The impact of health checks for people with intellectual disabilities: an updated systematic review of evidence

Annual health checks for people with intellectual disabilities: An exploration of experiences, follow-up and self-management of health conditions

BACKGROUND

Little is known about how health issues identified at the annual health check (AHC) are followed up and addressed, how participants self-manage their health in between AHCs, and what support they receive. This research aimed to explore this.

METHODS

People with intellectual disabilities (n = 12), and/or their supporters residing in Wales, were interviewed following their AHC and again at 6 and 11 months. A recurrent cross-sectional thematic analysis was undertaken.

RESULTS

Five main themes emerged from interview one: going for a health check, issues identified, and actions taken, supporting the self-management of health, the personal context, and addressing health inequities. Four main themes emerged from follow-up interviews: follow-up, supporting the self-management of health, the need for reasonably adjusted health services, and going for another health check.

CONCLUSION

A broader system of support around the AHC is required if people are to achieve or maintain the best possible health.

'It seems like a luxury to be able to offer that': Factors influencing the implementation of annual health checks for autistic people in England

LAY ABSTRACT

Autistic people are more likely to have mental and physical health problems than non-autistic people. Annual health checks could reduce these problems by finding and treating them early. Annual health checks are yearly medical appointments where a primary healthcare provider (such as a doctor or nurse) can check things like a patient's weight and heart rate and ask if they have any worries about their health. In this study, we wanted to understand what might encourage primary healthcare providers to use annual health checks with their autistic patients. First, we spoke to 10 autistic people and 11 primary healthcare providers. Using the findings from these conversations, we created an online survey for primary healthcare providers in England. We used the findings from the interviews and survey to help us understand what would encourage primary healthcare providers to offer annual health checks for autistic people. Our participants said that a lack of time and staff would make it hard to provide health checks. To help, they said other members of staff (such as nurses and healthcare assistants) could do the health checks, rather than doctors. They also said parts of the process could be made automatic to save time (e.g. sending automatic reminders). Knowledge about autism was important too (e.g. knowing about the common conditions autistic people have, and how to best support autistic patients). Participants said training on these topics, produced and delivered with autistic people, could encourage them to use annual health checks with their autistic patients.

Towards developing an intervention to support periodic health checks for adults with intellectual and developmental disabilities: Striving for health equity

BACKGROUND

Although the Canadian Consensus Guidelines for Primary Care of Adults with Intellectual and Developmental Disabilities recommends conducting periodic health checks in primary care, uptake is lacking. This study seeks to understand factors influencing the conduct of periodic health checks and identify what needs to change to increase them.

METHOD

Qualitative data from five stakeholder groups (adults with intellectual and developmental disabilities, primary care providers, administrative staff, family, disability support workers) was guided by the Behaviour Change Wheel and the Theoretical Domains Framework to identify barriers and 'what needs to change' to support periodic health checks.

RESULTS

Stakeholders (n = 41) voiced multiple barriers. A total of 31 common and 2 unique themes were identified plus 33 items 'needing to change'.

CONCLUSION

Despite barriers, stakeholders saw merit in periodic health checks as a preventative and equitable healthcare offering for adults with intellectual and developmental disabilities. Results will inform future intervention development steps.

Understanding the contribution of intellectual disability nurses. Paper 2 of 4 - Survey

The objective was to identify ID nursing interventions and their impact on the health and healthcare of people with IDs. Data was collected using an online survey questionnaire from a voluntary response and snowball sample of 230 participants. Thematic, descriptive statistical, and inferential statistical analyses were undertaken. We identified 878 interventions that could be undertaken by ID nurses from 7 countries. We categorised the interventions into five themes: effectuating nursing procedures, enhancing impact of ID services, enhancing impact of mainstream services, enhancing quality of life, and enhancing ID nursing practice. Findings demonstrate that ID nurses play important roles in improving the health and healthcare experiences of people with IDs.

Hospital admissions of school-age children with an intellectual disability: A population-based survey

AIM

To describe the profiles of hospital admissions of school-age children identified with a learning disability (ICD-11 intellectual developmental disorder) and/or safeguarding needs compared to children without learning disability, in a population where proactive identification of learning disabilities in children is embedded in practice.

METHOD

Data were collected about the reasons for and duration of hospital admissions of school-age children living in the study catchment area between April 2017 and March 2019; the presence (or absence) of learning disability and/or safeguarding flags in the medical record was also noted. The impact of the presence of flags on the outcomes was explored using negative binomial regression modelling.

RESULTS

Of 46 295 children in the local population, 1171 (2.53%) had a learning disability flag. The admissions of 4057 children were analysed (1956 females; age range 5-16 years, mean 10 years 6 months, SD 3 years 8 months). Of these, 221 out of 4057 (5.5%) had a learning disability, 443 out of 4057 (10.9%) had safeguarding flags, 43 out of 4057 (1.1%) had both, and 3436 out of 4057 (84.7%) had neither. There was a significantly increased incidence of hospital admissions and length of stay in children with either or both flags, compared to children with neither.

INTERPRETATION

Children with learning disabilities and/or safeguarding needs have higher rates of hospital admissions than children without. Robust identification of learning disabilities in childhood is required to make the needs of this group visible in routinely collected data as the first step towards needs being appropriately addressed.

WHAT THIS PAPER ADDS

Children with learning disabilities must be consistently identified in populations so that their needs are made visible. Information about these needs must be collected from educational, health, and social care sources and scrutinized systematically. Children with learning disabilities and safeguarding needs have an increased incidence of hospital admissions and length of stay.

Reasons for Encounters and Comorbidities in Adolescents with Intellectual Disability in General Practice: A Retrospective Analysis of Data from the Ask Study

Adolescents with intellectual disability have substantial health needs. This retrospective analysis of data from the Ask Study describes reasons for primary care encounters and the prevalence and incidence of chronic physical and mental conditions among a cohort of community-dwelling adolescents with intellectual disability. Participants attended secondary schools in southern Queensland, Australia. Primary care data were extracted from primary care records. Demographic and health information was collected using carer-completed questionnaires. Reasons for primary care encounters, disease prevalence at age 16 years, and disease incidence through adolescence were reported. Data were obtained for 432 adolescents with intellectual disability (median follow-up: 4.1 years). Skin problems (29.4 per 100 encounters) were the most common reason patients presented for primary care, followed by psychological and behavioural problems (14.4 per 100 encounters) and musculoskeletal problems (13.8 per 100 encounters). Conditions with the highest prevalence were autism spectrum disorder (18.6%) and asthma (18.1%). The prevalence of epilepsy, visual impairment, and cerebral palsy were 14.7, 11.1, and 8.0%, respectively. Gastroesophageal reflux had the highest incidence (9.4 cases per 1000 person-years). Adolescents with intellectual disability have significant healthcare needs, which general practitioners need to be aware of and address. Study findings should inform the development of training programs for general practitioners.

