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Nicholson E, Mimmo L, Christophers L, Costa Sa ME, MacKeogh T. Facilitating choice when engaging young people with disabilities: reflections from co-researcher training. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:90. [PMID: 39187898 PMCID: PMC11348645 DOI: 10.1186/s40900-024-00626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND A collaborative approach is critical in inclusive research and should incorporate taking time to build relationships with co-researchers based on trust and shared understanding. Involvement can often be seen as tokenistic and in order to avoid this, it is important to provide opportunities for people to exercise choice throughout the research process. MAIN BODY The current paper outlines learnings from a co-researcher training process for young people with disabilities to identify the ways in which meaningful choice can be facilitated with this group. While conducting training of co-researchers in topics such as research methods, we were continuously led by the group with regards to the directions that the sessions took and promoted problem solving with the group to accommodate the unique needs of all members. The overall aim of a wider project was to develop research capacity in a group of young people with disabilities through co-researcher training and this paper will report on learnings from this work with regards to how we sought to provide opportunities for the co-researchers to exercise choice within research projects. Feedback from the group of young people highlighted the variety of needs and expectations that must be accommodated in such a process and therefore, allowing them to dictate the extent and manner of their engagement is key. Young people with disabilities are a heterogeneous group and therefore, some methodologies and ways of working required adaptation in order to facilitate meaningful choice and engagement for all. CONCLUSION Providing meaningful opportunities for demonstrating their choices, in relation to elements of research projects, is a critical component of facilitating a rights-based approach when conducting co-research and requires researchers to cede some level of control over the research process to co-researchers. This can be difficult to achieve in practice and researchers must continuously reflect on their own practice and be willing to change and adapt throughout the process.
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Affiliation(s)
- Emma Nicholson
- School of Psychology, Faculty of Health and Science, Dublin City University, Glasnevin Campus, Dublin 9, Ireland.
| | - Laurel Mimmo
- Sydney Children's Hospital Network, High St, Randwick, NSW, 2031, Australia
| | - Lauren Christophers
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | | | - Trish MacKeogh
- Central Remedial Clinic, Vernon Ave, Clontarf East, Dublin, D03 R973, Ireland
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Mastebroek M, Everlo NCM, Cuypers M, Bischoff EWMA, Schalk BWM. Asthma and COPD management of patients with intellectual disabilities in general practice. NPJ Prim Care Respir Med 2024; 34:15. [PMID: 38926395 PMCID: PMC11208168 DOI: 10.1038/s41533-024-00375-w] [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: 07/03/2023] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
People with intellectual disabilities experience overall poorer health and healthcare access than the general population. It is largely unknown how this applies to asthma and chronic obstructive pulmonary disease (COPD) management by general practitioners (GPs). In a 10-year retrospective matched cohort study, n = 34,429, we examined year prevalence of asthma and COPD in adult patients with and without intellectual disabilities and potential differences in the delivery of asthma and COPD disease management activities in Dutch general practices (2010-2019). We collected information on patient characteristics, comorbidity, consultation patterns, use and outcomes of asthma/COPD control questionnaires, spirometry measurement, pulmonology referrals, and prescribed medication. Asthma patients with intellectual disabilities suffered more frequently from obesity (53.2% vs. 39.5% without intellectual disabilities), and both asthma and COPD patients with intellectual disabilities were more frequently current smokers (45.2% vs. 22.1% without intellectual disabilities, and 76.6% vs. 51.4% without intellectual disabilities, respectively). Also, a statistically significant larger number of asthma patients with intellectual disabilities were prescribed antibiotics (69.9% vs. 54.5%). COPD patients with intellectual disabilities, compared with matched controls without intellectual disabilities, received significantly more often either no COPD-related practice consultation at all (respectively 20.8% vs. 8.5%, p = 0.004) or a large number of practice consultations (>31 consultations, respectively 16.7% vs. 5.3%, p = 0.004). For asthma, there was no statistical difference between patients with or without intellectual disabilities regarding the number and type of consultations. The asthma year point prevalence in patients with intellectual disabilities was, from 2014 onward, significantly higher, and in 2019 was 8.7% vs. 6.0% for people without intellectual disabilities. For COPD, it was comparable in both groups. Both asthma and COPD patients with intellectual disabilities appeared considerably younger in age than patients without intellectual disabilities. Our findings warrant further research into the causes of the differences found for asthma and COPD and whether they also infer differences in the quality or the effectiveness of GP disease management, especially for young adults with intellectual disabilities.
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Affiliation(s)
- Mathilde Mastebroek
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Nadeem C M Everlo
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maarten Cuypers
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik W M A Bischoff
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bianca W M Schalk
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
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Downs J, Keeley J, Skoss R, Mills J, Nevill T, Schippers A, Lindly O, Thompson S. Perspectives on the essential skills of healthcare decision making in children and adolescents with intellectual disability. Int J Equity Health 2024; 23:119. [PMID: 38849806 PMCID: PMC11162048 DOI: 10.1186/s12939-024-02204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Involvement in healthcare decisions is associated with better health outcomes for patients. For children and adolescents with intellectual disability, parents and healthcare professionals need to balance listening to a child's wishes with the responsibility of keeping them safe. However, there is a scarcity of literature evaluating how to effectively involve them in decision making. In this context, we review the concept of health literacy, focusing on the skills of healthcare decision making for children and adolescents with intellectual disability. METHODS We describe the concept of health literacy and models explaining shared decision making (individuals and healthcare professionals collaborate in decision making process) and supported decision making (when a trusted person supports the individual to collaborate with the healthcare professional in the decision-making process), and a rapid review of the literature evaluating their efficacy. We discuss healthcare decision making for children and adolescents with intellectual disability in the context of relevant recommendations from the recent Disability Royal Commission into Violence, Abuse, Neglect, and Exploitation of People with Disability in Australia. RESULTS Health literacy skills enable individuals to access, understand, appraise, remember and use health information and services. Shared decision making has been described for children with chronic conditions and supported decision making for adults with intellectual disability. Decision-making contributes to how individuals appraise and use healthcare. The rapid review found very limited evidence of outcomes where children and adolescents with intellectual disability have been supported to contribute to their healthcare decisions. Recommendations from the Disability Royal Commission highlight current needs for greater efforts to support and build the capacity of individuals with disability to be involved in the decisions that affect their life, including healthcare decision making. CONCLUSIONS Existing rights frameworks and healthcare standards confirm the importance of providing all people with the opportunities to learn and practise health literacy skills including decision making. There is little literature examining interventions for healthcare decision making for children with intellectual disability. Childhood is a critical time for the development of skills and autonomy. Evidence for how children and adolescents with intellectual disability can learn and practice healthcare decision-making skills in preparation for adulthood is needed to reduce inequities in their autonomy.
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Affiliation(s)
- Jenny Downs
- Centre for Child Health Research, Telethon Kids Institute, University of Western Australia, Perth, Australia.
- Curtin School for Allied Health, Curtin University, Perth, Australia.
| | - Jessica Keeley
- Centre for Child Health Research, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Rachel Skoss
- Centre for Child Health Research, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Institute for Health Research, University of Notre Dame, Fremantle, Australia
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | | | - Thom Nevill
- Centre for Child Health Research, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Alice Schippers
- Disability Studies, Department of Care Ethics, University of Humanistic Studies, Utrecht, the Netherlands
| | - Olivia Lindly
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Sandra Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
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Chien AT, Spence SJ, Okumura MJ, Lu S, Chan CH, Houtrow AJ, Kuo DZ, Van Cleave JM, Shanske SA, Schuster MA, Kuhlthau KA, Toomey SL. Impairment Types and Combinations Among Adolescents and Young Adults with Disabilities: Colorado 2014-2018. Acad Pediatr 2024; 24:587-595. [PMID: 37925071 PMCID: PMC11056312 DOI: 10.1016/j.acap.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/25/2023] [Accepted: 10/29/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE Understanding the types of functional challenges faced by adolescents and young adults with disabilities (AYA-WD) can help payers, clinicians, community-based service providers, and policymakers recognize and meet needs. This paper describes state-level prevalence rates for 1) AYA-WD overall and for 2) impairment types singly and in combinations; and 3) examines how rates may differ between those insured by Medicaid versus commercial insurance. METHODS This descriptive study uses Colorado's All Payer Claims Dataset 2014-2018 to identify insured 10- to 26-year-olds (Medicaid only: 333,931; commercially only: 392,444). It then applies the previously validated Children with Disabilities Algorithm (CWDA) and its companion, the Diagnosis-to-Impairment-Type Algorithm (DITA), to compare state-level prevalence rates by insurance source for disability overall and for each of five impairment types singly and in combination. RESULTS Disability prevalence was greater among the Medicaid-insured AYA-WD by +7.6% points (pp)-Medicaid: 11.9% (47,654/333,931), commercial: 4.3% (16,907/392,444). Most AYA-WD had a single impairment, but the prevalence of AYA-WD with two or more impairments was greater among the Medicaid-insured than the commercially insured (+9.9 pp; Medicaid: 33.5% [15,963/47,654], commercial: 23.7% [3992/16, 907]), as was the prevalence of impairment types that were physical (+6.7 pp; Medicaid: 54.7% [26,054/47,654], commercial: 48.0% [8121/16,907]); developmental (+4.1 pp; Medicaid: 35.4% [16,874/47,654], commercial: 31.3% [5290/16,907]); psychiatric (+6.7 pp; Medicaid 21.3% [10,175/47,654], commercial: 14.6% [2470/16,907]), and intellectual (+9.3 pp; Medicaid: 26.2% [12,501/47,654], commercial: 16.9% [2858/16,907]). CONCLUSIONS CWDA and DITA can be used to understand the rates at which impairment types and combinations occur in a population with childhood-onset disabilities.
