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Caltabiano P, Bailie J, Laycock A, Shea B, Dykgraaf SH, Lennox N, Ekanayake K, Bailie R. Identifying barriers and facilitators to primary care practitioners implementing health assessments for people with intellectual disability: a Theoretical Domains Framework-informed scoping review. Implement Sci Commun 2024; 5:39. [PMID: 38627849 PMCID: PMC11020327 DOI: 10.1186/s43058-024-00579-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION People with intellectual disability experience poorer health outcomes compared with the general population, partly due to the difficulties of accessing preventive care in primary care settings. There is good evidence that structured annual health assessments can enhance quality of care for people with intellectual disability, and their use has become recommended policy in several high-income countries. However, uptake remains low. The Theoretical Domains Framework (TDF) offers a conceptual structure for understanding barriers to implementation and has been usefully applied to inform implementation of health assessments for other high-need groups, but not for people with intellectual disability. We conducted a scoping review of the literature, using the TDF, to identify barriers and facilitators influencing primary care practitioners' implementation of annual health assessments for people with intellectual disability as part of routine primary care practice. METHODS This study was conducted according to the JBI methodological approach for scoping reviews. Searches were conducted in Medline (OVID-SP), Embase (OVID-SP), PsycINFO (OVID-SP), CINHAL (EBSCO), Scopus (Elsevier) and Web of Science (Clarivate) for relevant peer-reviewed publications up to May 2023. Screening, full-text review and data extraction were completed by two independent reviewers. Data were extracted and mapped to the TDF to identify relevant barriers and facilitators. RESULTS The search yielded 1057 publications, with 21 meeting the inclusion criteria. Mapping data to the TDF, the most frequently identified domains were (a) environmental context and resources, (b) skills, (c) knowledge and (d) emotion. Predominant factors impacting on implementation included practitioners' lack of awareness about health assessments and their identified benefits; inadequate training and experience by practitioners in the delivery of health assessments for people with intellectual disability; insufficient time to provide health assessments; and practitioner burnout. CONCLUSION Using a theory-informed behavioural framework, our review aids understanding of the barriers and facilitators to improving the implementation of health assessments as part of routine care for people with intellectual disability. However, there is a clear need for further qualitative research to examine the perceptions of primary care practitioners regarding implementation barriers and facilitators to health assessments in general, including views from practitioners who are not currently undertaking health assessments.
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Affiliation(s)
- Paul Caltabiano
- School of Rural Health, The University of Sydney, Dubbo, Australia
- Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, Australia.
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, Australia.
| | - Alison Laycock
- University Centre for Rural Health, The University of Sydney, Lismore, Australia
| | - Bradley Shea
- Sydney Medical School, The University of Sydney, Camperdown, Australia
- University Centre for Rural Health, The University of Sydney, Lismore, Australia
| | - Sally Hall Dykgraaf
- Rural Clinical School, Australian National University, ACT, Canberra, Australia
| | - Nicholas Lennox
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Kanchana Ekanayake
- University of Sydney Library, The University of Sydney, Camperdown, Australia
| | - Ross Bailie
- School of Public Health, The University of Sydney, Camperdown, Australia
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McNeil K, Achenbach J, Lawson B, Delahunty-Pike A, Barber B, Diepstra H. Towards developing an intervention to support periodic health checks for adults with intellectual and developmental disabilities: Striving for health equity. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13169. [PMID: 37984404 DOI: 10.1111/jar.13169] [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: 03/03/2023] [Revised: 08/21/2023] [Accepted: 10/09/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Although the Canadian Consensus Guidelines for Primary Care of Adults with Intellectual and Developmental Disabilities recommends conducting periodic health checks in primary care, uptake is lacking. This study seeks to understand factors influencing the conduct of periodic health checks and identify what needs to change to increase them. METHOD Qualitative data from five stakeholder groups (adults with intellectual and developmental disabilities, primary care providers, administrative staff, family, disability support workers) was guided by the Behaviour Change Wheel and the Theoretical Domains Framework to identify barriers and 'what needs to change' to support periodic health checks. RESULTS Stakeholders (n = 41) voiced multiple barriers. A total of 31 common and 2 unique themes were identified plus 33 items 'needing to change'. CONCLUSION Despite barriers, stakeholders saw merit in periodic health checks as a preventative and equitable healthcare offering for adults with intellectual and developmental disabilities. Results will inform future intervention development steps.