Understanding the contribution of intellectual disabilities nurses: Paper 3 of 4 - evaluation

The overall objective of this research was to identify intellectual disability nursing interventions and their impact on the health and healthcare of people with intellectual disability. This is part 3 of a 4-part series. In this paper we report the findings from quantitative questions from an online survey of intellectual disability nurses. The objective of this part of the study was to a evaluate intellectual disability nurses' confidence in their understanding of the interventions they undertook. Quantitative data was collected using an online survey questionnaire from a voluntary response and snowball sample of 230 participants from 7 countries. Thematic, descriptive statistical, and inferential statistical analyses were undertaken. The evaluation data suggest and demonstrate a lack of clarity among intellectual disability nurses of the interventions they can effectively undertake. There appears to be correlations between lack of role clarity and the types of employer organisations and countries. Further work need to be undertaken by nurse leaders ascertain and address this lack of clarity.

Adults with intellectual disabilities' satisfaction regarding their hospitalization: A correlational descriptive study

When hospitalized, adults with intellectual disabilities are more anxious and have more unmet needs than the general population. Despite these problems, studies report contradictory results about their satisfaction with hospitalization. The aim of this study was to determine the level of satisfaction of adults with intellectual disabilities regarding their hospital care and the factors associated with satisfaction. An analysis of the Patient Satisfaction Scale (PSS) and Cognitive Appraisal of Health Scale (CAHS) instruments completed by adults with intellectual disabilities, or their caregivers, after hospitalization was done. The 32 participants' mean PSS score was 3.6/5, with means of 13.3/25 and 8.7/25 on the CAHS' 'harm/loss' dimension and 'challenge' dimension, respectively. None of the factors studied was associated with the total PSS score. Adults with intellectual disabilities were not fully satisfied with their hospital care, experiencing challenges and losses. These findings call for a rethink of the care provided to this population.

Improving access to primary care and annual health checks for people who have a learning disability: a multistakeholder qualitative study

OBJECTIVES

To investigate key stakeholders' views on how to improve access to primary care in general practice settings for people with learning disabilities (or intellectual disabilities). Further to explore how inequalities and barriers in specific areas including annual health checks might be addressed.

DESIGN

A qualitative study design was used with data collected during focus groups, interviews and open-response surveys; data analysis was thematic and informed by stakeholder consultation. Processes to facilitate quality included triangulation of stakeholder perspectives, triangulation of data collection methods and checking interpretation of findings with participants.

SETTING

UK regional services including learning disability organisations, primary care general practitioner (GP) clinical practice networks and supported housing organisations.

PARTICIPANTS

Sixteen people participated in the study: four people with learning disabilities participated in a focus group; four relatives completed an interview or survey; eight GPs, practice nurses and supported housing managers participated in interviews.

RESULTS

Five overarching themes describing approaches to improve primary care access for people with learning disabilities were identified including: prioritisation, proactivity, innovation and improvement, personalisation and prevention and follow-up. Definitions of themes were described and illustrated with quotes. Ten recommendations informed by the thematic analysis, stakeholder consultation, research and primary care guidance were codeveloped with people with learning disabilities.

CONCLUSIONS

All stakeholders identified problems, with primary care interfaces being misaligned with the needs of people with learning disabilities. The recommendations informed by all stakeholders can be used to guide development of service provision to better meet the needs of people with learning disabilities in primary care. Future research should explore professionals' understanding of reasonable adjustments.

Views about primary care health checks for autistic adults: UK survey findings

BACKGROUND

Compared with the general population, autistic adults experience higher rates of physical and mental health conditions, premature morbidity and mortality, and barriers to health care. A health check for autistic people may improve their health outcomes.

AIM

To establish the views of autistic people towards a primary care health check for autistic people.

DESIGN & SETTING

Cross-sectional questionnaire study in England and Wales.

METHOD

A questionnaire was sent to autistic adults with physical health conditions in England and Wales. A total of 458 people (441 autistic adults and 17 proxy responders) completed the questionnaire.

RESULTS

Most responders (73.4%, n = 336) thought a health check is needed for all autistic people. Around half of the participants thought a health check should be offered from childhood and the health check appointment should last between 15 and 30 minutes. Autistic people were positive about providing primary care staff with contextual information regarding their health and the reasonable adjustments they would like before their health check appointment. Training about autism and the health check was considered important, alongside adequate time for discussions in the health check appointment (all by over 70% of responders). The clinician's autism knowledge, seeing a familiar clinician, environmental adaptations, appropriate information, and accessible appointments were considered particularly important in making a health check accessible.

CONCLUSION

Autistic people and relatives were supportive of a primary care health check for autistic people. Information gathered was used to support the design of a primary care health check for autistic adults.

Should inclusion have an expiry date? Older people's attitudes on intellectual disabilities

BACKGROUND

Older people with intellectual disabilities represent a new and neglected population in need of services, yet it may be problematic to include them in generic services without having a clear idea of how elderly people from the general population feel towards them. To the best of our knowledge, this topic has not been addressed quantitatively.

METHOD

Seventy-three participants over 63 years of age (23 females and 50 males) from the general population without an intellectual disability completed two valid measures: the CLAS-MR and the WHOQOL-OLD.

RESULTS

Level of education and quality of life were positively associated with attitudes towards people with intellectual disabilities. Age was negatively associated with knowledge regarding intellectual disability.

CONCLUSIONS

When preparing for the inclusion of older people with intellectual disabilities in generic services, attention should be given to members' level of education, quality of life, and knowledge regarding intellectual disabilities. Sensitivity should be applied to potential tendencies to shelter people with intellectual disabilities.

Barriers to the access of people with disabilities to health services: a scoping review

OBJECTIVE

To analyze the scientific evidence regarding barriers to the access of people with disabilities to health services.

METHODS

A scoping review was carried out from the main question: "What are the main barriers that people with disabilities face in accessing health services?" The articles were surveyed in July 2019 in six scientific literature databases. Of the 1,155 documents identified in the searches, after selection by title and abstract, 170 publications were read in full and, thus, 96 articles were included and categorized according to the theoretical framework.

RESULTS

The main barriers indicated by the users of the service were: communication failure between professionals and patient/caregiver; financial limitations; attitudinal/behavioral issues; scarce service provision; organizational and transport barriers. The main barriers presented by service providers were: lack of training to professionals; failure of the health system; physical barriers; lack of resources/technology; and language barriers.

CONCLUSIONS

It was evident that people with disabilities face several barriers when trying to access the health services they need and that users and health professionals have distinct and complementary views on difficulties.

Prevalence of anxiety symptomatology and diagnosis in syndromic intellectual disability: A systematic review and meta-analysis

Individuals with syndromic intellectual disability are at increased risk of experiencing anxiety. Comparing prevalence estimates of anxiety will allow the identification of at-risk groups and inform causal pathways of anxiety. No known study has explored estimates of anxiety symptomatology and diagnosis, including specific anxiety profiles, across groups whilst accounting for methodological quality of studies. This systematic review and meta-analysis aimed to fill this gap. Prior to review completion, methodology and analysis plans were registered and documented in a protocol (CRD42019123561). Data from 83 papers, involving a pooled sample of 13,708 across eight syndromes were synthesised using a random effects model. Anxiety prevalence ranged from 9 % (95 % CI: 4-14) in Down syndrome to 73% in Rett syndrome (95 % CI: 70-77). Anxiety prevalence across syndromic intellectual disability was higher than for intellectual disability of mixed aetiology and general population estimates. Substantial variability between syndromes identified groups at higher risk than others. The identification of high-risk groups is crucial for early intervention, allowing us to refine models of risk and identify divergent profiles.