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Affiliation(s)
- Alyna T Chien
- Division of General Pediatrics (AT Chien and SL Toomey), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (AT Chien and SL Toomey), Harvard Medical School, Boston, Mass.
| | - Sarah J Spence
- Department of Neurology (SJ Spence), Boston Children's Hospital, Boston, Mass
| | - Megumi J Okumura
- Division of General Pediatrics (MJ Okumura), University of California San Francisco Benioff Children's Hospital
| | - Sifan Lu
- College of Medicine, State University of New York-Downstate (S Lu), Brooklyn, NY
| | - Christina H Chan
- Biostatistics and Research Design Center (CH Chan), Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | - Amy J Houtrow
- Department of Physical Medicine and Rehabilitation (AJ Houtrow), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Dennis Z Kuo
- Department of Pediatrics (DZ Kuo), University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jeanne M Van Cleave
- Department of Pediatrics (JM Van Cleave), Anschutz School of Medicine, University of Colorado, Aurora, CO
| | - Susan A Shanske
- Department of Social Work (SA Shanske), Boston Children's Hospital, Boston, Mass
| | - Mark A Schuster
- Kaiser Permanent Bernard J. Tyson School of Medicine (MA Schuster), Pasadena, Calif
| | - Karen A Kuhlthau
- Center for Child and Adolescent Health Research and Policy (KA Kuhlthau), Department of General Pediatrics, Massachusetts General Hospital for Children, Boston, Mass
| | - Sara L Toomey
- Division of General Pediatrics (AT Chien and SL Toomey), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (AT Chien and SL Toomey), Harvard Medical School, Boston, Mass
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Mahmoudi E, Lin P, Rubenstein D, Guetterman T, Leggett A, Possin KL, Kamdar N. Use of preventive service and potentially preventable hospitalization among American adults with disability: Longitudinal analysis of Traditional Medicare and commercial insurance. Prev Med Rep 2024; 40:102663. [PMID: 38464419 PMCID: PMC10920729 DOI: 10.1016/j.pmedr.2024.102663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024] Open
Abstract
Objective Examine the association between traditional Medicare (TM) vs. commercial insurance and the use of preventive care and potentially preventable hospitalization (PPH) among adults (18+) with disability [cerebral palsy/spina bifida (CP/SB); multiple sclerosis (MS); traumatic spinal cord injury (TSCI)] in the United States. Methods Using 2008-2016 Medicare and commercial claims data, we compared adults with the same disability enrolled in TM vs. commercial insurance [Medicare: n = 21,599 (CP/SB); n = 7,605 (MS); n = 4,802 (TSCI); commercial: n = 11,306 (CP/SB); n = 6,254 (MS); n = 5,265 (TSCI)]. We applied generalized estimating equations to address repeated measures, comparing cases with controls. All models were adjusted for age, sex, race/ethnicity, and comorbid conditions. Results Compared with commercial insurance, enrolling in TM reduced the odds of using preventive services. For example, adjusted odds ratios (OR) of annual wellness visits in TM vs. commercial insurance were 0.31 (95% confidence interval (CI): 0.28-0.34), 0.32 (95% CI: 0.28-0.37), and 0.19 (95% CI: 0.17-0.22) among adults with CP/SB, TSCI, and MS, respectively. Furthermore, PPH risks were higher in TM vs. commercial insurance. ORs of PPH in TM vs. commercial insurance were 1.50 (95% CI: 1.18-1.89), 1.83 (95% CI: 1.40-2.41), and 2.32 (95% CI: 1.66-3.22) among adults with CP/SB, TSCI, and MS, respectively. Moreover, dual-eligible adults had higher odds of PPH compared with non-dual-eligible adults [CP/SB: OR = 1.47 (95% CI: 1.25-1.72); TSCI: OR = 1.61 (95% CI: 1.35-1.92), and MS: OR = 1.80 (95% CI: 1.55-2.10)]. Conclusions TM, relative to commercial insurance, was associated with lower receipt of preventive care and higher PPH risk among adults with disability.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, Michigan Medicine, University of Michigan, USA
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Dana Rubenstein
- Clinical and Translational Science Institute, Duke University School of Medicine, 701 West Main Street, Durham, NC, USA
| | - Timothy Guetterman
- Department of Family Medicine, Michigan Medicine, University of Michigan, USA
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amanda Leggett
- Institute of Gerontology & Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Katherine L. Possin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Liao P, Trollor J, Reppermund S, Cvejic RC, Srasuebkul P, Vajdic CM. Factors associated with acute care service use after epilepsy hospitalisation in people with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1317-1335. [PMID: 36330725 PMCID: PMC10952954 DOI: 10.1111/jir.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/30/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This study aimed to identify factors associated with unplanned acute hospital readmission and emergency department (ED) presentation after hospitalisation for epilepsy in people with intellectual disability (ID). METHODS This study is a retrospective cohort study using linked administrative datasets. We identified 3293 people with ID aged 5-64 years with a hospitalisation for epilepsy between 2005 and 2014 in New South Wales, Australia. We examined unplanned readmission and ED presentation within 30 or 365 days and associations with demographic, socio-economic and health status variables. Modified Poisson regression with robust estimation was used to model outcomes within 30 days. Negative binomial regression was used to account for the overdispersion of the data and to model 365-day outcome rates. RESULTS Around half of the cohort had an unplanned readmission and ED presentation within 365 days of the index hospitalisation. In fully adjusted models, being female, being a young adult and having a longer or acute care index admission, mental and physical comorbidities and a history of incarceration were associated with an elevated risk of readmission or ED presentation. The strongest association was observed between history of self-harm and 365-day readmission (incidence rate ratio 2.15, 95% confidence interval 1.41-3.29). CONCLUSIONS Socio-demographic, justice and health factors are associated with unplanned readmission and ED presentation risk after hospitalisation for epilepsy in people with ID. Interventions targeting improving continuity of care should be tailored for individuals and their support workers. The findings also emphasise the importance of person-centred multidisciplinary care across different health sectors.
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Affiliation(s)
- P. Liao
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - J. Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - S. Reppermund
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - R. C. Cvejic
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - P. Srasuebkul
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - C. M. Vajdic
- Centre for Big Data Research in Health, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
- Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
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Zondlak AN, Oh EJ, Neiman PU, Fan Z, Taylor KK, Sangji NF, Hemmila MR, Scott JW. Association of Intellectual Disability with Delayed Presentation and Worse Outcomes in Emergency General Surgery. Ann Surg 2023; 278:e1118-e1122. [PMID: 36994738 DOI: 10.1097/sla.0000000000005863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To examine the association between intellectual disability and both severity of disease and clinical outcomes among patients presenting with common emergency general surgery (EGS) conditions. BACKGROUND Accurate and timely diagnosis of EGS conditions is crucial for optimal management and patient outcomes. Individuals with intellectual disabilities may be at increased risk of delayed presentation and worse outcomes for EGS; however, little is known about surgical outcomes in this population. METHODS Using the 2012-2017 Nationwide Inpatient Sample, we conducted a retrospective cohort analysis of adult patients admitted for 9 common EGS conditions. We performed multivariable logistic and linear regression to examine the association between intellectual disability and the following outcomes: EGS disease severity at presentation, any surgery, complications, mortality, length of stay, discharge disposition, and inpatient costs. Analyses were adjusted for patient demographics and facility traits. RESULTS Of 1,317,572 adult EGS admissions, 5,062 (0.38%) patients had a concurrent ICD-9/-10 code consistent with intellectual disability. EGS patients with intellectual disabilities had 31% higher odds of more severe disease at presentation compared with neurotypical patients (aOR 1.31; 95% CI 1.17-1.48). Intellectual disability was also associated with a higher rate of complications and mortality, longer lengths of stay, lower rate of discharge to home, and higher inpatient costs. CONCLUSION EGS patients with intellectual disabilities are at increased risk of more severe presentation and worse outcomes. The underlying causes of delayed presentation and worse outcomes must be better characterized to address the disparities in surgical care for this often under-recognized but highly vulnerable population.
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Affiliation(s)
- Allyse N Zondlak
- University of Michigan Medical School, Ann Arbor, MI
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Esther J Oh
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Pooja U Neiman
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Zhaohui Fan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Kathryn K Taylor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, Stanford University, Stanford, CA
| | - Naveen F Sangji
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Mark R Hemmila
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - John W Scott
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
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Nicholson E, McDonnell T, Conlon C, De Brún A, Doherty E, Collins C, Bury G, McAuliffe E. Factors that affect GP referral of a child with intellectual disability for a mild illness: A discrete choice experiment. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1241-1250. [PMID: 37489607 DOI: 10.1111/jar.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/26/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND General practitioners (GP) report multiple challenges when treating individuals with intellectual disabilities which may influence referral rates. The study aimed to establish factors that influence GP's decision-making when referring a child with intellectual disabilities to the emergency department. METHOD Discrete choice experiments (DCEs) are increasingly used in health research to further understand complex decision making. A DCE was designed to assess the relative importance of factors that may influence a GP's (N = 157) decision to refer. RESULTS A random parameters model indicated that perceived limited parental capacity to manage an illness was the most important factor in the decision to refer a child to the ED, followed by a repeat visit, a referral request from the parent, and a Friday afternoon appointment. CONCLUSION Understanding the factors that influence referral is important for service improvement and to strengthen primary care provision for this population and their families.
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Affiliation(s)
- Emma Nicholson
- School of Psychology, Dublin City University, Dublin, Ireland
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health Systems, University College Dublin, UCD College of Health and Agricultural Sciences, Dublin, Ireland
| | - Thérèse McDonnell
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health Systems, University College Dublin, UCD College of Health and Agricultural Sciences, Dublin, Ireland
| | - Ciara Conlon
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health Systems, University College Dublin, UCD College of Health and Agricultural Sciences, Dublin, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health Systems, University College Dublin, UCD College of Health and Agricultural Sciences, Dublin, Ireland
| | - Edel Doherty
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | | | - Gerard Bury
- UCD School of Medicine, UCD College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery and Health Systems, University College Dublin, UCD College of Health and Agricultural Sciences, Dublin, Ireland
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van den Bemd M, Cuypers M, Schalk BW, Leusink GL, Bischoff EW. Chronic disease management in patients with intellectual disabilities: a matched study in Dutch general practice. Br J Gen Pract 2023; 73:e744-e751. [PMID: 37666513 PMCID: PMC10498381 DOI: 10.3399/bjgp.2023.0029] [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: 01/13/2023] [Accepted: 05/12/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Disease management programmes (DMPs) aim to deliver standardised, high- quality care to patients with chronic diseases. Although chronic diseases are common among people with intellectual disabilities (ID), this approach may be suboptimal for meeting their care needs. AIM To examine differences between patients with and without ID who have a chronic illness in DMP enrolment and disease monitoring in Dutch general practice. DESIGN AND SETTING Observational study utilising the Nivel Primary Care Database (2015-2018) comparing patients with ID and cardiovascular disease, diabetes mellitus, or chronic obstructive pulmonary disease (COPD) with matched (1:5) controls with these conditions but without ID. METHOD Using conditional logistic regression, enrolment in DMP per chronic disease was examined and differences tested between groups in the frequencies of consultations, medication prescriptions, and routine examinations. RESULTS A total of 2653 patients with chronic illness with ID were matched with 13 265 controls without ID. Patients with both diabetes mellitus and ID were more likely than controls to be enrolled in DMP (odds ratio [OR] = 1.44, 95% confidence interval [CI] = 1.27 to 1.64). Independent of DMP enrolment, patients with chronic illness with ID were more likely than controls to have frequent consultations. Patients with both diabetes mellitus and ID and patients with both COPD and ID who were not enrolled in DMPs had more medication prescriptions than non-enrolled patients with diabetes or COPD but without ID (OR = 1.46, 95% CI = 1.10 to 1.95; OR = 1.28, 95% CI = 0.99 to 1.66, respectively). Most patients with ID and their controls enrolled in DMPs received routine examinations at similar frequencies. CONCLUSION Although DMPs do not specifically address the needs of patients with both chronic illness and ID, these patients do not seem underserved in the management of chronic diseases in terms of consultation, medication, and tests.
