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Zandam H, Moura I, Akobirshoev I, Mitra M. Non-COVID Respiratory Infections Related Emergency Room Visits Among Autistic Adults in the United States. Am J Prev Med 2024:S0749-3797(24)00290-3. [PMID: 39181342 DOI: 10.1016/j.amepre.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 08/17/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION This is a retrospective study that examines the risk of non-COVID-19 respiratory infection (RI)-related emergency department (ED) visits and hospitalizations among autistic adults. The study compares these findings to non-autistic adults using the 2018 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. METHODS The data were analyzed in 2022 using the ICD-10-CM codes to extract 46,996 case records that included an autism diagonosis matched by age and sex (140,997) records that did not include an autism diagnosis in a 1:3 case-control ratio. Respiratory infections were also identified using the ICD-10-CM codes and classified by type. Logistic regression models were conducted for the likelihood of presenting with respiratory infections to the emergency department and subsequent hospitalization. All models were adjusted for covariates. RESULTS Autistic adults were more likely to present with any type of respiratory infection at the emergency department (AOR=1.83, CI=1.69-2.42), lower respiratory infections (AOR=1.37, CI=1.09-1.50), and pneumonia (AOR=2.42, CI=1.98-2.47) compared to non-autistic adults.. They were also more likely to be hospitalized from respiratory infection during emergency department visits (AOR=3.87, CI=3.21-4.30), including upper respiratory infections and lower respiratory infections, pneumonia, and bronchitis. CONCLUSIONS Individuals with autism were more likely to experience emergency department visits and hospitalizations because of respiratory infections than individuals without autism. Amid growing evidence of the disproportionate impact of COVID-19 on the autistic population, the study findings highlight a broader, pre-existing burden of respiratory infections among adults with autism in the U.S. that extend beyond the recent pandemic.
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Affiliation(s)
- Hussaini Zandam
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
| | - Ian Moura
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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Williams J, Royer J, Lauer E, Kurth NK, Horner-Johnson W, McDermott S, Levy A, Hall JP. Injury-related emergency department use among people with intellectual and developmental disabilities insured by Medicaid from 2010 to 2016. Inj Prev 2024; 30:138-144. [PMID: 37945329 DOI: 10.1136/ip-2023-045043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/08/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Data on non-fatal injuries and visits to the emergency department (ED) for injuries are not readily available. The objective of this paper is to describe injury-related ED visits for people with intellectual and developmental disabilities who are covered by the Medicaid insurance programme. METHODS We aggregated 2010-2016 Medicaid claims data from eight states. Using these data, we identified individuals with intellectual and developmental disabilities and then determined an all-cause ED visit rate, ED visit due to injury rate and admission from ED due to injury rate. Data were stratified by sex and age group. Results were compared with national rates. RESULTS Medicaid members with intellectual and developmental disabilities visited EDs at approximately 1.8 times the rate of the general population. The ED visit rate due to injury was approximately 1.5 times that observed in the population overall. When ED visits due to injury data were stratified by age and sex, the largest discrepancy was observed in women ages 45-64, who visited EDs due to injury at a rate 2.1 times that of women of the same age in the general population. The admission rate from ED due to injury increased over the study period most notably in the older age groups. CONCLUSIONS While rates and patterns of ED utilisation among Medicaid members with intellectual and developmental disabilities vary by age and gender, our findings suggest this group visits the ED due to injury at rates well above the general population.