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Affiliation(s)
- Karen McNeil
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jillian Achenbach
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Brittany Barber
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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Shea B, Bailie J, Dykgraaf SH, Fortune N, Lennox N, Bailie R. Access to general practice for people with intellectual disability in Australia: a systematic scoping review. BMC PRIMARY CARE 2022; 23:306. [PMID: 36447186 PMCID: PMC9707181 DOI: 10.1186/s12875-022-01917-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND People with intellectual disability experience inadequate access to general practice and poorer health outcomes than the general population. While some access barriers have been identified for this population, these studies have often used narrow definitions of access, which may not encompass the multiple dimensions that influence access to general practice. To address this gap, we conducted a scoping review to identify factors impacting access to general practice for people with intellectual disability in Australia, using a holistic framework of access conceptualised by Levesque and colleagues. METHODS This scoping review followed Joanna Briggs Institute methodology and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Medline (Ovid), Scopus, CINAHL, Informit and PsycINFO databases were searched. Screening, full-text review and data extraction were completed by two independent reviewers, with consensus reached at each stage of the study. Data were extracted, coded and synthesised through deductive qualitative analysis - using the five corresponding conceptual dimensions within Levesque and colleagues' theoretical framework of access, which incorporate both supply-side features of health systems and services, and demand-side characteristics of consumers and populations. RESULTS The search identified 1364 publications. After duplicate removal, title and abstract screening and full-text review, 44 publications were included. Supply-side factors were more commonly reported than demand-side factors, with the following issues frequently identified as impacting access to general practice: limited general practitioner education about, and/or experience of, people with intellectual disability; communication difficulties; and inadequate continuity of care. Less frequently included were factors such as the health literacy levels, promotion of general practice services and availability of complete medical records. CONCLUSIONS This is the first scoping review to assess access barriers for people with intellectual disability using a comprehensive conceptualisation of access. The findings highlight the need for increased efforts to address demand-side dimensions of access to general practice and offer a basis for a balanced portfolio of strategies that can support recent policy initiatives to enhance access to care for people with intellectual disability.
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Affiliation(s)
- Bradley Shea
- grid.1013.30000 0004 1936 834XSydney Medical School, The University of Sydney, Sydney, NSW Australia
| | - Jodie Bailie
- grid.1013.30000 0004 1936 834XUniversity Centre for Rural Health, The University of Sydney, Lismore, NSW Australia ,grid.1013.30000 0004 1936 834XCentre for Disability Research and Policy, The University of Sydney, Sydney, NSW Australia
| | - Sally Hall Dykgraaf
- grid.1001.00000 0001 2180 7477Rural Clinical School, Australian National University, Canberra, ACT Australia
| | - Nicola Fortune
- grid.1013.30000 0004 1936 834XCentre for Disability Research and Policy, The University of Sydney, Sydney, NSW Australia ,grid.1008.90000 0001 2179 088XCentre of Research Excellence in Disability and Health, University of Melbourne, Carlton, VIC Australia
| | - Nicholas Lennox
- grid.1003.20000 0000 9320 7537Queensland Centre for Intellectual and Developmental Disability, University of Queensland, Brisbane, QLD Australia
| | - Ross Bailie
- grid.1013.30000 0004 1936 834XSydney Medical School, The University of Sydney, Sydney, NSW Australia