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Affiliation(s)
- Milou van den Bemd
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Maarten Cuypers
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Bianca Wm Schalk
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Geraline L Leusink
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Erik Wma Bischoff
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
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Geiger I, Schang L, Sundmacher L. Assessing needs-based supply of physicians: a criteria-led methodological review of international studies in high-resource settings. BMC Health Serv Res 2023; 23:564. [PMID: 37259109 PMCID: PMC10231959 DOI: 10.1186/s12913-023-09461-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Many health systems embrace the normative principle that the supply of health services ought to be based on the need for healthcare. However, a theoretically grounded framework to operationalize needs-based supply of healthcare remains elusive. The aim of this paper is to critically assess current methodologies that quantify needs-based supply of physicians and identify potential gaps in approaches for physician planning. To this end, we propose a set of criteria for consideration when estimating needs-based supply. METHODS We conducted searches in three electronic bibliographic databases until March 2020 supplemented by targeted manual searches on national and international websites to identify studies in high-resource settings that quantify needs-based supply of physicians. Studies that exclusively focused on forecasting methods of physician supply, on inpatient care or on healthcare professionals other than physicians were excluded. Additionally, records that were not available in English or German were excluded to avoid translation errors. The results were synthesized using a framework of study characteristics in addition to the proposed criteria for estimating needs-based physician supply. RESULTS 18 quantitative studies estimating population need for physicians were assessed against our criteria. No study met all criteria. Only six studies sought to examine the conceptual dependency between need, utilization and supply. Apart from extrapolations, simulation models were applied most frequently to estimate needs-based supply. 12 studies referred to the translation of need for services with respect to a physician's productivity, while the rest adapted existing population-provider-ratios. Prospective models for estimating future care needs were largely based on demographic predictions rather than estimated trends in morbidity and new forms of care delivery. CONCLUSIONS The methodological review shows distinct heterogeneity in the conceptual frameworks, validity of data basis and modeling approaches of current studies in high-resource settings on needs-based supply of physicians. To support future estimates of needs-based supply, this review provides a workable framework for policymakers in charge of health workforce capacity planning.
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Affiliation(s)
- Isabel Geiger
- Technical University of Munich, Munich, Germany.
- Ludwig-Maximilians-University (LMU) Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Laura Schang
- Pettenkofer School of Public Health, Munich, Germany
| | - Leonie Sundmacher
- Department of Health Economics, Technical University of Munich, Munich, Germany
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11
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Kim S, Jeon B. Who are the most vulnerable populations for primary care? Avoidable hospitalizations across individuals with different types of disabilities in South Korea. Public Health 2023; 217:138-145. [PMID: 36889052 DOI: 10.1016/j.puhe.2023.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/22/2022] [Accepted: 01/31/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Individuals with disabilities have limited access to primary care, the quality of care must be examined. OBJECTIVE To examine avoidable hospitalizations among individuals with disabilities and determine the most vulnerable populations across types of disabilities. METHODS Using the Korean National Health Insurance Claims Database, we compared hypertension- and diabetes-related avoidable hospitalizations (HRAH and DRAH, respectively) across disability status and disability type based on age-sex standardized rates from 2011 to 2020 and logistic regression. RESULTS The gap between those with and without disabilities in age-sex standardized HRAH and DRAH increased over 10 years. Odds ratios for HRAH were higher for those with disabilities, with individuals with mental disabilities having the highest odds ratio, followed by those with intellectual/developmental disabilities, then those with physical disabilities; for DRAH, the three highest odds ratios belonged to individuals with mental, intellectual/developmental, and visual disabilities. Among those with disabilities, HRAH was higher for those with mental, intellectual/developmental, and severe physical disabilities, whereas DRAH was higher for those with mental, severe visual, and intellectual/developmental disabilities compared to those with mild physical disabilities. CONCLUSION This study reveals high avoidable hospitalization rates among individuals with disabilities and calls for policies supporting quality primary care and comprehensively addressing disparities.
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Affiliation(s)
- S Kim
- Korea Institute for Health and Social Affairs, Republic of Korea.
| | - B Jeon
- Department of Health and Medical Information, Myongji College, Republic of Korea.
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12
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Pouls KPM, Cuypers M, Mastebroek M, Wieland J, Koks-Leensen MCJ, Leusink GL, Assendelft WJJ. Mental healthcare for adults with mild intellectual disabilities: population-based database study in Dutch mental health services. BJPsych Open 2023; 9:e48. [PMID: 36866924 PMCID: PMC10044331 DOI: 10.1192/bjo.2023.31] [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: 03/04/2023] Open
Abstract
BACKGROUND Adults with mild intellectual disability (MID) experience more mental health disorders than the general population. However, mental healthcare may be insufficiently tailored to match their needs. Detailed information is lacking regarding care provided to people with MID in mental health services. AIMS To compare mental health disorders and care provided to patients with and without MID in Dutch mental health services, including patients with missing MID status in the service files. METHOD In this population-based database study, we used a Statistics Netherlands mental health service database, containing health insurance claims of patients who utilised advanced mental health services in 2015-2017. Patients with MID were identified by linking this database with Statistic Netherlands' social services and long-term care databases. RESULTS We identified 7596 patients with MID, of whom 60.6% had no intellectual disability registration in the service files. Compared with patients without intellectual disability (n = 329 864), they had different profiles of mental health disorders. They received fewer diagnostic (odds ratio 0.71, 95% CI 0.67-0.75) and treatment activities (odds ratio 0.56, 95% CI 0.53-0.59), and required more interprofessional consultations outside of the service (odds ratio 2.06, 95% CI 1.97-2.16), crisis interventions (odds ratio 2.00, 95% CI 1.90-2.10) and mental health-related hospital admissions (odds ratio 1.72, 95% CI 1.63-1.82). CONCLUSIONS Patients with MID in mental health services have different profiles of mental health disorders and care than patients without intellectual disability. In particular, fewer diagnostics and treatments are provided, especially in those with MID with no intellectual disability registration, putting patients with MID at risk of undertreatment and poorer mental health outcomes.
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Affiliation(s)
- Katrien P M Pouls
- Department of Primary and Community Care, Radboud University Medical Center, The Netherlands
| | - Maarten Cuypers
- Department of Primary and Community Care, Radboud University Medical Center, The Netherlands
| | - Mathilde Mastebroek
- Department of Primary and Community Care, Radboud University Medical Center, The Netherlands
| | - Jannelien Wieland
- Curium LUMC, Leiden University Medical Center, The Netherlands; and Poli+, Leiden, The Netherlands
| | | | - Geraline L Leusink
- Department of Primary and Community Care, Radboud University Medical Center, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, The Netherlands
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13
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Golub-Victor AC, Peterson B, Calderón J, Lopes AD, Fitzpatrick DF. Student Confidence in Providing Healthcare to Adults With Intellectual Disability: Implications for Health Profession Curricula. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:477-483. [PMID: 36454614 DOI: 10.1352/1934-9556-60.5.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/16/2022] [Indexed: 06/17/2023]
Abstract
Self-perceived confidence of health professions students at one university in caring for adults with intellectual disability (ID) was examined via an electronic survey using the Therapy Confidence Scale - Intellectual Disabilities (TCS-ID). A stepwise multiple regression of data collected from 232 completed surveys revealed that prior training and prior experience were predictors of TCS-ID total score. Adults with ID experience healthcare disparities due, in part, to poor provider communication and a lack of confidence. Results from this novel study suggest that opportunities for experiential learning and training with people with ID are important considerations for health professions curricula. Further research is needed for generalizability of results.
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Affiliation(s)
- Ann C Golub-Victor
- Ann C. Golub-Victor, Brianna Peterson, Jessica Calderón, Alexandre Dias Lopes, and Diane F. Fitzpatrick, Northeastern University
| | - Brianna Peterson
- Ann C. Golub-Victor, Brianna Peterson, Jessica Calderón, Alexandre Dias Lopes, and Diane F. Fitzpatrick, Northeastern University
| | - Jessica Calderón
- Ann C. Golub-Victor, Brianna Peterson, Jessica Calderón, Alexandre Dias Lopes, and Diane F. Fitzpatrick, Northeastern University
| | - Alexandre Dias Lopes
- Ann C. Golub-Victor, Brianna Peterson, Jessica Calderón, Alexandre Dias Lopes, and Diane F. Fitzpatrick, Northeastern University
| | - Diane F Fitzpatrick
- Ann C. Golub-Victor, Brianna Peterson, Jessica Calderón, Alexandre Dias Lopes, and Diane F. Fitzpatrick, Northeastern University
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14
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van den Bemd M, Schalk BWM, Bischoff EWMA, Cuypers M, Leusink GL. Chronic diseases and comorbidities in adults with and without intellectual disabilities: comparative cross-sectional study in Dutch general practice. Fam Pract 2022; 39:1056-1062. [PMID: 35579254 PMCID: PMC9680667 DOI: 10.1093/fampra/cmac042] [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: 11/14/2022] Open
Abstract
BACKGROUND Chronic disease and comorbidity patterns in people with intellectual disabilities (ID) are more complex than in the general population. However, incomplete understanding of these differences limits care providers in addressing them. OBJECTIVE To compare chronic disease and comorbidity patterns in chronically ill patients with and without ID in Dutch general practice. METHODS In this population-based study, a multi-regional primary care database of 2018 was combined with national population data to improve identification of adults with ID. Prevalence was calculated using Poisson regression to estimate prevalence ratios and 95% confidence intervals for the highest-impact chronic diseases (ischemic heart disease (IHD), cerebrovascular disease (CVD), diabetes mellitus (DM), and chronic obstructive pulmonary disease (COPD)) and comorbidities. RESULTS Information from 18,114 people with ID and 1,093,995 people without ID was available. When considering age and sex, CVD (PR = 1.1), DM (PR = 1.6), and COPD (PR = 1.5) times more prevalent in people with than without ID. At younger age, people with ID more often had a chronic disease and multiple comorbidities. Males with ID most often had a chronic disease and multiple comorbidities. Comorbidities of circulatory nature were most common. CONCLUSIONS This study identified a younger onset of chronic illness and a higher prevalence of multiple comorbidities among people with ID in general practice than those without ID. This underlines the complexity of people with ID and chronic diseases in general practice. As this study confirmed the earlier onset of chronic diseases and comorbidities, it is recommended to acknowledge these age differences when following chronic disease guidelines.
