frequently at ID group encounters than at non-ID group encounters. Antidepressant and anxiolytic recommendation rates did not differ between groups. Narcotic analgesic and antihypertensive recommendations were significantly lower at ID group encounters. Conclusion: Higher rates of epilepsy and mental illness, and off-label use of some antipsychotics and anticonvulsants for behaviour management in people with ID, may have contributed to medication recommendations observed in this analysis. Lower narcotic analgesic recommendations at ID group encounters may relate to complex presentations and the nature of problems managed, while lower antihypertensive recommendations may indicate some potential omission of routine blood pressure measurement.