Community Monitoring of Health Parameters in People with Intellectual Disabilities Prescribed Lithium

Background: Lithium is well described in managing certain mental illnesses including in people with intellectual disabilities (ID). It requires regular monitoring particularly of serum levels and relevant biochemistry. However, existing monitoring protocols do not provide ID-specific guidance leading to increased risk of poor-quality care. This study aims to construct a protocol to aid monitoring in primary care in this cohort. Need for a protocol is further explored by retrospectively auditing monitoring standards in people with ID in Cornwall, UK, and confirming gaps in current practice which may be minimized with clearer guidance. Methods: Protocol was developed drawing on existing guidance for the general population and considering challenges and best practice associated with monitoring in people with ID. The protocol was applied as an audit to all people with ID currently on lithium on the GP ID register across all GP practices in the county of Cornwall, UK, to explore current standards of monitoring to help elucidate whether increased guidance may be of use. Results: A novel protocol was developed and supplemented with additional information which is hoped to provide a useful reference guide in primary care. During audit, nine of the ten people with ID receiving prescriptions for lithium across the county were identified and data collected. Audit showed monitoring was to a reasonably high standard, though blood tests and annual health checks were not always performed within preferred maximum timeframes. Conclusions: This protocol represents the first ID-specific approach for monitoring lithium and associated health parameters in primary care. Auditing against the protocol showed gaps in current standards of care which may indicate a need for clearer published guidance. Some groupings of results highlighted particular areas of need. We hope that clear protocols, such as ours, may aid safe and timely monitoring of lithium treatment in future.