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Affiliation(s)
- Milou van den Bemd
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bianca W M Schalk
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik W M A Bischoff
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maarten Cuypers
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geraline L Leusink
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Song M, Ware RS, Doan TN, Harley D. Characteristics associated with frequent health system use by Australian adults with intellectual disability: A cohort study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1403-1417. [DOI: 10.1111/jar.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/23/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Menghuan Song
- Queensland Centre for Intellectual and Developmental Disability (QCIDD) Mater Research Institute‐University of Queensland (MRI‐UQ) South Brisbane Queensland Australia
| | - Robert S. Ware
- Queensland Centre for Intellectual and Developmental Disability (QCIDD) Mater Research Institute‐University of Queensland (MRI‐UQ) South Brisbane Queensland Australia
- Menzies Health Institute Queensland Griffith University Nathan Queensland Australia
| | - Tan N. Doan
- Department of Medicine at The Royal Melbourne Hospital University of Melbourne Melbourne Victoria Australia
| | - David Harley
- Centre for Clinical Research University of Queensland South Brisbane Queensland Australia
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16
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Liao P, Vajdic CM, Reppermund S, Cvejic RC, Watkins TR, Srasuebkul P, Trollor J. Readmission and emergency department presentation after hospitalisation for epilepsy in people with intellectual disability: A data linkage study. PLoS One 2022; 17:e0272439. [PMID: 35913969 PMCID: PMC9342714 DOI: 10.1371/journal.pone.0272439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Despite the high prevalence of epilepsy and multiple barriers to care in people with intellectual disability, the risk of returning to hospital after an admission for epilepsy is largely unknown. In this study, we sought to quantify and compare readmission and emergency department (ED) presentations after hospitalisation for epilepsy in people with and without intellectual disability.
Methods and findings
Using linked administrative datasets, we conducted a retrospective cohort study of people aged 5–64 years with an acute hospitalisation for epilepsy from 2005–2014 in New South Wales, Australia. Acute readmission and ED presentation rates within 30, 90, and 365 days of the index hospitalisation were estimated and compared between people with and without intellectual disability using modified Poisson regression. Of 13537 individuals with an index hospitalisation, 712 children and 1862 adults had intellectual disability. Readmission and ED presentation after the index hospitalisation were common in people with intellectual disability. Within 30 days, 11% of children and 15.6% of adults had an all-cause readmission and 18% of children and 23.5% of adults had an ED presentation. Over 60% of both children and adults presented to an ED within a year. Neurological, respiratory, and infectious conditions were overrepresented reasons for readmission in people with intellectual disability. Age-adjusted relative risks (RRs) within each period showed a higher risk of readmission and ED presentation in children and adults with intellectual disability than without. Most RRs remained statistically significant after controlling for covariates. The largest adjusted RRs were observed for readmission for epilepsy (RR 1.70, 95% CI: 1.42 to 2.04) and non-epilepsy related conditions (RR 1.73, 95%: CI 1.43 to 2.10) in children. Study limitations include lack of clinical data.
Conclusions
Increased risk of returning to acute care after epilepsy hospitalisation suggests there is a need to improve epilepsy care for people with intellectual disability. We recommend research into strategies to improve management of both seizures and comorbidity.
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Affiliation(s)
- Peiwen Liao
- Faculty of Medicine and Health, Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Claire M. Vajdic
- Faculty of Medicine and Health, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
- * E-mail:
| | - Simone Reppermund
- Faculty of Medicine and Health, Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Rachael C. Cvejic
- Faculty of Medicine and Health, Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Tim R. Watkins
- Faculty of Medicine and Health, Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Preeyaporn Srasuebkul
- Faculty of Medicine and Health, Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Julian Trollor
- Faculty of Medicine and Health, Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
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17
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Jelleli H, Guelmami N, Ben Mohamed K, Hindawi O, Bouassida A. Reliability and Validity of the Arabic Version of Attitudes Towards Intellectual Disability Questionnaire-Short Form (A-ATTID-S). Psychol Res Behav Manag 2022; 15:1283-1293. [PMID: 35619948 PMCID: PMC9129264 DOI: 10.2147/prbm.s358181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hilmi Jelleli
- Higher Institute of Sport and Physical Education of Kef, University of Jendouba, Jendouba, Tunisia
- Correspondence: Hilmi Jelleli, Higher Institute of Sport and Physical Education of Kef, University of Jendouba, Jendouba, Tunisia, Tel +201695937471, Email
| | - Noomen Guelmami
- Higher Institute of Sport and Physical Education of Kef, University of Jendouba, Jendouba, Tunisia
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Khouloud Ben Mohamed
- National Institute of Health and Medical Research, Marseille, France
- Carthage University, Tunis, Tunisia
| | - Omar Hindawi
- College of Physical Education and Sport Science, Hashemite University, Zarqa, Jordan
| | - Anissa Bouassida
- Higher Institute of Sport and Physical Education of Kef, University of Jendouba, Jendouba, Tunisia
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Nicholson E, Conlon C, Mimmo L, Doherty E, Guerin S. Unscheduled healthcare for children with intellectual disabilities: A systematic scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:736-751. [PMID: 35322908 PMCID: PMC9314007 DOI: 10.1111/jar.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022]
Abstract
Background The provision of unscheduled healthcare for children with intellectual disability is less researched than that focused on hospital settings or for adult services. The aim of the scoping review was to map the evidence base in this area and identify areas for future study. Method A five‐stage scoping review framework was adopted. CINAHL, PubMed, SCOPUS, PsycINFO, Embase, ProQuest Dissertation & Theses and Google Scholar were searched. Studies published in English after 1/1/2000 were considered eligible for inclusion. Results A total of 3158 titles and abstracts were screened, 137 full‐text articles were reviewed, and 25 papers met the inclusion criteria. Descriptive themes focused on inequities, needs and experiences of families', poor GP training, and limitations of existing evidence. Conclusion Describing trends in healthcare utilisation by this population is valuable for monitoring quality of healthcare, however, addressing observed inequities will require approaches that recognise specific issues within the health system that result in inequities.
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Affiliation(s)
- Emma Nicholson
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.,School of Psychology, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Ciara Conlon
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Laurel Mimmo
- School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Edel Doherty
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | - Suzanne Guerin
- UCD Centre for Disability Studies, UCD School of Psychology, University College Dublin, Dublin, Ireland
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19
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Don A, O'Byrne P. Exploring how the diagnostic process stratifies children with intellectual disability navigating the service system in Ontario, Canada. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:50-69. [PMID: 32909868 DOI: 10.1177/1744629520954765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Children with intellectual disability experience a higher prevalence of dental disease, obesity, challenging behaviours, and mental health disorders compared to children without intellectual disability. Children with intellectual disability concurrently face health and social service navigational barriers that are associated with unresolved health needs and hospital admissions, and parent burnout and employment interruptions. In this study, we explored the knowledge gap of how carers and governmental agencies, providing services, understand intellectual disability using discourse analysis, and a theoretical framework applying Deleuze and Guattari's concepts of the rhizome and stratification. We found that children with intellectual disability were stratified into eligible or ineligible service recipients through the diagnostic process that prioritized specified characteristics. Carers did not perceive that their children's unique characteristics and needs were accounted for within the diagnostic process and expressed feelings of being dismissed by clinicians and providers in decision-making about priority needs and services.
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Affiliation(s)
- Anna Don
- 6363University of Ottawa, Canada
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20
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Pouls KP, Koks-Leensen MC, Mastebroek M, Leusink GL, Assendelft WJ. Adults with intellectual disabilities and mental health disorders in primary care: a scoping review. Br J Gen Pract 2022; 72:e168-e178. [PMID: 34903519 PMCID: PMC8884443 DOI: 10.3399/bjgp.2021.0164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND GPs are increasingly confronted with patients with both intellectual disabilities (ID) and mental health disorders (MHD). Currently, the care provided to these patients is found to be insufficient, putting them at risk of developing more severe MHD. Improving the quality of GP care will improve the whole of mental health care for this patient group. Therefore, an overview of the content and quality of care provided to them by the GP may be helpful. AIM To provide an up-to-date literature overview of the care provided by GPs to patients with ID and MHD, identify knowledge gaps, and inform research, practice, and policy about opportunities to improve care. DESIGN AND SETTING Scoping review. METHOD PubMed, PsycINFO, EMBASE, and grey literature were searched for publications concerning primary care and patients with ID and MHD. Selected publications were analysed qualitatively. RESULTS One hundred publications met the inclusion criteria. Five overarching themes were identified: GP roles, knowledge and experience, caregiver roles, collaboration, and a standardised approach. The results show GPs' vital, diverse, and demanding roles in caring for patients with both ID and MHD. GPs experience problems in fulfilling their roles, and gaps are identified regarding effective GP training programmes, applicable guidelines and tools, optimal collaborative mental health care, and corresponding payment models. CONCLUSION The improvement required in the current quality of GP care to patients with ID and MHD can be achieved by bridging the identified gaps and initiating close collaborations between care professionals, policymakers, and organisational managers.