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Affiliation(s)
- Jessica Williams
- Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Julie Royer
- Health and Demographics Division, South Carolina Revenue and Fiscal Affairs, Columbia, South Carolina, USA
| | - Emily Lauer
- Department of Family Medicine & Community Health, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Noelle K Kurth
- Institute for Health and Disability Policy Studies, University of Kansas College of Liberal Arts and Sciences, Lawrence, Kansas, USA
| | - Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon, USA
| | - Suzanne McDermott
- Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Anna Levy
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Jean P Hall
- Research and Training Center on Independent Living and the Institute for Health and Disability Policy Studies, University of Kansas College of Liberal Arts and Sciences, Lawrence, Kansas, USA
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Sandberg M, Axmon A, Ahlström G, Kristensson J. Predictors of specialist somatic healthcare utilization among older people with intellectual disability and their age-peers in the general population: a national register study. BMJ Open 2023; 13:e072679. [PMID: 37407048 DOI: 10.1136/bmjopen-2023-072679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES To compare somatic healthcare usage among older people with intellectual disabilities (ID) to that of their age-peers in the general population, taking into account health and demographic factors, and to identify predictors for somatic healthcare usage among older people with ID. PARTICIPANTS Equally sized cohorts, one with people with ID and one referent cohort, one-to-one-matched by sex and year of birth, were created. Each cohort comprised 7936 people aged 55+ years at the end of 2012. DESIGN Retrospective register-based study. SETTING All specialist inpatient and outpatient healthcare clinics in Sweden. OUTCOME MEASURES Data regarding planned/unplanned and inpatient/outpatient specialist healthcare were collected from the Swedish National Patient Register for 2002-2012. Diagnoses, previous healthcare usage, sex, age and cohort affiliation was used to investigate potential impact on healthcare usage. RESULTS Compared with the referent cohort, the ID cohort were more likely to have unplanned inpatient and outpatient care but less likely to have planned outpatient care. Within the ID cohort, sex, age and previous use of healthcare predicted healthcare usage. CONCLUSIONS Older people with ID seem to have lower risks of planned outpatient care compared with the general population that could not be explained by diagnoses. Potential explanations are that people with ID suffer from communication difficulties and experience the healthcare environment as unfriendly. Moreover, healthcare staff lack knowledge about the particular needs of people with ID. Altogether, this may lead to people with ID being exposed to discrimination. Although these problems are known, few interventions have been evaluated, especially related to planned outpatient care.
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Affiliation(s)
- Magnus Sandberg
- Department of Health Sciences, Lunds Universitet, Lund, Sweden
| | - Anna Axmon
- EPI@LUND (Epidemiology, Population studies and Infrastructures at Lund University), Division of Occupational and Environmental Medicine, Lunds University, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Lunds Universitet, Lund, Sweden
| | - Jimmie Kristensson
- Department of Health Sciences, Lunds Universitet, Lund, Sweden
- Institute for Palliative Care, Lund University, Region Skåne, Lund, Sweden
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Zandam H, Mitra M, Akobirshoev I, Li FS, Ne'eman A. Infectious Diseases-Related Emergency Department Visits Among Non-Elderly Adults with Intellectual and Developmental Disabilities in the United States: Results from the National Emergency Department Sample, 2016. Popul Health Manag 2021; 25:335-342. [PMID: 34665664 DOI: 10.1089/pop.2021.0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Emerging evidence on the disproportionate impact of COVID-19 on people with intellectual and developmental disabilities (IDD) points to the underlying risk and burden of infectious diseases (IDs) in this population. The objective of this study was to examine the risk of ID-related emergency department (ED) visits, subsequent hospitalizations, and hospital-based mortality during ID-related visits among adults with IDD compared to those without IDD. The authors conducted a retrospective study using data from the 2016 Nationwide Emergency Department Sample. The sample included 94,928 adults with IDD identified using ICD-10-CM codes, and age- and sex-matched 284,763 non-IDD adults in a 1:3 case-control ratio. A Poisson regression model was used to compare the risk of ID-related ED visits, subsequent hospitalizations, and hospital-based mortality during ID-related visits between adults with and without IDD. Covariates included sociodemographic and hospital characteristics. Results showed that adults with IDD are at a higher risk for ID-related ED visits, subsequent hospitalization, and mortality during ID-related ED visits compared to non-IDD adults. Adults with IDD continued to experience higher risks even after accounting for sociodemographic, hospital, and clinical characteristics. Septicemia and respiratory tract infections are the leading causes of ED visits, hospitalization, and mortality. This study found substantial disparities in ID-related ED visits, subsequent hospitalization, and mortality among the burdens for adults with IDD. These observations underscore the importance of integrated strategies to reduce ID-related morbidity among adults with IDD.
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Affiliation(s)
- Hussaini Zandam
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Frank S Li
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Ari Ne'eman
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
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Yamaki K, Wing C, Mitchell D, Owen R, Heller T. The Impact of Medicaid Managed Care on Health Service Utilization Among Adults With Intellectual and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:289-306. [PMID: 31373550 DOI: 10.1352/1934-9556-57.4.289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
People with intellectual and developmental disabilities (IDD) are frequent users of health services. We examined how their service utilization of emergency department (ED), inpatient hospitalization, and primary care physicians changed as they transitioned from fee-for-service to Medicaid managed care (MMC). Our results showed that MMC reduced the utilization of all of these services. A substantial decrease in ED visits was associated with the reduction in visits due to mental/behavioral health conditions and conditions that could be nonemergent and manageable with the community-based health services. These findings suggest that health service utilization of people with IDD is related not only to their health needs, but also to the delivery model that provides their health services.