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McNeil K, Hennen B, Joyce M, Marshall EG. Health check guidelines and billing for family physicians caring for adults with intellectual and developmental disabilities: Incentives to improve care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:e197-e201. [PMID: 34261728 DOI: 10.46747/cfp.6707e197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the degree to which Canadian consensus guideline recommendations for annual comprehensive preventive care assessments of adults with intellectual and developmental disabilities (IDD) are being taken up by Nova Scotia family physicians since the introduction of incentive billing codes; and to discuss the importance of complete physical examinations for this patient population, extra time needed in clinic encounters, and challenges for practitioners providing care. DESIGN Analysis of family physicians' billing of codes 03.04C and 03.03E from April 2012 to December 2016. SETTING Nova Scotia. PARTICIPANTS Family physicians. MAIN OUTCOME MEASURES Number of billings through fee-for-service and alternative payment plans, and number of providers who used these fee codes. RESULTS Analysis yielded 3 key results. Use of incentivized billing codes for adult IDD visits and complete examinations in Nova Scotia has steadily increased for patients since the introduction of the modified codes. There is measurable uptake of the IDD adult visit code in total numbers and numbers of providers billing the code. There is poor uptake of the complete examination code. CONCLUSION Enhanced billing codes will provide Nova Scotia family physicians with an incentive to employ the newly revised 2018 Canadian consensus guidelines in the care of adults with IDDs. With continued discussion and promotion of annual physical examinations for patients with IDD, more patients and caregivers might make this proactive care item a priority.
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Affiliation(s)
- Karen McNeil
- Assistant Professor in the Department of Family Medicine at Dalhousie University in Halifax, NS
| | - Brian Hennen
- Professor Emeritus at Western University in London, Ont, and at Dalhousie University
| | - Mike Joyce
- Director of Health Economics for the Nova Scotia Department of Health and Wellness in Halifax
| | - Emily Gard Marshall
- Associate Professor in the Department of Family Medicine at Dalhousie University
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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: 1] [Impact Index Per Article: 0.3] [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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Dahm MR, Georgiou A, Balandin S, Hill S, Hemsley B. Health Information Infrastructure for People with Intellectual and Developmental Disabilities (I/DD) Living in Supported Accommodation: Communication, Co-Ordination and Integration of Health Information. HEALTH COMMUNICATION 2019; 34:91-99. [PMID: 29068261 DOI: 10.1080/10410236.2017.1384431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
People with intellectual and/or developmental disability (I/DD) commonly have complex health care needs, but little is known about how their health information is managed in supported accommodation, and across health services providers. This study aimed to describe the current health information infrastructure (i.e., how data and information are collected, stored, communicated, and used) for people with I/DD living in supported accommodation in Australia. It involved a scoping review and synthesis of research, policies, and health documents relevant in this setting. Iterative database and hand searches were conducted across peer-reviewed articles internationally in English and grey literature in Australia (New South Wales) up to September 2015. Data were extracted from the selected relevant literature and analyzed for content themes. Expert stakeholders were consulted to verify the authors' interpretations of the information and content categories. The included 286 sources (peer-reviewed n = 27; grey literature n = 259) reflect that the health information for people with I/DD in supported accommodation is poorly communicated, coordinated and integrated across isolated systems. 'Work-as-imagined' as outlined in policies, does not align with 'work-as-done' in reality. This gap threatens the quality of care and safety of people with I/DD in these settings. The effectiveness of the health information infrastructure and services for people with I/DD can be improved by integrating the information sources and placing people with I/DD and their supporters at the centre of the information exchange process.