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Affiliation(s)
- Katrien Pm Pouls
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Monique Cj Koks-Leensen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mathilde Mastebroek
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Geraline L Leusink
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem Jj Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
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21
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Epilepsy related multimorbidity, polypharmacy and risks in adults with intellectual disabilities: a national study. J Neurol 2022; 269:2750-2760. [DOI: 10.1007/s00415-021-10938-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
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22
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Snoeijen-Schouwenaars FM, Young C, Rowe C, van Ool JS, Schelhaas HJ, Shankar R. People with epilepsy and intellectual disability: More than a sum of two conditions. Epilepsy Behav 2021; 124:108355. [PMID: 34624802 DOI: 10.1016/j.yebeh.2021.108355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Around 25% of people with Intellectual Disability (PwID) have comorbid epilepsy with seizures in up to two-thirds being drug-resistant. Little is known of the general characteristics and prescribing practices to this population. AIM Describe and compare characteristics of two cohorts of PwID and epilepsy in two different countries to inform clinical practice better. METHOD An explorative, retrospective, case-note review in a specialist ID community service in England and in an expert center for PwID and epilepsy in the Netherlands was conducted. Information on ID severity, medical/behavioral/psychiatric/neurodevelopmental/genetic comorbidities, psychotropic, and antiepileptic drugs (AEDs) for each cohort was collected. FINDINGS The English cohort consisted of 167 people (98 males; age range 18-73 years; mild/moderate ID- 35%) and the Dutch cohort of 189 people (111 males; age range 18-85 years; mild/moderate ID - 51%). The two cohorts were comparable in their baseline characteristics. The Dutch had higher rates of physical comorbidity, but less mental or behavioral disorders and were more likely to be on anti-psychotic medication. The mean dosages between three most common AEDs prescribed were similar. The most frequently prescribed drug in both centers is valproate. Three-quarters of the Dutch were on three or more AEDs compared to a third in the English cohort. CONCLUSIONS Structured description of the characteristics, differences, and commonalities of PwID, treatment, and services of both countries is presented. This is the first real-world study to reveal unique characteristics of managing epilepsy for a complex ID population. In particular, it highlights the considerable comorbid psychiatric burden and psychotropic prescribing.
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Affiliation(s)
- Francesca M Snoeijen-Schouwenaars
- Academic Centre for Epileptology Kempenhaeghe, Department of Residential Care, etherlands; Academic Centre for Epileptology Kempenhaeghe, Department of Neurology, Netherlands
| | - Charlotte Young
- Cornwall Partnership NHS Foundation Trust, Bodmin, United Kingdom
| | - Charles Rowe
- Cornwall Partnership NHS Foundation Trust, Bodmin, United Kingdom
| | - Jans S van Ool
- Academic Centre for Epileptology Kempenhaeghe, Department of Residential Care, etherlands; Academic Centre for Epileptology Kempenhaeghe, Department of Neurology, Netherlands
| | - Helenius J Schelhaas
- Academic Centre for Epileptology Kempenhaeghe, Department of Residential Care, etherlands; Academic Centre for Epileptology Kempenhaeghe, Department of Neurology, Netherlands
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Bodmin, United Kingdom; Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Peninsula Medical School, Truro, United Kingdom.
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23
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Weise JC, Srasuebkul P, Trollor JN. Potentially preventable hospitalisations of people with intellectual disability in New South Wales. Med J Aust 2021; 215:31-36. [PMID: 34028026 DOI: 10.5694/mja2.51088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/23/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine rates of potentially preventable hospitalisation of people with intellectual disability in New South Wales, and compare them with those for the NSW population. DESIGN Retrospective cohort study. SETTING Potentially preventable hospitalisations in NSW, as defined by the National Healthcare Agreement progress indicator 18, 1 July 2001 - 30 June 2015. PARTICIPANTS Data collected in a retrospective data linkage study of 92 542 people with intellectual disability in NSW; potentially preventable hospitalisations data for NSW published by HealthStats NSW. MAIN OUTCOME MEASURES Age-adjusted rates of potentially preventable hospitalisation by group (people with intellectual disability, NSW population), medical condition type (acute, chronic, vaccine-preventable), and medical condition. RESULTS The annual age-standardised rate for people with intellectual disability ranged between 5286 and 6301 per 100 000 persons, and for the NSW population between 1278 and 1511 per 100 000 persons; the rate ratio (RR) ranged between 3.5 (95% CI, 3.3-3.7) in 2014-15 and 4.5 (95% CI, 4.2-4.9) in 2002-03. The difference was greatest for admissions with acute (RR range: 5.3 [95% CI, 4.9-5.7] in 2014-15 to 8.1 [95% CI, 7.4-8.8] in 2002-03) and vaccine-preventable conditions (RR range: 2.1 [95% CI, 1.6-3.0] in 2007-08 to 3.4 [95% CI, 2.2-5.2] in 2004-05). By specific condition, the highest age-standardised rate was for admissions with convulsions and epilepsy (all years, 2567 per 100 000 population; v NSW population: RR, 22.2; 95% CI, 21.3-23.1). CONCLUSION Age-standardised rates of potentially preventable hospitalisation are higher for people with intellectual disability than for the general population. The reasons for these differences should be investigated, and strategies for averting potentially preventable hospitalisation developed.
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Bobbette N, Ouellette-Kuntz H, Tranmer J, Lysaght R, Ufholz LA, Donnelly C. Adults with intellectual and developmental disabilities and interprofessional, team-based primary health care: a scoping review. JBI Evid Synth 2021; 18:1470-1514. [PMID: 32813389 DOI: 10.11124/jbisrir-d-19-00200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
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.
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Affiliation(s)
- Nicole Bobbette
- 1School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada 2Department of Public Health Sciences & Psychiatry (Division of Developmental Disabilities), Faculty of Health Sciences, Queen's University, Kingston, Canada 3School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Canada 4Health Learning, Research & Practice, Wolters Kluwer Health, Toronto, Canada
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Phillips KG, Wishengrad JS, Houtenville AJ. Ambulatory Care Sensitive Conditions Among All-Payer Claimants With Intellectual and Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:203-215. [PMID: 33910241 DOI: 10.1352/1944-7558-126.3.203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/18/2020] [Indexed: 06/12/2023]
Abstract
Inpatient hospitalizations for ambulatory care sensitive conditions (ACSC) among beneficiaries with and without intellectual and developmental disabilities (IDD) were examined using Medicaid and commercial claims from 2010-2014 in New Hampshire. IDD was defined with International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes using algorithms from the Centers for Medicare and Medicaid Services, and inpatient encounters were identified using the Healthcare Effectiveness Data and Information Set. In adjusted analyses, beneficiaries with IDD had more hospitalizations for ACSC than those without IDD in both insurance groups. Differences in patterns of ACSC prevalence, comorbidities, and hospital admissions between the commercially and Medicaid-insured groups show the value of using all-payer claims data, when possible, to understand health needs and health care utilization of insurance beneficiaries with IDD.
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Affiliation(s)
- Kimberly G Phillips
- Kimberly G. Phillips, Jeanne S. Wishengrad, and Andrew J. Houtenville, University of New Hampshire
| | - Jeanne S Wishengrad
- Kimberly G. Phillips, Jeanne S. Wishengrad, and Andrew J. Houtenville, University of New Hampshire
| | - Andrew J Houtenville
- Kimberly G. Phillips, Jeanne S. Wishengrad, and Andrew J. Houtenville, University of New Hampshire
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Cuypers M, Leijssen M, Bakker-van Gijssel EJ, Pouls KPM, Mastebroek MM, Naaldenberg J, Leusink GL. Patterns in the prevalence of diabetes and incidence of diabetic complications in people with and without an intellectual disability in Dutch primary care: Insights from a population-based data-linkage study. Prim Care Diabetes 2021; 15:372-377. [PMID: 33323353 DOI: 10.1016/j.pcd.2020.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 11/06/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
AIMS To conduct an epidemiological analysis of patterns observed in diabetes care provided to individuals with and without intellectual disabilities (ID) in primary care settings. METHODS An ID-cohort (N = 21,203) was compared with a control group of similar age and sex from the general Dutch population (N = 267,628). Distinctive data for diabetes (both type 1 and type 2) and related complications were retrieved from national databases. RESULTS The prevalence of diabetes was higher in people with ID than in the general population (9.9% versus 6.6%). Largest differences were seen in younger age groups. Women with ID had diabetes more often than men with ID. Complications were less common in people with ID than in the general population (IR 58.6 vs. 70.4). In particular, cardiological complications were noted less, while surgical interventions and hospitalization occurred more often. CONCLUSIONS Although diabetes was 1.5 times more prevalent in people with ID than in other people, related complications were less common, followed different patterns and were more severe than in the general population. Future research is needed to understand of the underlying causal mechanisms and to lower the risk of severe diabetic complications among people with ID.
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Affiliation(s)
- Maarten Cuypers
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Martijn Leijssen
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther J Bakker-van Gijssel
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katrien P M Pouls
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathilde M Mastebroek
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jenneken Naaldenberg
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geraline L Leusink
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Lauer E, Lindgren S, Momany E, Cope T, Royer J, Cogan L, McDermott S, Armour B. Health Service Utilization Patterns Among Medicaid-Insured Adults With Intellectual and Developmental Disabilities: Implications for Access Needs in Outpatient Community-Based Medical Services. J Ambul Care Manage 2021; 44:138-147. [PMID: 33492884 PMCID: PMC8675230 DOI: 10.1097/jac.0000000000000373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Limited existing evidence suggests that adults with intellectual and developmental disabilities (IDD) experience substantial disparities in numerous areas of health care, including quality ambulatory care. A multistate cohort of adults with IDD was analyzed for patterns of inpatient admissions and emergency department utilization. Utilization was higher (inpatient [RR = 3.2], emergency department visits [RR = 2.6]) for adults with IDD, particularly for ambulatory care-sensitive conditions (eg, urinary tract [RR = 6.6] and respiratory infections [RRs = 5.5-24.7]), and psychiatric conditions (RRs = 5.8-15). Findings underscore the importance of access to ambulatory care skilled in IDD-related needs to recognize and treat ambulatory care-sensitive conditions and to manage chronic medical and mental health conditions.
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Affiliation(s)
- Emily Lauer
- Center for Developmental Disabilities Evaluation and Research (CDDER), Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester (Ms Lauer); Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City (Dr Lindgren); University of Iowa Public Policy Center, Iowa City (Dr Momany); New York State Department of Health, Office of Quality and Patient Safety, Division of Information and Statistics, Albany (Ms Cope); South Carolina Revenue and Fiscal Affairs Office, Health and Demographics Section, Columbia (Ms Royer); New York State Department of Health, Office of Quality and Patient Safety, Division of Quality Measurement, Albany (Dr Cogan); Arnold School of Public Health, University of South Carolina, Columbia (Dr McDermott); and Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Armour)
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McLennan JD, Bahadur A, Cobigo V, Hrycko S, Fulford C. Cross-sector service use patterns among children with developmental disabilities in a district in Canada. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:546-555. [PMID: 33070429 DOI: 10.1111/jar.12821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a lack of information about cross-sector service use by children with developmental disabilities despite their need for services from multiple sectors. METHODS Responses to service use questions from a parent-completed survey on school-aged children who attended clinics specific for those with developmental disabilities at a Canadian children's hospital were examined. RESULTS School meetings were the most common of three professional meeting types attended in the last 12 months (64.9%) for the sample of 205 children. Recreational services were the most common of five service types received in the same time period (79.0%). Using ordinal logistic regression models, a higher number of behavioural difficulties was the only variable consistently related to indices of more meeting types (school, physician, other) attended and more service types received (recreation, respite, etc.). CONCLUSIONS The service relationship with behavioural problems, and not socio-demographic variables, is consistent with a needs-based oriented delivery system.