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Affiliation(s)
- Kiyoshi Yamaki
- Kiyoshi Yamaki, University of Illinois at Chicago; Coady Wing, Indiana University Bloomington; and Dale Mitchell, Randall Owen, and Tamar Heller, University of Illinois at Chicago
| | - Coady Wing
- Kiyoshi Yamaki, University of Illinois at Chicago; Coady Wing, Indiana University Bloomington; and Dale Mitchell, Randall Owen, and Tamar Heller, University of Illinois at Chicago
| | - Dale Mitchell
- Kiyoshi Yamaki, University of Illinois at Chicago; Coady Wing, Indiana University Bloomington; and Dale Mitchell, Randall Owen, and Tamar Heller, University of Illinois at Chicago
| | - Randall Owen
- Kiyoshi Yamaki, University of Illinois at Chicago; Coady Wing, Indiana University Bloomington; and Dale Mitchell, Randall Owen, and Tamar Heller, University of Illinois at Chicago
| | - Tamar Heller
- Kiyoshi Yamaki, University of Illinois at Chicago; Coady Wing, Indiana University Bloomington; and Dale Mitchell, Randall Owen, and Tamar Heller, University of Illinois at Chicago
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Ailey SH, Johnson TJ, Cabrera A. Evaluation of Factors Related to Prolonged Lengths of Stay for Patients With Autism With or Without Intellectual Disability. J Psychosoc Nurs Ment Health Serv 2019; 57:17-22. [PMID: 30753733 DOI: 10.3928/02793695-20190205-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/18/2018] [Indexed: 11/20/2022]
Abstract
Patients with autism spectrum disorder and/or intellectual disability (ASD/ID) face unique health care challenges. In addition to hospital experiences characterized by fear and insufficient staff training, these patients have 1.5-times longer lengths of stay (LOS) than patients without ASD/ID, and 3.4% of patients with ASD/ID have prolonged LOS (i.e., ≥30 days). Little research exists on factors related to prolonged LOS of patients with ASD/ID, hindering efforts to develop and implement evidence-based practices to improve care and reduce prolonged LOS. The purpose of the current study was to describe factors related to prolonged LOS of adult patients with ASD/ID in acute care settings using a retrospective chart review of 10 patients discharged from one academic medical center. Findings indicate that health care institutions should evaluate performance with this patient population and identify evidence-based strategies to provide a safe environment for care and reduce LOS that is due to non-health care needs. [Journal of Psychosocial Nursing and Mental Health Services, 57(7), 17-22.].
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Heutmekers M, Naaldenberg J, Verheggen SA, Assendelft WJJ, van Schrojenstein Lantman-de Valk HMJ, Tobi H, Leusink GL. Health problems of people with intellectual disabilities in Dutch out-of-hours primary care. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:475-481. [DOI: 10.1111/jar.12537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Marloes Heutmekers
- Department of Primary and Community Care; Radboud Institute for Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - Jenneken Naaldenberg
- Department of Primary and Community Care; Radboud Institute for Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - Sabine A. Verheggen
- General Practitioner Cooperative Nijmegen and Boxmeer; Nijmegen The Netherlands
| | - Willem J. J. Assendelft
- Department of Primary and Community Care; Radboud Institute for Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | | | - Hilde Tobi
- Biometris; Wageningen University and Research; Wageningen The Netherlands
| | - Geraline L. Leusink
- Department of Primary and Community Care; Radboud Institute for Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
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McDermott S, Royer J, Mann JR, Armour BS. Factors associated with ambulatory care sensitive emergency department visits for South Carolina Medicaid members with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:165-178. [PMID: 29027297 PMCID: PMC5803329 DOI: 10.1111/jir.12429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/07/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Ambulatory care sensitive conditions (ACSCs) can be seen as failure of access or management in primary care settings. Identifying factors associated with ACSCs for individuals with an Intellectual Disability (ID) provide insight into potential interventions. METHOD To assess the association between emergency department (ED) ACSC visits and a number of demographic and health characteristics of South Carolina Medicaid members with ID. A retrospective cohort of adults with ID was followed from 2001 to 2011. Using ICD-9-CM codes, four ID subgroups, totalling 14 650 members, were studied. RESULTS There were 106 919 ED visits, with 21 214 visits (19.8%) classified as ACSC. Of those, 82.9% were treated and released from EDs with costs averaging $578 per visit. People with mild and unspecified ID averaged greater than one ED visit per member year. Those with Down syndrome and other genetic cause ID had the lowest rates of ED visits but the highest percentage of ACSC ED visits that resulted in inpatient hospitalisation (26.6% vs. an average of 16.8% for other subgroups). When compared with other residential types, those residing at home with no health support services had the highest ED visit rate and were most likely to be discharged back to the community following an ED visit (85.2%). Adults residing in a nursing home had lower rates of ED visits but were most likely to be admitted to the hospital (38.9%) following an ED visit. Epilepsy and convulsions were the leading cause (29.6%) of ACSC ED visits across all subgroups and residential settings. CONCLUSION Prevention of ACSC ED visits may be possible by targeting adults with ID who live at home without health support services.