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Affiliation(s)
- Maria R Dahm
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation , Macquarie University
| | - Andrew Georgiou
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation , Macquarie University
| | - Susan Balandin
- b School of Health and Social Development , Faculty of Health, Deakin University
| | - Sophie Hill
- c Centre for Health Communication and Participation, School of Psychology and Public Health , La Trobe University
| | - Bronwyn Hemsley
- d School of Humanities and Social Science, Faculty of Education and Arts , The University of Newcastle
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Kersten MCO, Taminiau EF, Schuurman MIM, Weggeman MCDP, Embregts PJCM. How to improve sharing and application of knowledge in care and support for people with intellectual disabilities? A systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:496-520. [PMID: 29696724 DOI: 10.1111/jir.12491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND To optimise care and support for people with intellectual disabilities (ID), sharing and application of knowledge is a precondition. In healthcare in general, there is a body of knowledge on bridging the 'know-do-gap'. However, it is not known to what extent the identified barriers and facilitators to knowledge sharing and application also hold for the care and support of people with ID, due to its specific characteristics including long-term care. Therefore, we conducted a systematic review to identify which organisational factors are enabling and/or disabling in stimulating the sharing and application of knowledge in the care and support of people with ID. METHOD A systematic review was conducted using five electronic databases of relevant articles published in English between January 2000 and December 2015. During each phase of selection and analysis a minimum of two independent reviewers assessed all articles according to PRISMA guidelines. RESULTS In total 2,256 articles were retrieved, of which 19 articles met our inclusion criteria. All organisational factors retrieved from these articles were categorised into three main clusters: (1) characteristics of the intervention (factors related to the tools and processes by which the method was implemented); (2) factors related to people (both at an individual and group level); and, (3) factors related to the organisational context (both material factors (office arrangements and ICT system, resources, time and organisation) and immaterial factors (training, staff, size of team)). CONCLUSION Overall analyses of the retrieved factors suggest that they are related to each other through the preconditional role of management (i.e., practice leadership) and the key role of professionals (i.e. (in)ability to fulfill new roles).
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Affiliation(s)
- M C O Kersten
- Tilburg School of Social and Behavioural Sciences, Tilburg University, The Netherlands
- Dutch Association of Healthcare Providers for People with Disabilities (VGN), Utrecht, The Netherlands
| | - E F Taminiau
- Tilburg School of Social and Behavioural Sciences, Tilburg University, The Netherlands
| | | | - M C D P Weggeman
- Industrial Engineering and Innovation Sciences, Technical University Eindhoven, The Netherlands
| | - P J C M Embregts
- Tilburg School of Social and Behavioural Sciences, Tilburg University, The Netherlands
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Hanlon P, MacDonald S, Wood K, Allan L, Cooper SA. Long-term condition management in adults with intellectual disability in primary care: a systematic review. BJGP Open 2018; 2:bjgpopen18X101445. [PMID: 30564710 PMCID: PMC6181081 DOI: 10.3399/bjgpopen18x101445] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/02/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Adults with intellectual disabilities have higher morbidity and earlier mortality than the general population. Access to primary health care is lower, despite a higher prevalence of many long-term conditions. AIM To synthesise the evidence for the management of long-term conditions in adults with intellectual disabilities and identify barriers and facilitators to management in primary care. DESIGN & SETTING Mixed-methods systematic review. METHOD Seven electronic databases were searched to identify both quantitative and qualitative studies concerning identification and management of long-term conditions in adults with intellectual disability in primary care. Both the screening of titles, abstracts, and full texts, and the quality assessment were carried out in duplicate. Findings were combined in a narrative synthesis. RESULTS Fifty-two studies were identified. Adults with intellectual disabilities are less likely than the general population to receive screening and health promotion interventions. Annual health checks may improve screening, identification of health needs, and management of long-term conditions. Health checks have been implemented in various primary care contexts, but the long-term impact on outcomes has not been investigated. Qualitative findings highlighted barriers and facilitators to primary care access, communication, and disease management. Accounts of experiences of adults with intellectual disabilities reveal a dilemma between promoting self-care and ensuring access to services, while avoiding paternalistic care. CONCLUSION Adults with intellectual disabilities face numerous barriers to managing long-term conditions. Reasonable adjustments, based on the experience of adults with intellectual disability, in addition to intervention such as health checks, may improve access and management, but longer-term evaluation of their effectiveness is required.