Health Needs and Their Relationship with Life Expectancy in People with and without Intellectual Disabilities in England

Health needs are common in people living with intellectual disabilities, but we do not know how they contribute to life expectancy. We used the Clinical Practice Research Datalink (CPRD) linked with hospital/mortality data in England (2017–2019) to explore life expectancy among people with or without intellectual disabilities, indicated by the presence or absence, respectively, of: epilepsy; incontinence; severe visual loss; severe visual impairment; severe mobility difficulties; cerebral palsy and PEG feeding. Life expectancy and 95% confidence intervals were compared using flexible parametric methods. At baseline, 46.4% (total n = 7794) of individuals with intellectual disabilities compared with 9.7% (total n = 176,807) in the comparison group had ≥1 health need. Epilepsy was the most common health need (18.7% vs. 1.1%). All health needs except hearing impairment were associated with shorter life expectancy: PEG feeding and mobility difficulties were associated with the greatest loss in life years (65–68% and 41–44%, respectively). Differential life expectancy attenuated but remained (≈12% life years lost) even after restricting the population to those without health needs (additional years expected to live at 10 years: 65.5 [60.3, 71.1] vs. 74.3 [73.8, 74.7]). We conclude that health needs play a significant role but do not explain all of the differential life expectancy experienced by people with intellectual disabilities.

Health checks for adults with intellectual disability and association with survival rates: a linked electronic records matched cohort study in Wales, UK

OBJECTIVE

To examine if mortality rates are lower in people with intellectual disability who have had a health check compared with those who have not had health checks.

SETTING

General practice records of 26 954 people with an intellectual disability in Wales between 2005-2017, of which 7650 (28.4%) with a health check were matched 1:2 with those without a health check.

PRIMARY OUTCOME MEASURE

Office of National Statistics mortality data; a Cox regression was utilised to examine time to death adjusted for comorbidities and gender.

RESULTS

Patients who had a health check were stratified by those who (1) had a confirmed health check, that is, Read Code for a health check (n=7650 (28.4 %)) and (2) had no evidence of receiving a health check in their medical record. Patients with a health check were matched for age at time of health check with two people who did not have a health check. The health check was associated with improved survival for those with autism or Down's Syndrome (HR 0.58 (95% CI 0.37 to 0.91) and HR 0.76 (95% CI 0.64 to 0.91), respectively). There was no evidence of improved survival for those diagnosed with diabetes or cancer. The people who had a health check were more likely to be older, have epilepsy and less likely to have autism or Down's syndrome.

CONCLUSIONS

Health checks are likely to influence survival if started before a person is diagnosed with a chronic condition, especially for people with autism or Down's syndrome.

Roadmap for Creating Effective Communication Tools to Improve Health Equity for Persons With Intellectual and Developmental Disabilities

Persons with intellectual and developmental disabilities (IDD) live 20 fewer years than the average person and almost 40% of their deaths are from preventable causes. They suffer from well-documented disparities in health and healthcare, and much of this inequity is rooted in information transfer failures between patients, their caregivers, and their healthcare providers. Tools to improve communication between these stakeholders, such as health checks and hand-held health records, or health passports, have been implemented in Europe, Australia and Canada with mixed results, and there are no standard information tools currently in widespread use in the U.S. We review the evidence of the effectiveness of these tools, as well as their barriers to adoption, to inform proposed development of next-generation information transfer tools most useful to patients with IDD and their healthcare providers. The repair of health information transfer failures will be a major step toward achieving health equity for this population.

Health Conditions in Adults With Cerebral Palsy: The Association With CP Subtype and Severity of Impairments

Aim: To determine the prevalence of common health conditions in adults with cerebral palsy (CP) and to identify associations with the CP subtype or the severity of impairments.

Methods: A population-based, cross-sectional study of 153 adults with CP born from 1959 to 1978 (87 males, 66 females; median age 48 years 3 months, range 37–58 years; 41% with unilateral spastic, 36% bilateral spastic, 19% dyskinetic, and 4% with ataxic CP). Data was gathered through interviews, physical assessments, and medical record reviews.

Results: The most common health conditions in adults with CP were pain 65%, upper gastrointestinal disorders 33%, dysphagia 29%, epilepsy 29%, and depression 27%. Cerebral palsy subtype was significantly associated with the presence of pain (p = 0.029), gastrointestinal (p < 0.001), and respiratory disorders (p = 0.006). A more severe physical impairment was associated with a higher prevalence of gastrointestinal disorders (p < 0.001), respiratory disorders (p < 0.001), and pressure ulcers (p < 0.001). Intellectual disability was associated with a higher prevalence of gastrointestinal disorders (p < 0.001), pneumonia (p = 0.001) epilepsy (p = 0.001), and pressure ulcers (p < 0.001), but with a lower prevalence of pain (p < 0.004) and hypertension (p = 0.043).

Conclusion: The prevalence of several common health conditions is related to the CP subtype and severity of impairments, indicating that CP plays a role in the development of these health conditions. Follow-up of adults with CP needs to include not only impairments, but general health as well. Increased attention directed toward signs of gastrointestinal and respiratory disorders in individuals with either dyskinetic CP, gross motor function classification system (GMFCS) levels IV–V, or intellectual disability, is recommended.

Health check guidelines and billing for family physicians caring for adults with intellectual and developmental disabilities: Incentives to improve care

OBJECTIVE

To examine the degree to which Canadian consensus guideline recommendations for annual comprehensive preventive care assessments of adults with intellectual and developmental disabilities (IDD) are being taken up by Nova Scotia family physicians since the introduction of incentive billing codes; and to discuss the importance of complete physical examinations for this patient population, extra time needed in clinic encounters, and challenges for practitioners providing care.

DESIGN

Analysis of family physicians' billing of codes 03.04C and 03.03E from April 2012 to December 2016.

SETTING

Nova Scotia.

PARTICIPANTS

Family physicians.

MAIN OUTCOME MEASURES

Number of billings through fee-for-service and alternative payment plans, and number of providers who used these fee codes.

RESULTS

Analysis yielded 3 key results. Use of incentivized billing codes for adult IDD visits and complete examinations in Nova Scotia has steadily increased for patients since the introduction of the modified codes. There is measurable uptake of the IDD adult visit code in total numbers and numbers of providers billing the code. There is poor uptake of the complete examination code.

CONCLUSION

Enhanced billing codes will provide Nova Scotia family physicians with an incentive to employ the newly revised 2018 Canadian consensus guidelines in the care of adults with IDDs. With continued discussion and promotion of annual physical examinations for patients with IDD, more patients and caregivers might make this proactive care item a priority.