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Affiliation(s)
- S McDermott
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - J Royer
- Revenue and Fiscal Affairs Office, Columbia, SC, USA
| | - J R Mann
- Department of Preventive Medicine, School of Medicine and John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - B S Armour
- National Center on Birth Defects and Developmental Disabilities (NCBDDD), Centers for Disease Control and Prevention, Atlanta, GA, USA
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Chronic Respiratory Disorders and Their Treatment among Older People with Intellectual Disability and/or Autism Spectrum Disorder in Comparison with the General Population. Healthcare (Basel) 2017; 5:healthcare5030040. [PMID: 28763010 PMCID: PMC5618168 DOI: 10.3390/healthcare5030040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 02/08/2023] Open
Abstract
Respiratory disorders are common among people with intellectual disabilities (ID). However, few studies have investigated these disorders among older people with ID. We identified 7936 people, aged 55+ years, with ID and a reference cohort from the general population. Data on diagnoses of chronic respiratory disorders, with a focus on asthma and chronic obstructive pulmonary disease (COPD), were collected, as was information on health care visits due to such disorders. We also added data on the prescription of drugs for obstructive airway diseases. Whereas the risk of having at least one diagnosis of asthma during the study period was similar in the two cohorts, people with ID were less likely than the general population to have been diagnosed with COPD. The same was found for health care visits due to asthma and COPD, respectively. The patterns of drug prescription were similar among people with ID and the general population, with the exception of adrenergics for systemic use, which were more commonly prescribed to people with ID. Thus, older people with ID do not seem to have an increased risk of asthma or COPD. Moreover, the indications are that when diagnosed with any of these disorders, they receive treatment adapted to their particular needs.
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Perez CM, Wagner AP, Ball SL, White SR, Clare ICH, Holland AJ, Redley M. Prognostic models for identifying adults with intellectual disabilities and mealtime support needs who are at greatest risk of respiratory infection and emergency hospitalisation. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:737-754. [PMID: 28497469 PMCID: PMC5518212 DOI: 10.1111/jir.12376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 11/15/2016] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Among adults with intellectual disabilities (ID), problems with eating, drinking and swallowing (EDS), and an associated need for mealtime support, are common, with an estimated 15% of adults known to specialist ID services requiring mealtime support. We set out to identify which adults with ID who receive mealtime support are at an increased risk of respiratory infections and emergency hospitalisation related to EDS problems. METHOD An exploratory, prospective cohort study was undertaken in the East of England. At baseline, structured interviews with the caregivers of 142 adults with ID and any type of mealtime support needs were used to gather information on health and support needs over the previous 12 months. These interviews were repeated at follow-up, 12 months later. The resulting dataset, covering a 24-month period, was analysed with logistic regression, using model averaging to perform sensitivity analysis, and backwards step-wise variable selection to identify the most important predictors. RESULTS Individuals with a history of respiratory infections (in the first year of study), those who had epilepsy and those with caregiver-reported difficulty swallowing were most likely to have respiratory infections in the second year. Adults with increasing mealtime support needs, epilepsy and/or full mealtime support needs (fed mainly or entirely by a caregiver or enterally) were at increased risk of emergency hospitalisation for EDS-related problems. CONCLUSIONS Our findings highlight the importance of carefully monitoring health issues experienced by adults with ID and EDS problems, as well as their eating, drinking and swallowing skills. However, the models developed in this exploratory research require validation through future studies addressing the EDS problems commonly experienced by adults with ID and their implications for health outcomes and quality of life. Further research into the relationship between epilepsy and EDS problems would provide much-needed insight into the complex relationship between the two areas.