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Affiliation(s)
- Peter Hanlon
- SCREDS Clinical Lecturer in General Practice and Primary Care, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sara MacDonald
- Senior Lecturer, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Karen Wood
- Research Assistant, General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Linda Allan
- Clinical Associate Professor, Health and Social Care Integration Directorate, Scottish Government, Edinburgh, UK
| | - Sally-Ann Cooper
- Professor of Learning Disabilities, Mental Health and Wellbeing Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Bakker-van Gijssel EJ, Lucassen PLBJ, Olde Hartman TC, van Son L, Assendelft WJJ, van Schrojenstein Lantman-de Valk HMJ. Health assessment instruments for people with intellectual disabilities-A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 64:12-24. [PMID: 28327382 DOI: 10.1016/j.ridd.2017.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/15/2017] [Accepted: 03/05/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) experience health disparities and are less likely to undergo recommended age- and gender-specific screening and health promotion. New diagnoses are frequently missed. Assessments with the aid of health assessment instruments are a way to address these problems. AIM The aim of this review is to find the available health assessment instruments for people with ID used in primary care and evaluate their quality. METHODS We conducted an electronic literature search of papers published between January 2000 and May 2016. After a two-phase selection process (kappa: 0.81 and 0.77) we collected data from the 29 included peer-reviewed articles on the following four domains; development, clinimetric properties (i.e. validity, reliability, feasibility, acceptability), content (i.e. ID-related health problems, prevention and health promotion topics) and effectiveness of the instruments. RESULTS/CONCLUSIONS We distinguished 20 different health assessment instruments. Limited information was found on the development of the instruments as well as on their clinimetric properties. The content of the instruments was rather diverse. The included papers agreed that health assessment instruments are effective. However, only three instruments evaluated effectiveness in a randomised controlled trial. Patients with ID, carers and general practitioners (GPs) generally appreciated the health assessment instruments. IMPLICATION Two instruments, "Stay well and healthy -Health risk appraisal (SWH-HRA)"and the "Comprehensive Health Assessment Programme (CHAP)", appeared to have the highest quality. These instruments can be used to construct a health assessment instrument for people with ID that meets scientific standards.
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Affiliation(s)
- E J Bakker-van Gijssel
- Radboud University Nijmegen Medical Center, Department of Primary and Community Care, PO Box 9101, 6500 HB Nijmegen, The Netherlands; Siza, Residential Care Facility For People With Disabilities, PO Box 532, 6800 AM Arnhem, The Netherlands.
| | - P L B J Lucassen
- Radboud University Nijmegen Medical Center, Department of Primary and Community Care, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - T C Olde Hartman
- Radboud University Nijmegen Medical Center, Department of Primary and Community Care, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - L van Son
- Radboud University Nijmegen Medical Center, Department of Primary and Community Care, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - W J J Assendelft
- Radboud University Nijmegen Medical Center, Department of Primary and Community Care, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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GPs' opinions of health assessment instruments for people with intellectual disabilities: a qualitative study. Br J Gen Pract 2016; 67:e41-e48. [PMID: 27993898 DOI: 10.3399/bjgp16x688585] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 10/05/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND GPs provide health care to people with intellectual disabilities (ID). People with ID find it difficult to express themselves concerning health-related matters. Applying health assessments is an effective method to reveal health needs, and can play a role in prevention and health promotion. AIM The aim of this qualitative study was to explore GPs' considerations about applying a health assessment for people with ID. DESIGN AND SETTING This focus group study was conducted among a selection of Dutch GPs. METHOD An interview guide was developed. All discussions were audiorecorded and transcribed. Analysis was performed using the framework analysis approach. Two researchers independently applied open coding and identified a thematic framework. This framework and the summaries of views per theme were discussed in the research team. RESULTS After four focus groups, with 23 GPs, saturation was reached. Three main themes evolved: health assessments in relation to GPs' responsibility; the usefulness and necessity of health assessments; and barriers to using health assessments on people with ID. A health assessment instrument for people with ID can help GPs to focus on certain issues that are not so common in the general population. GPs are motivated to use such a tool if it is scientifically tested, and results in significant health gains. However, GPs identify barriers at the level of GP, patient, and organisation. CONCLUSION Most GPs in the focus groups consider providing medical care to people with ID their responsibility and indicate that a health assessment instrument could be a valuable tool. In order to deliver good care, they need education and support. Many barriers need to be overcome before a health assessment instrument can be implemented.