Organizational attributes of interprofessional primary care for adults with intellectual and developmental disabilities in ontario, Canada: a multiple case study

Background

Access to high-quality primary care has been identified as a pressing need for adults with intellectual and developmental disabilities (IDD). Adults with IDD live with complex physical and mental health conditions, use health services differently than the general population and continue to face challenges when accessing health services. Interprofessional primary care teams offer comprehensive and coordinated approaches to primary care delivery and are well-positioned to address the needs of adults with IDD and other vulnerable populations. Although interprofessional primary care teams are recommended, there is currently limited understanding of how interprofessional care is delivered and how access to a team of providers improves the health of this population. The aim of this paper is to describe the organizational attributes of interprofessional primary care for adults with IDD within and across models of team-based care in one local health service context.

Methods

A multiple case study was conducted with five interprofessional primary care teams in Ontario, Canada. Multiple methods were used to generate data including: a survey, document review, electronic medical record report and qualitative interviews. Pattern matching was the primary analytic approach for the within and across case analysis.

Results

Adults with IDD were found to be a small part of the patient population served and this group was poorly identified in three of five teams. Key organizational attributes that support the delivery of interprofessional primary care for adults with IDD were identified. Two examples of targeted programs of care for this group were also found. Despite the presence of interprofessional health providers in all teams, there were limited organizational processes to engage a wide-range of interprofessional services in the care of this group. There was no consistent reporting of outcomes or processes in place to measure the impact of interprofessional services for this population.

Conclusions

This study provides important insights into the current state of interprofessional primary care for adults with IDD in Ontario and highlight a critical need for further work in the field to develop organizational structures and processes to engage in team-based care and demonstrate the value of the approach for this population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01502-z.

Respiratory-associated deaths in people with intellectual disabilities: a systematic review and meta-analysis

OBJECTIVE

To review and synthesise evidence on rates of respiratory-associated deaths and associated risk factors in the intellectual disability population.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Embase, CINAHL, ISI Web of Science (all databases including Medline) and PsychINFO were searched for studies published between 1st January 1985 and 27th April 2020 and examined study and outcome quality. Reference lists and Google Scholar were also hand searched.

RESULTS

We identified 2295 studies, 17 were included in the narrative synthesis and 10 studies (11 cohorts) in the meta-analysis. Data from 90 302 people with intellectual disabilities and 13 808 deaths from all causes in people with intellectual disabilities were extracted. Significantly higher rates of respiratory-associated deaths were found among people with intellectual disabilities (standardised mortality ratio(SMR): 10.86 (95% CI: 5.32 to 22.18, p<0.001) compared with those in the general population, lesser rates for adults with ID (SMR: 6.53 (95% CI: 4.29 to 9.96, p<0.001); and relatively high rates from pneumonia 26.65 (95% CI: 5.63 to 126.24, p<0.001). The overall statistical heterogeneity was I²=99.0%.

CONCLUSION

Premature deaths due to respiratory disorders are potentially avoidable with improved public health initiatives and equitable access to quality healthcare. Further research should focus on developing prognostic guidance and validated tools for clinical practice to mitigate risks of respiratory-associated deaths.

PROSPERO REGISTRATION NUMBER

CRD42020180479.

Complete physical examinations in Manitoba adults with an intellectual or developmental disability: A retrospective cohort study

BACKGROUND

Complete physical examinations (CPE) can identify health disparities in persons with intellectual or developmental disabilities. The objective of this study was to determine and compare rates of CPE among Manitoba adults with and without intellectual or developmental disabilities over time and to identify factors that were associated with receiving a CPE.

METHOD

A retrospective cohort study using linked administrative health and non-health data from 1995 to 2015 was conducted. Poisson and logistic regression were used to calculate CPE rates and examine factors associated with CPE.

RESULTS

The rates of CPE are decreasing over time and are higher among Manitobans with an intellectual or developmental disability. Characteristics such as being male, living rurally, low socioeconomic status, and high continuity of care led to lower odds of receiving a CPE.

CONCLUSIONS

The current state of CPE provision to adults with intellectual or developmental disabilities in Manitoba is encouraging but needs improvement.

A qualitative study of the needs of older adults with intellectual disabilities

BACKGROUND

Research indicates that adults with intellectual disabilities are living longer. However, there is limited research on how this affects health and care needs.

OBJECTIVE

The present study aimed to examine the health and social care needs of older adults with intellectual disabilities in Ireland using multiple informants.

METHODS

Data were gathered from a sample of 20 adults aged 50 years or older (Mean = 59.1, SD = 5.9, range = 50-72; 11 female). The sample included individuals with mild (n = 7), moderate (n = 10) and severe/profound (n = 3) intellectual disabilities. Additional data from keyworkers (n = 19) and family carers (n = 15) provided a more complete understanding of needs.

RESULTS

Results revealed some areas of agreement and difference between adults with intellectual disability and their carers regarding the social care, employment, retirement, physical and mental health needs of this population.

CONCLUSIONS

The findings of this study have potential implications for the provision of high-quality services for older adults with intellectual disabilities.

Adults with intellectual and developmental disabilities and interprofessional, team-based primary health care: a scoping review

OBJECTIVE

This scoping review aimed to examine the state of the evidence for interprofessional, team-based primary health care for adults with intellectual and developmental disabilities.

INTRODUCTION

Adults with intellectual and developmental disabilities are a complex, vulnerable population known to experience health inequities. Interprofessional primary health care teams are recommended to improve access to comprehensive and coordinated health care for these individuals. Limited information is available regarding what services interprofessional primary health care teams provide and how services are evaluated specific to the care of this population.

INCLUSION CRITERIA

This scoping review considered all studies that referenced individuals with intellectual and/or developmental disabilities who were 18 years or older. It considered all studies that referred to health care provision within a primary health care context. All studies that discussed the provision of interprofessional primary health care services were included. "Interprofessional primary health care team" was the term used to describe services provided by health providers (e.g. physicians, nurse practitioners, nurses, dietitians, social workers, mental health workers, occupational therapists, physical therapists) working in a team-based model of care.

METHODS

This scoping review was conducted in accordance with JBI methodology for scoping reviews. Quantitative, qualitative, and mixed methods study designs were considered for inclusion. In addition, systematic reviews, program descriptions, clinical reviews, and opinion papers were considered. Studies published in English and French were included. The period considered was from 2000 to the date of the searches (July and August 2018 for bibliographic databases and January 2019 for the final searches of unpublished studies and selected papers from key authors).

RESULTS

The search identified 2761 records. Despite the global search strategy, only 20 records were included in the final review, mainly consisting of work based in the United States and Canada. Results were heterogeneous and descriptive in nature, consisting of cross-sectional designs, program descriptions, and clinical reviews. The findings represent only a few distinct interprofessional primary health care team models of care and multiple contributions from a small pool of researchers. Roles for physicians, nurse practitioners, nurses, social workers, and mental health providers were identified. Ten studies identified either patient-reported outcomes or health-utilization outcomes. Overall, there was no consistent reporting of outcomes across studies, and outcomes specifically related to many interprofessional services were not captured. Although interprofessional, team-based approaches are supported at a policy and practice level, the concept of interprofessional primary health care for this population remains understudied and is challenged by differences in primary health care provision across the world, complexity in how the field is defined, as well as a lack of consistent reporting of the organizational attributes and processes that support interprofessional primary health care provision.