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Affiliation(s)
- C. M. Perez
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - A. P. Wagner
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- Health Economics Group, Norwich Medical SchoolUniversity of East AngliaNorwichUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
| | - S. L. Ball
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - S. R. White
- MRC Biostatistics UnitUniversity of CambridgeCambridgeUK
| | - I. C. H. Clare
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
| | - A. J. Holland
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
| | - M. Redley
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of PsychiatryUniversity of CambridgeCambridgeUK
- National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of EnglandCambridgeUK
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Dunn K, Hughes-McCormack L, Cooper SA. Hospital admissions for physical health conditions for people with intellectual disabilities: Systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 1:1-10. [PMID: 28467010 DOI: 10.1111/jar.12360] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND People with intellectual disabilities may have inequalities in hospital admissions compared with the general population. The present authors aimed to investigate admissions for physical health conditions in this population. METHODS The present authors conducted a systematic review, searching six databases using terms on intellectual disabilities and hospital admission. Papers were selected based on pre-defined inclusion/exclusion criteria, data extracted, tabulated and synthesized and quality assessed. PROSPERO registration number: CRD42015020575. RESULTS Seven of 29,613 papers were included. There were more admissions, and a different pattern of admissions (more medical and dental), for people with intellectual disabilities, but most studies did not take account of higher disease prevalence. Three papers considered admissions for ambulatory care-sensitive conditions, two of which accounted for disease prevalence (asthma, diabetes) and found higher admission rates for people with intellectual disabilities. CONCLUSION Admissions are common. Asthma and diabetes admission data suggest suboptimal primary health care for people with intellectual disabilities compared with the general population, but evidence is limited.
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Affiliation(s)
- Kirsty Dunn
- Institute of Health and Wellbeing, Gartnavel Royal Hospital, University of Glasgow, Glasgow, UK
| | - Laura Hughes-McCormack
- Institute of Health and Wellbeing, Gartnavel Royal Hospital, University of Glasgow, Glasgow, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, Gartnavel Royal Hospital, University of Glasgow, Glasgow, UK
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Amor-Salamanca A, Menchon JM. Pain underreporting associated with profound intellectual disability in emergency departments. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:341-347. [PMID: 28054733 DOI: 10.1111/jir.12355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 10/24/2016] [Accepted: 10/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Little information is available regarding the visits made by persons with profound intellectual disability (PID) to general hospital emergency departments (ED). This study aims to know whether persons with PID who attend ED are given the same type of diagnoses as people with no such disability. METHODS Over a period of 18 months, we gathered data from all non-scheduled visits to an ED by persons with PID to identify the reason for consultation (according to the classification used by the Spanish Society for Emergency Nursing) and the final diagnosis upon discharge. The results were compared with data obtained from a control group of people with no ID who attended an ED for any reason during the same period. RESULTS Somatic complaints were the main reason for ED attendance among persons with PID (90% of consultations). These complaints were more often related to the central nervous system than was the case among non-ID patients (16 vs. 4.7%), whereas other kinds of non-central nervous system somatic complaint were less common among persons with PID (74 vs. 91%). A diagnosis implying physical pain was given less often to people with PID than to controls (3 vs. 20%). CONCLUSIONS The results suggest that persons with PID are less able to conceptualise and communicate information about their symptoms, especially as regards pain, and that this influences the diagnosis they are given when attending an ED. Professionals working in this environment need to be aware of this possibility so as not to underestimate or overlook such symptoms and the illnesses related to them.