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Lennox N, McPherson L, Bain C, O'Callaghan M, Carrington S, Ware RS. A health advocacy intervention for adolescents with intellectual disability: a cluster randomized controlled trial. Dev Med Child Neurol 2016; 58:1265-1272. [PMID: 27343021 DOI: 10.1111/dmcn.13174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 11/28/2022]
Abstract
AIM Adolescents with intellectual disability experience poorer heath than their peers in the general population, partially due to communication barriers and knowledge gaps in their health history. This study aimed to test a health intervention package against usual care for a range of health promotion and disease detection outcomes. METHOD A parallel-group cluster randomized controlled trial was conducted with Australian adolescents with intellectual disability living in the community. Randomization occurred at school level. The intervention package consisted of classroom-based health education, a hand-held personalized health record, and a health check. Evidence of health promotion, disease prevention, and case-finding activities were extracted from general practitioners' records for 12 months post-intervention. RESULTS Clinical data was available for 435 of 592 (73.5%) participants from 85 schools. Adolescents allocated to receive the health intervention were more likely to have their vision (odds ratio [OR] 3.3; 95% confidence interval [CI] 1.8-6.1) and hearing (OR 2.7; 95% CI 1.0-7.3) tested, their blood pressure checked (OR 2.4; 95% CI 1.6-3.7), and weight recorded (OR 4.8; 95% CI 3.1-7.6). There was no difference between health intervention and usual care for identification of new diseases. INTERPRETATION The school-based intervention package increased healthcare activity in adolescents with intellectual disability living in the community.
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Affiliation(s)
- Nicholas Lennox
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-UQ, The University of Queensland, Brisbane, Qld, Australia
| | - Lyn McPherson
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-UQ, The University of Queensland, Brisbane, Qld, Australia
| | - Chris Bain
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
| | - Michael O'Callaghan
- Paediatrics and Child Health, The University of Queensland, Brisbane, Qld, Australia
| | - Suzanne Carrington
- School of Learning & Professional Studies, Queensland University of Technology, Brisbane, Qld, Australia
| | - Robert S Ware
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-UQ, The University of Queensland, Brisbane, Qld, Australia.,UQ Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia
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Shooshtari S, Temple B, Waldman C, Abraham S, Ouellette-Kuntz H, Lennox N. Stakeholders’ Perspectives towards the Use of the Comprehensive Health Assessment Program (CHAP) for Adults with Intellectual Disabilities in Manitoba. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:672-683. [DOI: 10.1111/jar.12261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Shahin Shooshtari
- Faculty of Health Sciences; Department of Community Health Sciences; St. Amant Research Centre; University of Manitoba; Winnipeg MB Canada
| | - Beverley Temple
- Faculty of Health Sciences; College of Nursing; St. Amant Research Centre; University of Manitoba; Winnipeg MB Canada
| | - Celeste Waldman
- Faculty of Health Sciences; College of Nursing; St. Amant Research Centre; University of Manitoba; Winnipeg MB Canada
| | - Sneha Abraham
- Faculty of Health Sciences; Department of Community Health Sciences; University of Manitoba; Winnipeg MB Canada
| | | | - Nicholas Lennox
- The Queensland Centre for Intellectual and Developmental Disability; School of Medicine; South Brisbane QLD Australia
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Durbin J, Selick A, Casson I, Green L, Spassiani N, Perry A, Lunsky Y. Evaluating the Implementation of Health Checks for Adults With Intellectual and Developmental Disabilities in Primary Care: The Importance of Organizational Context. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 54:136-150. [PMID: 27028255 DOI: 10.1352/1934-9556-54.2.136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Compared to other adults, those with intellectual and developmental disabilities have more health issues, yet are less likely to receive preventative care. One strategy that has shown success in increasing prevention activities and early detection of illness is the periodic comprehensive health assessment (the health check). Effectively moving evidence into practice is a complex process that often receives inadequate attention. This qualitative study evaluates the implementation of the health check at two primary-care clinics in Ontario, Canada, and the influence of the clinic context on implementation decisions. Each clinic implemented the same core components; however, due to contextual differences, some components were operationalized differently. Adapting to the setting context is important to ensuring successful and sustainable implementation.
