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Gilliand M, Bernier Emch A, Perrenoud B. Adults with intellectual disabilities' satisfaction regarding their hospitalization: A correlational descriptive study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231193461. [PMID: 37565271 DOI: 10.1177/17446295231193461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
When hospitalized, adults with intellectual disabilities are more anxious and have more unmet needs than the general population. Despite these problems, studies report contradictory results about their satisfaction with hospitalization. The aim of this study was to determine the level of satisfaction of adults with intellectual disabilities regarding their hospital care and the factors associated with satisfaction. An analysis of the Patient Satisfaction Scale (PSS) and Cognitive Appraisal of Health Scale (CAHS) instruments completed by adults with intellectual disabilities, or their caregivers, after hospitalization was done. The 32 participants' mean PSS score was 3.6/5, with means of 13.3/25 and 8.7/25 on the CAHS' 'harm/loss' dimension and 'challenge' dimension, respectively. None of the factors studied was associated with the total PSS score. Adults with intellectual disabilities were not fully satisfied with their hospital care, experiencing challenges and losses. These findings call for a rethink of the care provided to this population.
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Affiliation(s)
- Morgane Gilliand
- HESAV School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland; Institute of Higher Education and Research in Healthcare-IUFRS, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | - Béatrice Perrenoud
- Lausanne University Hospital (CHUV), Lausanne, Switzerland; La Source School of Nursing Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
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2
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Sandberg M, Axmon A, Ahlström G, Kristensson J. Predictors of specialist somatic healthcare utilization among older people with intellectual disability and their age-peers in the general population: a national register study. BMJ Open 2023; 13:e072679. [PMID: 37407048 DOI: 10.1136/bmjopen-2023-072679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES To compare somatic healthcare usage among older people with intellectual disabilities (ID) to that of their age-peers in the general population, taking into account health and demographic factors, and to identify predictors for somatic healthcare usage among older people with ID. PARTICIPANTS Equally sized cohorts, one with people with ID and one referent cohort, one-to-one-matched by sex and year of birth, were created. Each cohort comprised 7936 people aged 55+ years at the end of 2012. DESIGN Retrospective register-based study. SETTING All specialist inpatient and outpatient healthcare clinics in Sweden. OUTCOME MEASURES Data regarding planned/unplanned and inpatient/outpatient specialist healthcare were collected from the Swedish National Patient Register for 2002-2012. Diagnoses, previous healthcare usage, sex, age and cohort affiliation was used to investigate potential impact on healthcare usage. RESULTS Compared with the referent cohort, the ID cohort were more likely to have unplanned inpatient and outpatient care but less likely to have planned outpatient care. Within the ID cohort, sex, age and previous use of healthcare predicted healthcare usage. CONCLUSIONS Older people with ID seem to have lower risks of planned outpatient care compared with the general population that could not be explained by diagnoses. Potential explanations are that people with ID suffer from communication difficulties and experience the healthcare environment as unfriendly. Moreover, healthcare staff lack knowledge about the particular needs of people with ID. Altogether, this may lead to people with ID being exposed to discrimination. Although these problems are known, few interventions have been evaluated, especially related to planned outpatient care.
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Affiliation(s)
- Magnus Sandberg
- Department of Health Sciences, Lunds Universitet, Lund, Sweden
| | - Anna Axmon
- EPI@LUND (Epidemiology, Population studies and Infrastructures at Lund University), Division of Occupational and Environmental Medicine, Lunds University, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Lunds Universitet, Lund, Sweden
| | - Jimmie Kristensson
- Department of Health Sciences, Lunds Universitet, Lund, Sweden
- Institute for Palliative Care, Lund University, Region Skåne, Lund, Sweden
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Acosta EM, Dongarwar D, Everett T, Salihu HM. Understanding Characteristics and Predictors of Admission From the Emergency Department for Patients With Intellectual Disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:465-476. [PMID: 36454616 DOI: 10.1352/1934-9556-60.6.465] [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: 01/11/2021] [Accepted: 01/31/2022] [Indexed: 06/17/2023]
Abstract
The goal of this investigation is to compare rates of admission from the emergency department (ED) and the characteristics of patients with intellectual disability (ID) who get admitted from the ED. This was a retrospective study using data from the United States' Nationwide Emergency Data Sample (NEDS) to investigate the associations between the diagnosis of ID and admission to the hospital in patients ≥ 18 years during the years 2016-2017. Adults with ID were almost four times as likely to be admitted to the hospital from the ED as patients who were not identified as having ID. Identifying the major contributors to increased admission for patients with ID may help improve their care.