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Affiliation(s)
- A Amor-Salamanca
- Fundación Vallparadís, Department of Psychiatry, Mutua Terrassa University Hospital, Spain
| | - J M Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Spain
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Sandberg M, Ahlström G, Axmon A, Kristensson J. Somatic healthcare utilisation patterns among older people with intellectual disability: an 11-year register study. BMC Health Serv Res 2016; 16:642. [PMID: 27829424 PMCID: PMC5103402 DOI: 10.1186/s12913-016-1880-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 10/30/2016] [Indexed: 12/02/2022] Open
Abstract
Background People with intellectual disabilities (ID) are known to have more diseases and are believed to start aging earlier than the general population. The population of older people with ID is growing, but knowledge about their use of healthcare is limited. This study aimed to explore somatic healthcare utilisation patterns among people with ID living in Sweden, in comparison with the general population from 2002 to 2012. Methods Participants were a group of people with ID (n = 7936) aged 55 years and older in 2012, and an equal-sized, birth year and sex matched, general population sample (n = 7936). Participants were divided into age groups of 5-year intervals. Data regarding in- and outpatient care were collected from the Swedish National Patient Register. Results In the younger age groups, the ID group had higher healthcare utilisation compared with the general population sample, with higher risks for planned and unplanned somatic in- and outpatient care, particularly for unplanned inpatient registrations. Decreasing patterns were seen with age; with lower risks in the ID group for the oldest age groups. This was most evident in planned somatic in- and outpatient care. In those with at least one registration, the ID group had a longer unplanned length of stay in the younger age groups, but fewer planned visits to physicians in somatic outpatient care compared with the control group. Conclusions Compared with the general population, people with ID show higher healthcare utilisation in younger age groups. Healthcare utilisation decreases with age, and in old age, fewer people with ID use healthcare compared with the general population. The barriers to accessing planned healthcare for older people with ID need more investigation. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1880-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Magnus Sandberg
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
| | - Anna Axmon
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.,Department of Occupational and Environmental Medicine, Lund University, SE-221 85, Lund, Sweden
| | - Jimmie Kristensson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.,Department of Health, Blekinge Institute of Technology, SE-371 45, Karlskrona, Sweden
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Perez CM, Ball SL, Wagner AP, Clare ICH, Holland AJ, Redley M. The incidence of healthcare use, ill health and mortality in adults with intellectual disabilities and mealtime support needs. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:638-652. [PMID: 25363017 DOI: 10.1111/jir.12167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (ID) experience a wide range of eating, drinking and/or swallowing (EDS) problems, for which they receive diverse mealtime support interventions. Previous research has estimated that dysphagia (difficulty swallowing) affects 8% of all adults with ID and that 15% require some form of mealtime support. People with ID (whether they require mealtime support or not) also experience a greater burden of ill health and die younger than their peers in the general population with no ID. METHODS Using an exploratory, population-based cohort study design, we set out to examine health-related outcomes in adults with ID who receive mealtime support for any eating, drinking or swallowing problem, by establishing the annual incidence of healthcare use, EDS-related ill health, and all-cause mortality. This study was conducted in two counties in the East of England. RESULTS In 2009, 142 adults with mild to profound ID and a need for any type of mealtime support were recruited for a baseline survey. At follow-up 1 year later, 127 individuals were alive, eight had died and seven could not be contacted. Almost all participants had one or more consultations with a general practitioner (GP) each year (85-95%) and, in the first year, 20% reportedly had one or more emergency hospitalizations. Although their annual number of GP visits was broadly comparable with that of the general population, one-fifth of this population's primary healthcare use was directly attributable to EDS-related ill health. Respiratory infections were the most common cause of morbidity, and the immediate cause of all eight deaths, while concerns about nutrition and dehydration were surprisingly minor. Our participants had a high annual incidence of death (5%) and, with a standardized mortality ratio of 267, their observed mortality was more than twice that expected in the general population of adults with ID (not selected because of mealtime support for EDS problems). CONCLUSIONS All Annual Health Checks now offered to adults with ID should include questions about respiratory infections and EDS functioning, in order to focus attention on EDS problems in this population. This has the potential to reduce life-threatening illness.