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Affiliation(s)
- Janet Durbin
- Janet Durbin and Avra Selick, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Avra Selick
- Janet Durbin and Avra Selick, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Ian Casson
- Ian Casson, Queen's University, Kingston, Ontario, Canada
| | - Laurie Green
- Laurie Green, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Natasha Spassiani
- Natasha Spassiani, Andrea Perry, and Yona Lunsky, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Andrea Perry
- Natasha Spassiani, Andrea Perry, and Yona Lunsky, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
| | - Yona Lunsky
- Natasha Spassiani, Andrea Perry, and Yona Lunsky, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
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van Dooren K, Dean J, Boyle FM, Taylor-Gomez M, Lennox NG. Consider the Support Worker in the Role of Health Assessments. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 29:585-586. [DOI: 10.1111/jar.12211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kate van Dooren
- Queensland Centre for Intellectual and Developmental Disability; The University of Queensland; Brisbane Qld Australia
| | - Julie Dean
- School of Public Health; The University of Queensland; Brisbane Qld Australia
| | - Frances M. Boyle
- School of Public Health; The University of Queensland; Brisbane Qld Australia
| | - Miram Taylor-Gomez
- Queensland Centre for Intellectual and Developmental Disability; The University of Queensland; Brisbane Qld Australia
| | - Nicholas G. Lennox
- Queensland Centre for Intellectual and Developmental Disability; The University of Queensland; Brisbane Qld Australia
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Lennox N, Van Driel ML, van Dooren K. Supporting primary healthcare professionals to care for people with intellectual disability: a research agenda. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 28:33-42. [PMID: 25530572 DOI: 10.1111/jar.12132] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The vast health inequities experienced by people with intellectual disability remain indisputable. Persistent and contemporary challenges exist for primary healthcare providers and researchers working to contribute to improvements to the health and well-being of people with intellectual disability. Over two decades after the only review of supports for primary healthcare providers was published, this paper contributes to an evolving research agenda that aims to make meaningful gains in health-related outcomes for this group. METHODS The present authors updated the existing review by searching the international literature for developments and evaluations of multinational models of care. RESULTS Based on our review, we present three strategies to support primary healthcare providers: (i) effectively using what we know, (ii) considering other strategies that offer support to primary healthcare professionals and (iii) researching primary health care at the system level. CONCLUSIONS Strengthening primary care by supporting equitable provision of health-related care for people with intellectual disability is a much needed step towards improving health outcomes among people with intellectual disability. More descriptive quantitative and qualitative research, as well as intervention-based research underpinned by rigorous mixed-methods evaluating these strategies at the primary care level, which is sensitive to the needs of people with intellectual disability will assist primary care providers to provide better care and achieve better health outcomes. ACCESSIBLE ABSTRACT Many people with intellectual disability have poor health. The authors reviewed what has been written by other researchers about how to improve the health of people with intellectual disability. In the future, people who support adults with intellectual disability should continue doing what they do well, think of other ways to improve health, and do more research about health. At all times, the needs of people with intellectual disability should be the greatest concern for those trying to support them.