CONCLUSIONS

To fully realize the potential of interprofessional primary health care teams, health services research is needed to describe organizational attributes and processes, and evaluate interventions for this population. Engaging in this work will ultimately provide a more fulsome evidence base to support high-quality, interprofessional primary health care provision for adults with intellectual and developmental disabilities.

Using photovoice with people with intellectual disability to illuminate definitions of health and factors influencing participation in health promotion

BACKGROUND

Understanding the daily health experiences of people with intellectual disability is necessary to illuminate factors that may be influencing health and health disparities. The objective of this study is to understand how people with intellectual disability participate in and access health promotion.

METHODS

Ten adults with intellectual disability engaged in an adapted photovoice study.

RESULTS

Four themes emerged: Health Is Who We Are; Health is What We Do; Health Is Our Body, Mind, and Place; and Barriers and Facilitators. Participants communicated an understanding of health, a strong identity of themselves as being healthy, and diverse participation in health promotion. Additionally, participants identified specific resources and support necessary to pursue health. Participants' broad description of health aligns with understandings of the social determinants of health.

CONCLUSION

Participant's holistic view of health and experienced factors of health promotion should inform the development and implementation of inclusive health programming for people with intellectual disability.

Health care utilisation among older people with Down syndrome compared to specific medical guidelines for health surveillance: a Swedish national register study

Background

Specific medical guidelines for health surveillance exist for people with Down syndrome (DS) since 25 years but knowledge of adherence to the guidelines is lacking. The guidelines were developed to avoid unnecessary suffering from preventable conditions. The aims of the study were to investigate 1) planned health care visits in relation to the co-morbidities described in specific medical guidelines as a measure of adherence, 2) unplanned health care visits as a measure of potentially unmet health care needs and 3) gender differences in health care utilisation among older people with DS.

Methods

This register-based study includes people with DS (n = 472) from a Swedish national cohort of people with intellectual disability (n = 7936), aged 55 years or more, and with at least one support according to the disability law, in 2012. Data on inpatient and outpatient specialist health care utilisation were collected from the National Patient Register for 2002–2012.

Results

A total of 3854 inpatient and outpatient specialist health care visits were recorded during the 11 years, of which 54.6% (n = 2103) were planned, 44.0% (n = 1695) unplanned and 1.4% (n = 56) lacked information. More than half of the visits, 67.0% (n = 2582) were outpatient health care thus inpatient 33% (n = 1272). Most planned visits (29.4%, n = 618) were to an ophthalmology clinic, and most unplanned visits to an internal medicine clinic (36.6%, n = 621). The most common cause for planned visits was cataract, found at least once for 32.8% in this cohort, followed by arthrosis (8.9%), epilepsy (8.9%) and dementia (6.6%). Pneumonia, pain, fractures and epilepsy each accounted for at least one unplanned visit for approximately one-fourth of the population (27.1, 26.9, 26.3 and 19.7% respectively). Men and women had similar numbers of unplanned visits. However, women were more likely to have visits for epilepsy or fractures, and men more likely for pneumonia.

Conclusions

Increased awareness of existing specific medical guidelines for people with DS is vital for preventive measures. The relatively few planned health care visits according to the medical guidelines together with a high number of unplanned visits caused by conditions which potentially can be prevented suggest a need of improved adherence to medical guidelines.

Linked data analysis of learning disability health checks and emergency hospital admissions in the Kent Integrated Dataset

BACKGROUND

People with learning disabilities have higher rates of admitted patient care than the general population. This study explored emergency hospital admissions during 2018/19 in association with learning disability health check recording in general practice within the Kent Integrated Dataset during 2016/17 to 2018/19.

METHODS

Multiple logistic regression evaluated the odds of emergency hospital admission by sex, age, deprivation, residence, risk score, long-term conditions, severe health needs and health check. During 2018/19, one or more emergency hospital admissions were recorded for 10.9% of the 5,759 persons recorded with learning disability.

RESULTS

There were lower odds of emergency hospital admission in persons having had learning disability health check in the past 3 years even after adjustment.

CONCLUSIONS

Comparison to nationally representative research suggests a consistent finding of benefit from learning disability health check on indicators of unplanned care use, supporting the view that learning disability health checks facilitate the addressing of key health needs.

Homelessness and people with intellectual disabilities: A systematic review of the international research evidence

BACKGROUND

People with intellectual disabilities can experience homelessness, and some of the reasons differ from the general homeless population. Specific policy and practice responses are required.

METHOD

A systematic review of studies examining homelessness among people with intellectual disabilities utilizing CINAHL, MEDLINE, PsycINFO and Sociological Abstracts databases from inception to November 2019.

RESULTS

The search produced 259 papers, and following screening, a total of 13 papers were included in the review. The themes identified were (i) pathways into homelessness, (ii) experiencing homelessness and (iii) routes out of homelessness.

CONCLUSIONS

People with ID become homeless due to multifactorial issues. The identification of people within homeless services and their care and support concerns remains challenging, impacting upon the provision of assessments, interventions, care and supports. Psychosocial assessments, interventions and supports are necessary to assist people with ID to leave homelessness.

Healthcare services utilization among people with intellectual disability and comparison with the general population

BACKGROUND

Studies have reported unmet health needs in individuals with intellectual disability (ID). This study illustrated and analysed patterns of healthcare services utilization among people with intellectual disability and compared their use to that of the general population.

METHOD

Participants (N = 791, aged 15-82) were mainly recruited through government-financed agencies specializing in services for people with intellectual disabilities in Québec, Canada. Comparisons were possible by using health administrative data.

RESULTS

Some services were more used by people with intellectual disability than the general population (general medicine, psychiatry, PSA blood tests), and others were accessed at significantly lower frequencies (optometry, physiotherapy, Pap tests). Similar rates were found for mammography, dentistry and psychology. Inequities were more salient for individuals who had more severe levels of intellectual disability.

CONCLUSIONS

Our findings support that the population with intellectual disability would benefit from policies and practices aimed at enhancing the access to healthcare services.

Mediating the interface between voluntariness and coercion: A qualitative study of learning disability nurses' work in medical examinations of people with intellectual disability

AIMS AND OBJECTIVES

To gain knowledge of prevention and use of restraints in provision of medical care to people with intellectual disability. To this end, we explore how learning disability nurses in community services support the individual through medical examinations when facing resistance.

BACKGROUND

Despite increased focus on limiting restraints, there is a lack of knowledge of how restraints are prevented and used in the delivery of physical health care to people with intellectual disability.

DESIGN

We used an ethnographic comparative case design (n = 6).

METHODS

The study was carried out in Norway. The analysis is based on data from semi-structured interviews, participant observation and document studies, in addition to health sociological perspectives on how to support individuals to make their body available for medical examination and intervention. The SRQR checklist was used.