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Affiliation(s)
- John D McLennan
- Children's Hospital of Eastern Ontario-Research Institute, Ottawa, ON, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Virginie Cobigo
- Children's Hospital of Eastern Ontario-Research Institute, Ottawa, ON, Canada.,School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sophia Hrycko
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Casey Fulford
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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McMahon M, Hatton C. A comparison of the prevalence of health problems among adults with and without intellectual disability: A total administrative population study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:316-325. [DOI: 10.1111/jar.12785] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 05/23/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Martin McMahon
- Division of Health Research Lancaster University Lancaster UK
- Health and Community Services Government of Jersey Saint Helier Jersey
| | - Chris Hatton
- Division of Health Research Lancaster University Lancaster UK
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Nicholson E, Doherty E, Somanadhan S, Guerin S, Schreiber J, Bury G, Kroll T, Raley M, McAuliffe E. Health inequities in unscheduled healthcare for children with intellectual disabilities in Ireland: a study protocol. HRB Open Res 2020; 3:3. [PMID: 32832849 PMCID: PMC7431971 DOI: 10.12688/hrbopenres.12973.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Health inequities for children with intellectual disabilities are prevalent within different health systems, and children with intellectual disabilites have shorter life expectancies than the general population, higher mortality rates before the age of 17 and have a greater risk of potentially preventable hospitalisations. A health systems approach to research in this area provides a useful means through which research can inform policy and practice to ensure people with intellectual disabilities receive equitable healthcare; however, there is a paucity of evidence regarding how to address differences that have been described in the literature to date. The overall aim of this research is to establish the extent of health inequities for children with intellectual disabilities in Ireland compared to children without intellectual disabilities with respect to their utilisation of primary care and rates of hospitalisation, and to gain a better understanding of what influences utilisation of primary care and emergency department services in this population. Methods and analysis: The design of this research adopts a multi-methods approach: statistical analysis of health data to determine the extent of health inequities in relation to healthcare utilisation; discrete choice experiments to explore General Practitioners' decision making and parental preferences for optimal care; and concept mapping to develop consensus between stakeholders on how to address current healthcare inequities. Discussion: By applying a systems lens to the issue of health inequities for children with intellectual disabilities, the research hopes to gain a thorough understanding of the varying components that can contribute to the maintenance of such healthcare inequities. A key output from the research will be a set of feasible solutions and interventions that can address health inequities for this population.
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Affiliation(s)
- Emma Nicholson
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), University College Dublin, Belfield, Dublin 4, Ireland
| | - Edel Doherty
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, University Road, Galway, Ireland
| | - Suja Somanadhan
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Suzanne Guerin
- UCD Centre for Disability Studies, University College Dublin, Belfield, Dublin 4, Ireland
| | | | - Gerard Bury
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Thilo Kroll
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), University College Dublin, Belfield, Dublin 4, Ireland
| | - Meredith Raley
- Disability Federation of Ireland, Fumbally Court, Dublin 8, Ireland
| | - Eilish McAuliffe
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), University College Dublin, Belfield, Dublin 4, Ireland
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Morse BL, Solodiuk JC, Greco CD, Mauskar S, Hauer J. Initial Validation of GRASP: A Differential Diagnoses Algorithm for Children With Medical Complexity and an Unknown Source of Pain. Hosp Pediatr 2020; 10:633-640. [PMID: 32660957 DOI: 10.1542/hpeds.2019-0322] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Identifying the source of pain for children with medical complexity (MC) is challenging. The purpose of this study was the initial validation of a tool to guide the medical evaluation for identifying the source of pain in children with MC by using differential diagnoses. The tool is entitled Guidelines for Ruling Out and Assessing Source of Pain (GRASP). METHODS A mixed-methods approach that included expert review, focus groups, Web-based surveys, and a trial of the GRASP was used to determine validity as well as perceived clinical utility. RESULTS Focus groups were held with 26 inpatient and outpatient clinicians. Participants consistently responded in support of the GRASP. Participants advised several suggestions for tool organization such as designing the tool as a flow diagram. Seven clinicians participated in Web-based surveys and made specific suggestions for making the GRASP more comprehensive. Six participants trialed the GRASP for 14 children with MC and pain of unknown origin. Overall, participants found that the GRASP was a clinically effective tool for guiding medical evaluation. CONCLUSIONS These results provide preliminary evidence that the GRASP has content and face validity in evaluating the source of pain in children with MC. This tool can be used to systematically guide clinicians through a balanced approach to evaluation with a goal of determining the pain source, preventing harm, and relieving suffering without unnecessary tests.
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Affiliation(s)
- Brenna L Morse
- Solomont School of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts;
| | | | | | | | - Julie Hauer
- Boston Children's Hospital, Boston, Massachusetts; and.,Seven Hills Pediatric Center, Groton, Massachusetts
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Iacono T, Bigby C, Douglas J, Spong J. A prospective study of hospital episodes of adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:357-367. [PMID: 32173949 PMCID: PMC7216832 DOI: 10.1111/jir.12725] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Previous research has shown poor hospital experiences and dire outcomes for people with intellectual disability. The main objective of this study was to prospectively track episodes for adults with intellectual disability (ID) in Australian hospitals, with a focus on indications of the quality of care provided. METHODS A prospective audit of hospital records over 35 months yielded quantitative data about patient characteristics, frequency and length of hospital episodes, diagnostic assessments and outcomes, post-emergency department (ED) destinations and post-discharge recommendations. Fifty participants were recruited largely by identification on hospital ED entry. An audit of patients' hospital records was conducted towards the end of hospital episodes, using a tool developed for the study. RESULTS Participants were mostly men (70%), aged 42.9 years on average, living mostly with family (46%) or in supported accommodation (44%). Of 157 recorded episodes, 96% started in ED, 85% required urgent or semi-urgent care and 62% were in the first 3 months of study participation. Average time in ED exceeded the 4-h national benchmark, met in 40% of episodes. One or more diagnostic assessments were conducted in 91% episodes and others in short stay units. Almost half (49%) resulted in a ward stay. With an extreme data point removed, <1-35 days were spent in wards. The most frequent diagnosis in 75% of episodes was for digestive problems, followed by nervous system problems then injuries. Median length of bed stays reflected data available for Australian refined diagnosis-related groups. High hospital re-presentations were found: for 67% of episodes in total, 26% (n = 12) of which were within 72 h and 59% (n = 23) within 30 days. CONCLUSIONS Adults with ID presented frequently to ED and often had lengthy stays. We found no indication of poor care practices in terms of hospital staff willingness to keep patients in ED and conduct of diagnostic assessments. Frequent re-presentations, however, indicated failed hospital care at some level.
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Affiliation(s)
- T. Iacono
- Living with Disability Research CentreLa Trobe UniversityBendigoVic.Australia
| | - C. Bigby
- Living with Disability Research CentreLa Trobe UniversityMelbourneVic.Australia
| | - J. Douglas
- Living with Disability Research CentreLa Trobe UniversityMelbourneVic.Australia
| | - J. Spong
- Living with Disability Research CentreLa Trobe UniversityBendigoVic.Australia
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Glover G, Williams R, Oyinlola J. An observational cohort study of numbers and causes of preventable general hospital admissions in people with and without intellectual disabilities in England. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:331-344. [PMID: 32141168 DOI: 10.1111/jir.12722] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Hospital admissions for preventable reasons [ambulatory care sensitive (ACS) conditions] can indicate gaps in access to or quality of primary care. This paper seeks to document the numbers and causes of these admissions in England for people with intellectual disabilities (ID) compared with those without. METHODS Observational cohort study of number and duration of emergency admitted patient episodes for ACS conditions, overall and by cause, using the Clinical Practice Research Datalink GOLD primary care database and the linked Hospital Episode Statistics Admitted Patient Care dataset. RESULTS The study covered 5.2% of the population of England from April 2010 to March 2014 giving a total population base of 59 280 person-years for people with ID and 11 103 910 for people without identified ID. The rate of emergency admissions for ACS conditions for people with ID was 77.5 per 1000 person-years. As a crude comparison, this was 3.0 times the rate for those without ID, but standardising for the distinct demography of this group, the number of episodes was 4.8 times that expected if they had the same age-specific and sex-specific rates. Stay durations for these episodes were longer for both young-age and working-age people with ID. Overall people with ID used 399.8 bed-days per 1000 person-years. As a crude comparison, this is 2.8 times the figure for people without ID. Standardising for their age and sex profile, it is 5.4 times the number expected if they had the same age-specific and sex-specific rates. For patients with ID, 16.6% (one in six) of all admitted patient episodes and 24.3% (one in four) of in-patient care days for people with ID were for ACS conditions. Corresponding figures for those without ID were 8.3% (one in 12) and 14.4% (one in seven). The difference in rates between those with and without ID was most marked in people of working age. The three most common causes of emergency episodes for ACS conditions in people with ID were convulsions and epilepsy, influenza pneumonia and aspiration pneumonitis. Influenza pneumonia was also a common cause for people without ID. Episodes for convulsions and epilepsy and aspiration pneumonitis were specifically associated with people with ID. CONCLUSIONS Rates of hospital admissions for ACS conditions provide an important indicator of health literacy, basic self-care (or support by carers) and the accessibility of primary care. High rates are seen for some conditions specifically associated with premature death in people with ID. Local monitoring of these figures could be used to indicate the effectiveness of local primary health services in providing support to people with ID.