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Affiliation(s)
- Nicholas Lennox
- Queensland Centre for Intellectual and Developmental Disability, School of Medicine, The University of Queensland, Brisbane, Qld, Australia
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Robertson J, Hatton C, Emerson E, Baines S. The impact of health checks for people with intellectual disabilities: an updated systematic review of evidence. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2450-2462. [PMID: 24984052 DOI: 10.1016/j.ridd.2014.06.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 06/03/2023]
Abstract
Health checks for people with intellectual disabilities have been recommended as one component of international health policy responses to the poorer health of people with intellectual disabilities. This review updates a previously published review summarising evidence on the impact of health checks on the health and well-being of people with intellectual disabilities. Electronic literature searches and email contacts were used to identify literature relevant to the impact of health checks for people with intellectual disabilities published from 1989 to 2013. Forty-eight publications were identified, of which eight articles and two reports were newly identified and not included in the previous review. These involved checking the health of people with intellectual disabilities from a range of countries including a full range of people with intellectual disabilities. Health checks consistently led to detection of unmet health needs and targeted actions to address health needs. Health checks also had the potential to increase knowledge of the health needs of people with intellectual disabilities amongst health professionals and support staff, and to identify gaps in health services. Health checks are effective in identifying previously unrecognised health needs, including life threatening conditions. Future research should consider strategies for optimising the cost effectiveness or efficiency of health checks.
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Affiliation(s)
- Janet Robertson
- Centre for Disability Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom.
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom
| | - Eric Emerson
- Centre for Disability Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom; Centre for Disability Research and Policy, University of Sydney, Australia
| | - Susannah Baines
- Centre for Disability Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom
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Lennox N, Ware R, Carrington S, O'Callaghan M, Williams G, McPherson L, Bain C. Ask: a health advocacy program for adolescents with an intellectual disability: a cluster randomised controlled trial. BMC Public Health 2012; 12:750. [PMID: 22958354 PMCID: PMC3560226 DOI: 10.1186/1471-2458-12-750] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/04/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents with intellectual disability often have poor health and healthcare. This is partly as a consequence of poor communication and recall difficulties, and the possible loss of specialised paediatric services. METHODS/DESIGN A cluster randomised trial was conducted with adolescents with intellectual disability to investigate a health intervention package to enhance interactions among adolescents with intellectual disability, their parents/carers, and general practitioners (GPs). The trial took place in Queensland, Australia, between February 2007 and September 2010. The intervention package was designed to improve communication with health professionals and families' organisation of health information, and to increase clinical activities beneficial to improved health outcomes. It consisted of the Comprehensive Health Assessment Program (CHAP), a one-off health check, and the Ask Health Diary, designed for on-going use. Participants were drawn from Special Education Schools and Special Education Units. The education component of the intervention was delivered as part of the school curriculum. Educators were surveyed at baseline and followed-up four months later. Carers were surveyed at baseline and after 26 months. Evidence of health promotion, disease prevention and case-finding activities were extracted from GPs clinical records. Qualitative interviews of educators occurred after completion of the educational component of the intervention and with adolescents and carers after the CHAP. DISCUSSION Adolescents with intellectual disability have difficulty obtaining many health services and often find it difficult to become empowered to improve and protect their health. The health intervention package proposed may aid them by augmenting communication, improving documentation of health encounters, and improving access to, and quality of, GP care. Recruitment strategies to consider for future studies in this population include ensuring potential participants can identify themselves with the individuals used in promotional study material, making direct contact with their families at the start of the study, and closely monitoring the implementation of the educational intervention. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT00519311.
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Affiliation(s)
- Nicholas Lennox
- Queensland Centre for Intellectual and Developmental Disability, The University of Queensland, Mater Hospital, Raymond Terrace, South Brisbane, Qld 4101, Australia.
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