RESULTS

Learning disability nurses strove to ensure that examinations were carried out on the individual's terms, supporting the individual in three phases: preparing for the examination, facilitating the examination and, when facing resistance, intervening to ensure safe and compassionate completion of the examination.

CONCLUSIONS

Supporting the person was a precarious process where professionals had to balance considerations of voluntariness and coercion, progress and breakdown, safety and risk of injury, and dignity and violation. Through their support, learning disability nurses helped to constitute the "resistant" individual as "a cooperative patient," whose body could be examined within the knowledge and methods of medicine, but who could also be safeguarded as a human being through the strain of undergoing examination.

RELEVANCE TO CLINICAL PRACTICE

The article sheds light on how restraints are used in the medical examination and treatment of people with intellectual disabilities and demonstrates the significance of professional support workers' contributions, both in facilitating safe and efficient medical care and in ensuring the least restrictive and most compassionate care possible.

Exploring enablers and barriers to accessing health services after a fall among people with intellectual disability

BACKGROUND

Adults with intellectual disability experience high rates of falls making falls prevention an important health need. The purpose of the study was to seek perspectives of older adults with intellectual disability and their caregivers to (a) explore the experiences of older adults with intellectual disability when seeking healthcare services after a fall and (b) identify enablers and barriers when taking up evidence-based falls recommendations.

METHOD

A qualitative exploratory study was undertaken as part of a prospective observational cohort study. Semi-structured interviews were conducted with a purposeful sample. Data were analysed thematically using Colaizzi's method.

RESULTS

Seventeen interviews were conducted (n = 21). Emergent themes demonstrated that participants had limited knowledge about falls prevention. Enablers included individualizing falls prevention strategies. Barriers included not being offered access to established falls prevention pathways.

CONCLUSION

There is an urgent need to develop high-quality falls prevention services for older adults with intellectual disability.

Interprofessional team-based primary health care for adults with intellectual and developmental disabilities: a scoping review protocol

OBJECTIVE

This review aims to examine the state of the evidence for interprofessional team-based primary health care for adults with intellectual and developmental disabilities.

INTRODUCTION

Adults with intellectual and developmental disabilities have complex health needs, as well as experience health service inequities. Interprofessional primary healthcare teams offer access to comprehensive primary health care and are recommended as an approach to improve the health of this population. At present, limited information is available regarding what services interprofessional primary healthcare teams provide and how services are evaluated specific to the care of adults with intellectual and developmental disabilities.

INCLUSION CRITERIA

This review will consider all studies that reference individuals with intellectual and developmental disabilities who are 18 years and over. It will consider all studies that refer to interprofessional healthcare provision within a primary healthcare team context. Interprofessional care is the term that will be used to describe services provided by interprofessional health providers (e.g. nurses, dietitians, social workers) in these teams. Work completed by physicians and nurses within traditional general practices will be excluded.

METHODS

This review will be conducted according to the JBI methodology for scoping reviews. It will consider quantitative, qualitative and mixed methods study designs for inclusion. In addition, systematic reviews, program descriptions, clinical reviews and opinion papers will be considered. The review will consider all studies published since 2000 in English or French. All duplicates will be removed from identified citations. A data extraction tool will assist reviewers to identify and synthesize findings from selected papers.

Access to health care for older people with intellectual disability: a modelling study to explore the cost-effectiveness of health checks

Background

Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England.

Methods

Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters.

Results

Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective.

Conclusion

Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6912-0) contains supplementary material, which is available to authorized users.

The convergent validity of a Dutch Screening tool for Dysphagia (Signaleringslijst Verslikken) for people with severe or profound intellectual and multiple disabilities

BACKGROUND

Dysphagia is potentially life-threatening and highly prevalent in people with severe/profound intellectual and multiple disabilities (SPIMD). The "Signaleringslijst Verslikken" (SV) is a frequently used Dutch screening tool to detect dysphagia. The aim was to examine the convergent validity of the SV for people with SPIMD.

METHOD

Direct support staff completed the SV, with speech and language therapists scoring a validated tool, the Dysphagia Disorders Survey (DDS), for 41 persons with SPIMD, aged ≥50 years. The results were compared for agreement using the McNemar's Test.

RESULTS

The proportion of agreement was 0.59 (95% CI 0.43-0.72). The SV did not detect dysphagia in 17 participants (44%) who were assessed as having dysphagia according to the DDS. The difference in proportion of detection of dysphagia between the two methods was significant (p < 0.0001).

CONCLUSIONS

The results suggest that the convergent validity of the SV is insufficient: the SV is not sensitive for detecting dysphagia in people with SPIMD.

Barriers and facilitators to improving health care for adults with intellectual and developmental disabilities: what do staff tell us?

INTRODUCTION

Adults with intellectual and developmental disabilities (IDD) have high rates of morbidity and are less likely to receive preventive care. Emergency departments and primary care clinics are important entry points into the health care system. Improving care in these settings can lead to increased prevention activities, early disease identification, and ongoing management. We studied barriers and facilitators to improving the care of patients with IDD in three primary and three emergency care sites in Ontario.

METHODS

Data sources included structured implementation logs at each site, focus groups (n = 5) and interviews (n = 8). Barriers and facilitators were coded deductively based on the Consolidated Framework for Implementation Research (CFIR). Synthesis to higher level themes was achieved through review and discussion by the research team. Focus was given to differences between higher and lower implementing sites.

RESULTS

All sites were challenged to prioritize care improvement for a small, complex population and varied levels of implementation were achieved. Having national guidelines, using local data to demonstrate need and sharing evidence on value were important engagement strategies. Factors present at higher implementing sites included strong champions, alignment with site mandate, and use of electronic prompts/reminders. Lower implementing sites showed more passive endorsement of the innovation and had lower capacity to implement.

CONCLUSION

Providing effective care for small, complex groups, such as adults with IDD, is critical to improving long-term health outcomes but is challenging to achieve. At a systemic level, funding incentives, access to expertise and improved electronic record systems may enhance capacity.

Age and sex differences in the association between access to medical care and health outcomes among older Chinese

BACKGROUND

Whether the association between access to medical care and health outcomes differs by age and gender among older adults in China is unclear. We aimed to investigate the associations between self-reported inadequate access to care and multiple health outcomes among older men and women in mainland China.

METHODS

Based on four latest waves available so far from a national longitudinal study in mainland China in 2005-2014, we used multilevel random-effect logistic models to estimate the contemporaneous relationships between inadequate access to care and disabilities in instrumental activities of daily living (IADL) and cognitive impairment in men and women at ages 65-74, 75-84, 85-94, and 95+, separately. We also used multilevel hazard models to investigate the relationships between reported access to care and mortality in 2005-2014. Nested models were used to adjust for survey design, sociodemographic background, enrollment in health insurance, and health behaviors.

RESULTS

Approximately 6.5% of older adults in China reported inadequate access to care in the period of 2005-2014; and the percentages increased with age and were higher among women at older ages (≥75 years). Overall, older adults with self-reported inadequate access to care had greater odds of IADL and ADL disabilities and cognitive impairment than those with adequate access to healthcare. The elevated odds ratios (ORs) in men were higher in middle-old (75-84) and old-old (85-94) age groups compared to other age groups; whereas the elevated ORs in women were higher in young-old (65-74) and middle-old (75-84) age groups. The relationship between access to care and the health outcomes was generally weakest at the oldest-old ages (95+). Inadequate access to care was also linked with higher mortality risk, primarily in adults aged 75-84, and it was somewhat more pronounced in women than in men.