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Affiliation(s)
- G Glover
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - R Williams
- Clinical Practice Research Datalink Group, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - J Oyinlola
- Clinical Practice Research Datalink Group, Medicines and Healthcare Products Regulatory Agency, London, UK
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Risk of Hospitalizations Following Gastrostomy in Children with Intellectual Disability. J Pediatr 2020; 217:131-138.e10. [PMID: 31812294 DOI: 10.1016/j.jpeds.2019.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/23/2019] [Accepted: 10/09/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine the frequency of hospital admissions before and after gastrostomy insertion in children with severe intellectual disability. STUDY DESIGN We conducted a retrospective cohort study using linked health administrative and disability data from Western Australia (WA) and New South Wales (NSW). Children born between 1983 and 2009 in WA and 2002 and 2010 in NSW who had a gastrostomy insertion performed (n = 673 [WA, n = 325; NSW, n = 348]) by the end of 2014 (WA) and 2015 (NSW) were included. Conditional Poisson regression models were used to evaluate the age-adjusted effect of gastrostomy insertion on acute hospitalizations for all-cause, acute lower respiratory tract infections (LRTI), and epilepsy admissions. RESULTS The incidence of all-cause hospitalizations declined at 5 years after procedure (WA cohort 1983-2009: incidence rate ratio, 0.70 [95% CI, 0.60-0.80]; WA and NSW cohort 2002-2010: incidence rate ratio, 0.63 [95% CI, 0.45-0.86]). Admissions for acute LRTI increased in the WA cohort and remained similar in the combined cohort. Admissions for epilepsy decreased 4 years after gastrostomy in the WA cohort and were generally lower in the combined cohort. Fundoplication seemed to decrease the relative incidence of acute LRTI admissions in the combined cohort. CONCLUSIONS Gastrostomy was associated with health benefits including reduced all-cause and epilepsy hospitalizations, but was not protective against acute LRTI. These decreases in hospitalizations may reflect improved delivery of nutrition and medications.
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Nicholson E, Doherty E, Somanadhan S, Guerin S, Schreiber J, Bury G, Kroll T, Raley M, McAuliffe E. Health inequities in unscheduled healthcare for children with intellectual disabilities in Ireland: a study protocol. HRB Open Res 2020; 3:3. [PMID: 32832849 PMCID: PMC7431971 DOI: 10.12688/hrbopenres.12973.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2019] [Indexed: 03/30/2024] Open
Abstract
Background: Health inequities for children with intellectual disabilities (ID) are prevalent within different health systems, and children with ID have shorter life expectancies than the general population, higher mortality rates before the age of 17 and have a greater risk of potentially preventable hospitalisations. A health systems approach to research in this area provides a useful means through which research can inform policy and practice to ensure people with ID receive equitable healthcare; however, there is a paucity of evidence regarding how to address differences that have been described in the literature to date. The overall aim of this research is to establish the extent of health inequities for children with ID in Ireland compared to children without ID with respect to their utilisation of primary care and rates of hospitalisation, and to gain a better understanding of what influences utilisation of primary care and ED services in this population. Methods and analysis: The design of this research adopts a mixed-methods approach: statistical analysis of health data to determine the extent of health inequities in relation to healthcare utilisation; discrete choice experiments to explore General Practitioners' decision making and parental preferences for optimal care; and concept mapping to develop consensus between stakeholders on how to address current healthcare inequities. Discussion: By applying a systems lens to the issue of health inequities for children with ID, the research hopes to gain a thorough understanding of the varying components that can contribute to the maintenance of such healthcare inequities. A key output from the research will be a set of feasible solutions and interventions that can address health inequities for this population.
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Affiliation(s)
- Emma Nicholson
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), University College Dublin, Belfield, Dublin 4, Ireland
| | - Edel Doherty
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, University Road, Galway, Ireland
| | - Suja Somanadhan
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - Suzanne Guerin
- UCD Centre for Disability Studies, University College Dublin, Belfield, Dublin 4, Ireland
| | | | - Gerard Bury
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Thilo Kroll
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), University College Dublin, Belfield, Dublin 4, Ireland
| | - Meredith Raley
- Disability Federation of Ireland, Fumbally Court, Dublin 8, Ireland
| | - Eilish McAuliffe
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), University College Dublin, Belfield, Dublin 4, Ireland
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Health Care Use and Spending of Pediatric Patients With an Intellectual or Developmental Disability. Med Care 2020; 58:468-473. [PMID: 31934953 DOI: 10.1097/mlr.0000000000001293] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care costs and utilization for those with an intellectual or developmental disability (IDD) have been shown to be higher than the general population. OBJECTIVE To investigate the services that contribute to higher costs and utilization among noninstitutionalized children with an IDD. DESIGN Matched case-control secondary analysis of the 2000-2017 Medical Expenditure Panel Survey. Pediatric (age 0-21) patients with an IDD were matched to non-IDD subjects. Health care utilization and costs were evaluated with zero-inflated negative binomial regressions and generalized linear models, respectively. MEASURES Outcome measures included high-acuity health care utilization [ie, emergency department (ED) visits and hospital admissions], and cost outcomes for total spending, ED use, hospitalization, medications, office visits, home health, and physical therapy. RESULTS There was no statistical difference in utilization of EDs among the 2 groups though subjects with an IDD showed more hospitalizations than their matched cohort (incidence rate ratios=1.63, P=0.00). Total health care spending was higher among patients with an IDD (coefficient=$5831, P=0.00). Pediatric spending was higher in all measures except for ED. The biggest discrepancies in spending were seen in home health (coefficient=$2558, P=0.00) and outpatient visits (coefficient=$1180, P=0.00). CONCLUSIONS Pediatric patients with an IDD had higher health care spending and utilization than non-IDD subjects in all categories except for ED use.
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Fairthorne J, Bourke J, O'Donnell M, Wong K, de Klerk N, Llewellyn G, Leonard H. Pregnancy and birth outcomes of mothers with intellectual disability and their infants: Advocacy needed to improve well-being. Disabil Health J 2019; 13:100871. [PMID: 31806497 DOI: 10.1016/j.dhjo.2019.100871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pregnancy in women with intellectual disability (ID) is increasingly recognised, along with their increased likelihood of experiencing risk factors for adverse pregnancy and infant outcomes. OBJECTIVES We aimed to compare risks of socio-demographic, pregnancy and infant outcomes of women with ID to other women. METHODS All mothers with children born in Western Australia from 1983 to 2012 were linked to the population-based Intellectual Disability Exploring Answers database. Mothers with ID were matched by age and Aboriginality to a population sample of mothers without ID. Pregnancy and birth outcomes were compared for both groups and logistic regression was used to compare outcome risks. RESULTS Compared to non-Aboriginal mothers without ID, non-Aboriginal mothers with ID were more likely to be of low socio-economic status, be without partner, smoke antenatally and have pre-existing asthma. They had a 1.5 times increased risk of pregnancy complications, specifically pre-eclampsia, urinary tract infection, threatened preterm labour and post-partum haemorrhage. After adjustment for maternal medical conditions and pregnancy complications, infants of Aboriginal mothers with ID had twice the risk of preterm birth and 1.6 times the risk of having percentage of optimal head circumference <95% compared to infants of Aboriginal mothers without ID. Infants of both Aboriginal and non-Aboriginal mothers with ID were more likely to have percentage of optimal birth weight <85% compared to those without ID. CONCLUSIONS For mothers with ID, modifiable risk factors for adverse outcomes need addressing. They may require additional assistance during pregnancy, including more frequent consultations and support to assist with pregnancy management.
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Affiliation(s)
- Jenny Fairthorne
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Jenny Bourke
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Melissa O'Donnell
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Nick de Klerk
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | | | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
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Strobel NA, Bourke J, Leonard H, Richardson A, Edmond KM, McAullay D. Assessing the quality, efficiency and usefulness of the Western Australian population-based Intellectual Disability Exploring Answers (IDEA) surveillance system: a surveillance system evaluation. BMJ Open 2019; 9:e026003. [PMID: 31630096 PMCID: PMC6803127 DOI: 10.1136/bmjopen-2018-026003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Our overall aim was to evaluate the Western Australian Intellectual Disability Exploring Answers (IDEA) surveillance system. The primary objective was to evaluate the attributes of the system. The secondary objective was to provide recommendations to data custodians and stakeholders to strengthen the system. METHOD The IDEA system was evaluated using process observation, interviews and secondary data analysis of system attributes: usefulness, simplicity, data quality, acceptability, representativeness, timeliness and stability. 2001 US Centers for Disease Control and Prevention guidelines were used. RESULTS We found that the IDEA system was useful, simple, flexible, acceptable, representative, timely and stable. We compared individuals from the IDEA system (n=10 593) with those with cerebral palsy and intellectual disability (ID) (n=582) from another surveillance system. Of the 582 with cerebral palsy and ID, 501 (86.1%) were in the IDEA system and 81 (13.9%) were not. In total, 0.7% of cases (81/10674) with ID were not identified in the IDEA system. There were little differences in cases that were not identified in the IDEA system between Indigenous status, sex and place of residence. CONCLUSIONS The strengths of the IDEA system include having a high data quality resource contributing to national and international data on ID, strong government support and a dedicated management team. Output from studies linking to IDEA data have had major contributions to the international literature about ID. However, limited resources have prevented it from realising its full potential in relation to translational activities. The IDEA system is a valuable resource to address the needs of people living with ID.
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Affiliation(s)
- Natalie A Strobel
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
- NCEPH, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jenny Bourke
- Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Helen Leonard
- Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Alice Richardson
- NCEPH, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen M Edmond
- Department Of Women & Children's Health, King's College London, London, UK
| | - Daniel McAullay
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
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Krahn GL. A Call for Better Data on Prevalence and Health Surveillance of People With Intellectual and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:357-375. [PMID: 31568742 DOI: 10.1352/1934-9556-57.5.357] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The U.S. approach to the health of people with intellectual and developmental disabilities (IDD) is fraught with paradox. The health of this population has been of longstanding concern, yet we understand their health less well than many other groups. The U.S. spends much more per person on the well-being of people with IDD compared to the general population, yet the outcomes of those expenditures are disappointing and include significant preventable health disparities. Even as expectations for people with IDD have changed to include better health and greater participation in their communities, eligibility for services that support these outcomes is rooted in expectations of dependence and poverty. This article is a call for better data that considers a series of questions to provide context for understanding the need and directions for better health surveillance of people with IDD.