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Affiliation(s)
- C M Perez
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - S L Ball
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - A P Wagner
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
| | - I C H Clare
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - A J Holland
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - M Redley
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
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Ervin DA, Hennen B, Merrick J, Morad M. Healthcare for persons with intellectual and developmental disability in the community. Front Public Health 2014; 2:83. [PMID: 25077139 PMCID: PMC4098023 DOI: 10.3389/fpubh.2014.00083] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/02/2014] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION While there has been impressive progress in creating and improving community healthcare delivery systems that support people with intellectual and developmental disabilities (IDD), there is much more that can and should be done. METHODS This paper offers a review of healthcare delivery concepts on which new models are being developed, while also establishing an historical context. We review the need for creating fully integrated models of healthcare, and at the same time offer practical considerations that range from specific healthcare delivery system components to the need to expand our approach to training healthcare providers. The models and delivery systems, and the areas of needed focus in their development are reviewed to set a starting point for more and greater work going forward. CONCLUSION Today, we celebrate longer life spans of people with IDD, increased attention to the benefits of healthcare that is responsive to their needs, and the development of important healthcare delivery systems that are customized to their needs. We also know that the growing body of research on health status offers incentive to continue developing healthcare structures for people with IDD by training healthcare providers about the needs of people with IDD, by establishing systems of care that integrate acute healthcare with long-term services and support, by developing IDD medicine as a specialty, and by building health promotion and wellness resources to provide people with IDD a set of preventative health supports.
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Affiliation(s)
- David A. Ervin
- The Resource Exchange, Colorado Springs, CO, USA
- National Institute of Child Health and Human Development, Jerusalem, Israel
| | - Brian Hennen
- Department of Family Medicine, Dalhousie University, Dartmouth, NS, Canada
| | - Joav Merrick
- National Institute of Child Health and Human Development, Jerusalem, Israel
- Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services, Jerusalem, Israel
- Division of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Kentucky Children’s Hospital, University of Kentucky College of Medicine, Lexington, KY, USA
- Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Mohammed Morad
- National Institute of Child Health and Human Development, Jerusalem, Israel
- Kentucky Children’s Hospital, University of Kentucky College of Medicine, Lexington, KY, USA
- Yaski Medical Center, Clalit Health Services, Department of Family Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Chi DL, Masterson EE, Wong JJ. U.S. emergency department admissions for nontraumatic dental conditions for individuals with intellectual and developmental disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:193-204. [PMID: 24937745 PMCID: PMC4097187 DOI: 10.1352/1934-9556-52.3.193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The authors hypothesized that individuals with intellectual and developmental disabilities (IDDs) are more likely to have an emergency department (ED) admission for nontraumatic dental conditions (NTDCs). The authors analyzed 2009 U.S. National Emergency Department Sample data and ran logistic regression models for children ages 3-17 years and adults age 18 years or older. The prevalence of NTDC-related ED admissions was 0.8% for children and 2.0% for adults. Children with IDDs were at increased odds of NTDC-related ED admission, but this difference was not statistically significant (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 0.91, 1.23). Adults with IDDs had significantly lower odds of an ED admission for NTDCs (OR = 0.49; 95% CI = 0.44, 0.54). Children with IDDs are not at increased odds of NTDC-related ED admissions, whereas adults with IDDs are at significantly reduced odds.
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A comparison of medical and psychobehavioral emergency department visits made by adults with intellectual disabilities. Emerg Med Int 2012; 2012:427407. [PMID: 23056948 PMCID: PMC3465952 DOI: 10.1155/2012/427407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 09/01/2012] [Indexed: 12/02/2022] Open
Abstract
Study Objective. We describe and contrast medical to psychobehavioral emergency visits made by a cohort of adults with intellectual disabilities. Methods. This was a study of 221 patients with intellectual disabilities who visited the emergency department because of a psychobehavioral or medical emergency. Patient profiles are described and logistic regression was used to assess predictors of psychobehavioral emergencies in this group, including age, residence, psychiatric diagnosis, cognitive level, and life events. Results. Ninety-eight individuals had medical emergencies and 123 individuals presented with psychobehavioral emergencies. The most common medical issue was injury and the most common psychobehavioral issue was aggression. In the multivariate analysis, life events (odds ratio (OR) 0.28; 95% confidence interval (CI) 0.10 to 0.75), psychiatric diagnosis (OR 2.35; 95% CI 1.12 to 4.95), and age group (OR 4.97; 95% CI 1.28 to 19.38) were associated with psychobehavioral emergencies. Psychobehavioral emergencies were more likely to result in admission and caregivers reported lower rates of satisfaction with these visits. Conclusion. Emergency departments would benefit from greater understanding of the different types of presentations made by adults with intellectual disabilities, given the unique presentations and outcomes associated with them.
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