CONCLUSIONS

Increased odds of physical disability and cognitive impairment and increased risk of mortality are linked with inadequate access to care. The associations were generally stronger in women than in men and varied across age groups. The findings of the present study have important implications for further improving access to health care and improving health outcomes of older adults in China.

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

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.

Health conditions, functional status and health care utilization in adults with cerebral palsy

AIM

Health conditions in children with cerebral palsy (CP) are well described, yet health is less defined with advancing age. We examined health conditions, functional status and health care utilization in adults with CP across age groups.

METHODS

We collected cross-sectional data on health conditions, functional status and utilization from the medical records of adults with CP across a large university-affiliated primary care network using the Rochester Health Status Survey IV (RHSS-IV), a 58-item validated survey. Data from the National Health and Nutrition Examination Survey and National Health Interview Survey provided prevalence estimates for the general population as comparison.

RESULTS

Compared to the general population, adults with CP had higher rates of seizure disorder, obesity and asthma across all ages. Adults with CP under 30 years of age had higher rates of hypertension (16.7 versus 5.6%; P = 0.04), urinary incontinence (41.7 versus 10.5%; P < 0.001) and depression (16.7 versus 6.9%; P = 0.07). Conversely, there were lower rates of alcohol misuse, tobacco/nicotine and sexually transmitted illnesses. Independence with all activities of daily living decreased from 37.5% at 18-29 years of age to 22.5% in those 60 and over. Seizure disorders, urinary incontinence and gastroesophageal reflux disease were all independently associated with lower functional status. As expected, health care utilization increased with advancing age.

CONCLUSIONS

Adults with CP should be monitored for conditions occurring at higher prevalence in CP, as well as common conditions occurring with advancing age. Age-related functional decline should be anticipated, especially with coexisting seizure disorders and urinary incontinence.

Are we making a difference in primary care for adults with intellectual and developmental disabilities?

OBJECTIVES

To examine the impact of the dissemination of guidelines to physicians and of a population-level health communication intervention on the percentage of adults with intellectual and developmental disabilities (IDD) receiving preventive care through primary care.

METHODS

Noninstitutionalized adults with IDD in the province of Ontario, Canada, aged 40 to 64 years were matched to Ontarians without such disabilities each fiscal year (FY) from 2003 to 2016. Health administrative data were used to create a composite measure of receipt of recommended preventive primary care. Age-adjusted rates were used to assess trends, and average two-year rate ratios (RRs) and confidence intervals (CIs) were used to evaluate the effectiveness of the interventions.

RESULTS

The number of adults with IDD identified ranged from 20 030 in FY 2003 to 28 080 in FY 2016. The percentage of adults with IDD receiving recommended preventive primary care ranged from 43.4% in 2003 to 55.7% in 2015. Men with IDD had a 53.7% increase across the 13 years, while women with IDD only had a 30.9% increase. When evaluating the impact of the interventions, men with IDD were 4% more likely (RR: 1.04; 95% CI: 1.02-1.05) to receive recommended primary care in FY 2015 and FY 2016 as compared to FY 2009 and FY 2010; in contrast, women with IDD were 5% less likely (RR: 0.95; 95% CI: 0.93-0.98). A comparable drop was observed among women without IDD.

CONCLUSIONS

Nearly 45% of adults with IDD in Ontario still do not receive recommended preventive care through primary care. Long-term impacts of the interventions introduced in the province may still occur over time, so ongoing monitoring is warranted. Special attention should be given to the preventive care needs of women with IDD.

Long-term condition management in adults with intellectual disability in primary care: a systematic review

Background

Adults with intellectual disabilities have higher morbidity and earlier mortality than the general population. Access to primary health care is lower, despite a higher prevalence of many long-term conditions.

Aim

To synthesise the evidence for the management of long-term conditions in adults with intellectual disabilities and identify barriers and facilitators to management in primary care.

Design & setting

Mixed-methods systematic review.

Method

Seven electronic databases were searched to identify both quantitative and qualitative studies concerning identification and management of long-term conditions in adults with intellectual disability in primary care. Both the screening of titles, abstracts, and full texts, and the quality assessment were carried out in duplicate. Findings were combined in a narrative synthesis.

Results

Fifty-two studies were identified. Adults with intellectual disabilities are less likely than the general population to receive screening and health promotion interventions. Annual health checks may improve screening, identification of health needs, and management of long-term conditions. Health checks have been implemented in various primary care contexts, but the long-term impact on outcomes has not been investigated. Qualitative findings highlighted barriers and facilitators to primary care access, communication, and disease management. Accounts of experiences of adults with intellectual disabilities reveal a dilemma between promoting self-care and ensuring access to services, while avoiding paternalistic care.

Conclusion

Adults with intellectual disabilities face numerous barriers to managing long-term conditions. Reasonable adjustments, based on the experience of adults with intellectual disability, in addition to intervention such as health checks, may improve access and management, but longer-term evaluation of their effectiveness is required.

Factors associated with ambulatory care sensitive emergency department visits for South Carolina Medicaid members with intellectual disability

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.

An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

Background

People with intellectual disability (ID) have poorer health than the general population; however, there is a lack of comprehensive national data describing their health-care needs and utilisation. Annual health checks for adults with ID have been incentivised through primary care since 2009, but only half of those eligible for such a health check receive one. It is unclear what impact health checks have had on important health outcomes, such as emergency hospitalisation.

Objectives

To evaluate whether or not annual health checks for adults with ID have reduced emergency hospitalisation, and to describe health, health care and mortality for adults with ID.

Design

A retrospective matched cohort study using primary care data linked to national hospital admissions and mortality data sets.

Setting

A total of 451 English general practices contributing data to Clinical Practice Research Datalink (CPRD).

Participants

A total of 21,859 adults with ID compared with 152,846 age-, gender- and practice-matched controls without ID registered during 2009–13.

Interventions

None.

Main outcome measures

Emergency hospital admissions. Other outcomes – preventable admissions for ambulatory care sensitive conditions, and mortality.

Data sources

CPRD, Hospital Episodes Statistics and Office for National Statistics.

Results

Compared with the general population, adults with ID had higher levels of recorded comorbidity and were more likely to consult in primary care. However, they were less likely to have long doctor consultations, and had lower continuity of care. They had higher mortality rates [hazard ratio (HR) 3.6, 95% confidence interval (CI) 3.3 to 3.9], with 37.0% of deaths classified as being amenable to health-care intervention (HR 5.9, 95% CI 5.1 to 6.8). They were more likely to have emergency hospital admissions [incidence rate ratio (IRR) 2.82, 95% CI 2.66 to 2.98], with 33.7% deemed preventable compared with 17.3% in controls (IRR 5.62, 95% CI 5.14 to 6.13). Health checks for adults with ID had no effect on overall emergency admissions compared with controls (IRR 0.96, 95% CI 0.87 to 1.07), although there was a relative reduction in emergency admissions for ambulatory care-sensitive conditions (IRR 0.82, 95% CI 0.69 to 0.99). Practices with high health check participation also showed a relative fall in preventable emergency admissions for their patients with ID, compared with practices with minimal participation (IRR 0.73, 95% CI 0.57 to 0.95). There were large variations in the health check-related content that was recorded on electronic records.