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Affiliation(s)
- Gloria L Krahn
- Gloria L. Krahn, Oregon State University, College of Public Health and Human Sciences, Corvallis
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Balogh R, Leonard H, Bourke J, Brameld K, Downs J, Hansen M, Glasson E, Lin E, Lloyd M, Lunsky Y, O'Donnell M, Shooshtari S, Wong K, Krahn G. Data Linkage: Canadian and Australian Perspectives on a Valuable Methodology for Intellectual and Developmental Disability Research. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:439-462. [PMID: 31568733 DOI: 10.1352/1934-9556-57.5.439] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Data linkage holds great promise for generating new information about people with intellectual and developmental disabilities (IDD) as a population, yet few centers have developed the infrastructure to utilize this methodology. Two examples, from Canada and Australia, describe their efforts in building data linkage capabilities, and how linked databases can be used to identify persons with IDD and used for population-based research. The value of data linkage is illustrated through new estimates of prevalence of IDD; health service utilization patterns; associations with sociodemographic characteristics, and with physical and mental health conditions (e.g., chronic diseases, injury, fertility, and depression); and findings on equity in medical treatments. Examples are provided of findings used for governmental policy and program planning.
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Affiliation(s)
- Robert Balogh
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Helen Leonard
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Jenny Bourke
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Kate Brameld
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Jenny Downs
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Michele Hansen
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Emma Glasson
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Elizabeth Lin
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Meghann Lloyd
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Yona Lunsky
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Melissa O'Donnell
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Shahin Shooshtari
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Kingsley Wong
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Gloria Krahn
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
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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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Bobbette N, Donnelly C, Ufholz LA, Duggan J, Weatherbed E. Interprofessional team-based primary health care for adults with intellectual and developmental disabilities: a scoping review protocol. ACTA ACUST UNITED AC 2019; 17:2506-2516. [PMID: 31290791 DOI: 10.11124/jbisrir-2017-003999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
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.
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Affiliation(s)
- Nicole Bobbette
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Lee-Anne Ufholz
- Health Learning, Research & Practice, Wolters Kluwer Health, Ontario, Canada
| | - Jane Duggan
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Emily Weatherbed
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
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Engelman A, Valderama-Wallace C, Nouredini S. State of the Profession: The Landscape of Disability Justice, Health Inequities, and Access for Patients With Disabilities. ANS Adv Nurs Sci 2019; 42:231-242. [PMID: 30839329 DOI: 10.1097/ans.0000000000000261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The nursing profession can both perpetuate inequities and elevate the discourse around disability. Our article uses an intersectional lens to discuss the scope, magnitude, and determinants of health inequities that people with disabilities experience and the ways in which theoretical models of disability used in nursing education can further contribute to inequities. Our article makes the case for an intersectional social justice approach to nursing education by contextualizing the current state of affairs within historical and contemporary models of disability. This has the potential to be a revolutionary leap toward promoting health equity and upholding the Code of Ethics.
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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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Zhou M, Du W, Salvador-Carulla L, Glasgow N. Adverse drug event-related hospitalisation in persons with neurodevelopmental disorders: a state-wide retrospective cohort study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:429-440. [PMID: 30609156 DOI: 10.1111/jir.12586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/06/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Little is known about the sociodemographic and clinical characteristics of adverse drug events (ADEs) in patients with neurodevelopmental disorders (NDD). OBJECTIVE The objective of this study was to describe and compare the demographic details of people with and without NDD hospitalised due to ADEs. METHODS The all-inclusive New South Wales Admitted Patient Data Collection from 2001 to 2014 was employed to identify ADE-related hospitalisations in patients with NDD using the International Classification of Diseases 10th revision Australian modification codes. We derived case sets specific to different clinical groups and patient characteristics and compared proportional differences between patients with and without intellectual disability using chi squared tests. RESULTS A total of 2173 patients with NDD were admitted for acute care of ADEs, accounting for 0.7% of all ADE-related hospitalisations. Hospitalised ADEs among patients with NDD increased by twofold over the 14-year study period. Psychotropic medications and opioid analgesic medications were leading causes of ADE-related hospitalisations in patients with NDD. Compared with their counterparts, patients with NDD were younger, experienced more socio-economic disadvantage and less private insurance coverage, suffered with less severe but different co-morbid clinical conditions and incurred more challenges in the acute hospital care setting. CONCLUSION Although the pattern of ADE-related hospitalisations in patients with NDD differed from that in patients without NDD, there is a lack of targeted healthcare programmes to meet their special needs. This study suggests the need for countermeasures in primary healthcare settings to reduce the burden of ADEs in this vulnerable group.
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Affiliation(s)
- M Zhou
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
- Pharmacy department, People's Hospital of Xinjiang, Urumqi, China
| | - W Du
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Canberra, Australia
| | - L Salvador-Carulla
- Centre of Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australia
| | - N Glasgow
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Canberra, Australia
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Glover G, Williams R, Tompkins G, Oyinlola J. An observational study of the use of acute hospital care by people with intellectual disabilities in England. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:85-99. [PMID: 30221429 DOI: 10.1111/jir.12544] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 10/01/2017] [Accepted: 07/16/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Providing safe, high-quality admitted-patient care for people with intellectual disabilities (IDs) requires consideration for their special needs particularly in relation to communication and consent. To make allowance for these special requirements, it would be helpful for hospitals to know how often they are likely to arise. This study set out to identify the amount and patterns of use of acute, non-psychiatric hospital admitted-patient care in England by people with ID. Patterns are considered in relation to clinical specialties, modes of admission (emergency or planned) and life stages (children and young people, working age and older adults). In each case, patterns for people with ID are compared with patterns for those without. METHODS Descriptive observational study using a major general practitioner (GP) research database (Clinical Practice Research Datalink GOLD) linked to routine national statistical records of admitted-patient care. RESULTS Overall people identified by their GP as having ID had higher rates of admitted-patient care episodes and longer durations of stay than those without. Differences varied considerably between clinical specialties with rates more elevated in medical and paediatric than surgical specialties. Admitted-patient care rates for women with ID in obstetrics and gynaecology were lower than for other women, while rates for admitted-patient dental care were much higher for both men and women with ID. In an average English health administrative area with a local population of 250 000 people, at any time, there are likely to be approximately 670 people receiving acute admitted-patient care. Approximately six of these are likely to have been identified by their GP as having ID. At 0.9% of hospital in-patients, this is just under twice the proportion in the population. CONCLUSION AND IMPLICATIONS Our figures are likely to be an underestimate as GP identification of people with ID is known to be far from complete. However, they indicate that the number of people with ID in acute hospital settings is likely to be substantially more than a recent survey of English health services indicated they were aware of. The study is intended to help guide expectations for acute hospitals seeking to audit the completeness of their identification of people with ID and to indicate their likely distribution between clinical specialties.
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Affiliation(s)
- G Glover
- Public Health England Learning Disabilities Observatory, West Wing, Victoria House, Capital Park, Fulbourn, Cambridge, UK
| | - R Williams
- Clinical Practice Research Datalink Group, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - G Tompkins
- Public Health in Gateshead, Gateshead Council, Gateshead, UK
| | - J Oyinlola
- Clinical Practice Research Datalink Group, Medicines and Healthcare Products Regulatory Agency, London, UK
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Hand BN, Boan AD, Bradley CC, Charles JM, Carpenter LA. Ambulatory Care Sensitive Admissions in Individuals With Autism Spectrum Disorder, Intellectual Disability, and Population Controls. Autism Res 2018; 12:295-302. [DOI: 10.1002/aur.2050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/28/2018] [Accepted: 10/30/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Brittany N. Hand
- Department of Pediatrics The Ohio State University Charleston SC USA
| | - Andrea D. Boan
- Department of Pediatrics Medical University of South Carolina Charleston SC USA
| | | | - Jane M. Charles
- Department of Pediatrics Medical University of South Carolina Charleston SC USA
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Barnette DJ, Hanks C, Li W, Porter K. Patient-Level Medication Regimen Complexity in an Adolescent and Adult Population with Autism Spectrum Disorders. Pharmacotherapy 2018; 39:636-644. [PMID: 30508268 DOI: 10.1002/phar.2202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adults with autism spectrum disorder (ASD) frequently experience polypharmacy. However, there is limited understanding of how to quantify medication complexity in this vulnerable population. OBJECTIVES This study examined medication administration difficulty using the Medication Regimen Complexity Index (MRCI) tool in adolescents and adults with ASD. The outcomes compared the mean total MRCI score with the medication count, described MRCI contributions for over-the-counter medication (OTC), and compared MRCI scores by patient characteristics. METHODS This was a retrospective chart review of patients aged 7-45 years (mean = 20.1) enrolled in a primary care ASD transitions program. Each patient's listed medications were counted and then scored using the validated MRCI tool. RESULTS For the 142 patients studied, mean total MRCI was 14.6 ± 14.6 (range 0-89) and mean medication count was 6.3 ± 5.4 (range 0-38). For patients on 0-4 medications (66 of 142; 46.5%), the mean MRCI was 5.5 ± 4.2, 5-9 medications (50 of 142; 35.2%) the mean MRCI was 15.2 ± 6.8, and 10-38 medications (26 of 142; 18.3%) the mean MRCI was 36.5 ± 18.9 (p<0.001). Sixty percent (85 of 142) reported OTC use, which contributed 26.6% to the mean total MRCI. Reported benzodiazepine (mean MRCI 25.8 ± 17.2), antiepileptic (mean MRCI 23.7 ± 16.9), antipsychotic (mean MRCI 19.7 ± 15.9), or antidepressant (mean MRCI 17.0 ± 14.8) use received higher MRCI scores compared to nonuse (p<0.001 for all except antidepressants [p=0.004]). Total MRCI did not differ significantly by age group, sex, or attention-deficit-hyperactivity disorder (ADHD) medication use (stimulant or nonstimulant). CONCLUSIONS Medication regimen complexity in adolescents and adults with ASD was increased significantly for individuals taking ≥ 5 medications. Central nervous system agent use, other than ADHD therapy, identified patients with higher regimen complexity. The related clinical effects of these findings warrant further investigation.
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Affiliation(s)
- Debra J Barnette
- Department of Pharmacy Practice and Science, The Ohio State University College of Pharmacy, Columbus, Ohio.,Internal Medicine and Pediatrics at Hilliard, The Ohio State Wexner Medical Center, Hilliard, Ohio
| | - Christopher Hanks
- Internal Medicine and Pediatrics at Hilliard, The Ohio State Wexner Medical Center, Hilliard, Ohio
| | - Weiyi Li
- Department of Pharmacy Practice and Science, The Ohio State University College of Pharmacy, Columbus, Ohio
| | - Kyle Porter
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
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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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CE: Original Research: Pain in Nonverbal Children with Medical Complexity: A Two-Year Retrospective Study. Am J Nurs 2018; 118:28-37. [DOI: 10.1097/01.naj.0000544137.55887.5a] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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