Limitations

Patients with milder ID not known to health services were not identified. We could not comment on the quality of health checks.

Conclusions

Compared with the general population, adults with ID have more chronic diseases and greater primary and secondary care utilisation. With more than one-third of deaths potentially amenable to health-care interventions, improvements in access to, and quality of, health care are required. In primary care, better continuity of care and longer appointment times are important examples that we identified. Although annual health checks can also improve access, not every eligible adult with ID receives one, and health check content varies by practice. Health checks had no impact on overall emergency admissions, but they appeared influential in reducing preventable emergency admissions.

Future work

No formal cost-effectiveness analysis of annual health checks was performed, but this could be attempted in relation to our estimates of a reduction in preventable emergency admissions.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Health profiles in people with intellectual developmental disorders

Objective. To better understand the health profiles of people with intellectual disability (ID), focusing on the variables that are associated with a poorer health status. Materials and methods. Data were collected from the Survey on Disability, Personal Autonomy and Dependency (EDAD 2008) of the Spanish National Statistics Institute (INE). The health data of 2 840 subjects with IDD were analyzed in order to verify the impact of different variables on their health profiles. Results. People with severe and profound levels of IDD presented a higher number of medical diagnoses.At residence centers there was a larger proportion of individuals with a higher prevalence of chronic diseases and more severe conditions; age also was an important factor. Conclusion. The health profiles of individuals with IDD differ depending on the severity level of their IDD and their degree of institutionalization. Further research is needed to provide better health care for people with IDD.

Health assessment instruments for people with intellectual disabilities-A systematic review

BACKGROUND

People with intellectual disabilities (ID) experience health disparities and are less likely to undergo recommended age- and gender-specific screening and health promotion. New diagnoses are frequently missed. Assessments with the aid of health assessment instruments are a way to address these problems.

AIM

The aim of this review is to find the available health assessment instruments for people with ID used in primary care and evaluate their quality.

METHODS

We conducted an electronic literature search of papers published between January 2000 and May 2016. After a two-phase selection process (kappa: 0.81 and 0.77) we collected data from the 29 included peer-reviewed articles on the following four domains; development, clinimetric properties (i.e. validity, reliability, feasibility, acceptability), content (i.e. ID-related health problems, prevention and health promotion topics) and effectiveness of the instruments.

RESULTS/CONCLUSIONS

We distinguished 20 different health assessment instruments. Limited information was found on the development of the instruments as well as on their clinimetric properties. The content of the instruments was rather diverse. The included papers agreed that health assessment instruments are effective. However, only three instruments evaluated effectiveness in a randomised controlled trial. Patients with ID, carers and general practitioners (GPs) generally appreciated the health assessment instruments.

IMPLICATION

Two instruments, "Stay well and healthy -Health risk appraisal (SWH-HRA)"and the "Comprehensive Health Assessment Programme (CHAP)", appeared to have the highest quality. These instruments can be used to construct a health assessment instrument for people with ID that meets scientific standards.

In search of quality indicators for Down syndrome healthcare: a scoping review

BACKGROUND

The medical care chain around Down syndrome (DS) is complex, with many multidisciplinary challenges. The current quality of care is unknown. Outcome-oriented quality indicators have the potential to improve medical practice and evaluate whether innovations are successful. This is particularly interesting for the evolving care for people with DS and intellectual disabilities (ID). The aim of this study was to identify existing indicators for medical DS care, by reviewing the literature.

METHODS

We systematically searched six databases (PubMed, EMBASE, Web of Science, CINAHL, PsycINFO, Google Scholar) for studies concerning the development and implementation of quality indicators for DS and/or ID care, published until February 1st 2015. The scoping review method was used, including systematic data extraction and stakeholder consultation.

RESULTS

We identified 13 studies concerning quality indicators for ID care that obtained data originating from questionnaires (patient/family/staff), medical files and/or national databases. We did not find any indicator sets specifically for DS care. Consulted stakeholders did not come up with additional indicator sets. Existing indicators for ID care predominantly focus on support services. Indicators in care for people with ID targeting medical care are scarce. Of the 70 indicators within the 13 indicator sets, 10% are structure indicators, 34% process, 32% outcome and 24% mixed. Ten of the 13 sets include indicators on the WHO quality dimensions 'patient-centeredness', 'effectiveness' and 'efficiency' of care. 'Accessibility' is covered by nine sets, 'equitability' by six, and 'safety' by four. Most studies developed indicators in a multidisciplinary manner in a joint effort with all relevant stakeholders; some used focus groups to include people with ID.

CONCLUSION

To our knowledge, this is the first review that searched for studies on quality indicators in DS care. Hence, the study contributes to existing knowledge on DS care as well as on measuring quality of care. Future research should address the development of a compact set of quality indicators for the DS care chain as a whole. Indicators should preferably be patient-centred and outcome-oriented, including user perspectives, while developed in a multidisciplinary way to achieve successful implementation.

Physical health issues in adults with severe or profound intellectual and motor disabilities: a systematic review of cross-sectional studies

BACKGROUND

People with severe or profound intellectual and motor disabilities (SPIMD) encounter several risk factors associated with higher mortality rates. They are also likely to experience a cluster of health problems related to the severe brain damage/dysfunction. In order to earlier detect physical health problems in people with SPIMD, first of all, knowledge regarding the prevalence of physical health problems is necessary. The aim of this systematic review was to methodically review cross-sectional studies on the prevalence of various types of physical health problems in adults with SPIMD.

METHOD

MedLine/PubMed, CINAHL, Embase, PsycINFO and Web of Science were searched for studies published between 2004 and 2015. The quality of the incorporated studies was assessed utilising an adjusted 'risk of bias tool' for cross-sectional studies. To estimate the prevalence of the health problems, the proportion and corresponding confidence interval were calculated. A random effect meta-analysis was performed when at least three studies on a specific health problem were available.

RESULTS

In total, 20 studies were included and analysed. In the meta-analysis, a homogeneous prevalence rate of 70% (CI 65-75%) was determined for epilepsy. Heterogeneous results were ascertained in the meta-analysis for pulmonary/respiratory problems, hearing problems, dysphagia, reflux disease and visual problems. For the health problems identified in two studies or in a single study, the degree of evidence was low. As expected, higher prevalence rates were found in the current review compared with people with ID for visual problems, epilepsy and spasticity.

CONCLUSION

This review provides an overview of the current state of the art research on the prevalence of health problems in adults with SPIMD. There is a substantial need for comprehensive epidemiological data in order to find clusters of health problems specific for people with SPIMD. This would provide insight into the excess morbidity associated with SPIMD.