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Affiliation(s)
- Elisha M Acosta
- Elisha M. Acosta, Deepa Dongarwar, Tara Everett, and Hamisu M. Salihu, Baylor College of Medicine
| | - Deepa Dongarwar
- Elisha M. Acosta, Deepa Dongarwar, Tara Everett, and Hamisu M. Salihu, Baylor College of Medicine
| | - Tara Everett
- Elisha M. Acosta, Deepa Dongarwar, Tara Everett, and Hamisu M. Salihu, Baylor College of Medicine
| | - Hamisu M Salihu
- Elisha M. Acosta, Deepa Dongarwar, Tara Everett, and Hamisu M. Salihu, Baylor College of Medicine
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Olsen MI, Halvorsen MB, Søndenaa E, Strand BH, Langballe EM, Årnes A, Michalsen H, Larsen FK, Gamst W, Bautz-Holter E, Anke A. Factors associated with non-completion of and scores on physical capability tests in health surveys: The North Health in Intellectual Disability Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:231-242. [PMID: 34643025 DOI: 10.1111/jar.12942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 06/25/2021] [Accepted: 09/15/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study investigated the completion rates, scores and factors associated with non-completion and low scores on physical capability tests in a health survey administered to adults with intellectual disabilities. METHOD Assessment comprised body mass index (BMI), the Short Physical Performance Battery (SPPB), the timed up-and-go (TUG) test, the one-legged stance (OLS) test; and gross motor, communication and behavioural functioning tests. RESULTS The completion rates among 93 participants (aged 17-78) were 46% for the SPPB, 42% for the TUG, and 31% for the OLS. More severe intellectual disability (OR = 3.12, p < .001) and lower BMI (OR = 0.859, p = .001) were related to test non-completion. The SPPB scores were below the reference values from the general population. Lower scores were associated with older age, motor disabilities and intellectual disability severity. CONCLUSIONS Including physical capability tests in health surveys among adults with intellectual disabilities is important to monitor functional status and guide prevention strategies.
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Affiliation(s)
- Monica Isabel Olsen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marianne Berg Halvorsen
- Department of Paediatric Rehabilitation, University Hospital of North Norway, Tromsø, Norway
| | - Erik Søndenaa
- Faculty of Medicine, Institute of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Brøset, St. Olavs University Hospital, Trondheim, Norway
| | - Bjørn Heine Strand
- Norwegian National Advisory Unit on Ageing and Health, Vestfold County Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Ellen Melbye Langballe
- Norwegian National Advisory Unit on Ageing and Health, Vestfold County Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Anders Årnes
- Department of Pain, University Hospital of North Norway, Tromsø, Norway
| | - Henriette Michalsen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Frode Kibsgaard Larsen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold County Hospital Trust, Tønsberg, Norway
| | - Wenche Gamst
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Erik Bautz-Holter
- Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Model and Services (CHARM), University of Oslo, Oslo, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway.,Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Model and Services (CHARM), University of Oslo, Oslo, Norway
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5
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Drozd M, Chadwick D, Jester R. An integrative review of the hospital experiences of people with an intellectual disability: Lack of orthopaedic and trauma perspectives. Int J Orthop Trauma Nurs 2020; 39:100795. [DOI: 10.1016/j.ijotn.2020.100795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/16/2020] [Accepted: 06/29/2020] [Indexed: 01/13/2023]
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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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7
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Axmon A, Ahlström G, Sandberg M. Falls resulting in health care among older people with intellectual disability in comparison with the general population. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:193-204. [PMID: 30407691 PMCID: PMC7379981 DOI: 10.1111/jir.12564] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 09/25/2018] [Accepted: 10/21/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Falls are common among older people with intellectual disability (ID) and are also a major contributor to injuries in this population. Yet, fall characteristics have only been sparsely studied, and the results are inconsistent. The aim of the present study was to investigate type of falls, places where they occurred and activities that caused them, as well as health outcomes and health utilisation patterns after falls, among older people with ID in comparison with their age peers in the general population. METHODS We established an administrative cohort of people with ID aged 55 years, or more, and alive at the end of 2012 (ID cohort; n = 7936). A cohort from the general population, one-to-one matched by sex and year of birth, was used as referents. Data regarding fall-induced health care episodes in inpatient and outpatient specialist care were collected from the National Patient Register for the period 2002-2012. RESULTS With the exception of falls from one level to another (i.e. fall on and from stairs and steps, ladder and scaffolding; fall from, out of or through building or structure; fall from tree or cliff and diving or jumping into water; or other fall from one level to another), people in the ID cohort were more likely to fall and fall more often than those in the general population cohort. Falls during a vital activity (e.g. attending to personal hygiene or eating) were twice as common among people with ID compared with the general population. When falling, people with ID were more likely to injure their head and legs but less likely to sustain injuries to the thorax and elbow/forearm. They were more likely to have superficial injuries, open wounds and fractures but less likely to have dislocations, sprain and strains. Fall-related health care visits among people with ID were more likely to be in inpatient care and be unplanned. People with ID were also more likely than those in the general population to have a readmission within 30 days. CONCLUSIONS People with ID are more likely to require specialist care after a fall and also more likely to obtain injuries to the head, compared with the general population. This is important to consider when taking preventive measures to reduce falls and fall-related injuries.
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Affiliation(s)
- A. Axmon
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of MedicineLund UniversityLundSweden
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
| | - G. Ahlström
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
| | - M. Sandberg
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
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8
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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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9
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Amor-Salamanca A, Menchon JM. Rate and characteristics of urgent hospitalisation in persons with profound intellectual disabilities compared with general population. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:179-186. [PMID: 29082562 DOI: 10.1111/jir.12436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 09/19/2017] [Accepted: 09/22/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Little is known about the hospitalisation rate of adults with severe/profound intellectual disability (PID) presenting at emergency services or about the appropriateness of hospital admissions in this population. Examining the possible differences in the patterns of hospitalisation between people with PID and those without intellectual disability (ID) may shed light on aspects of health and illness in these patients and may in turn make it possible to differentiate more clearly between mild-moderate ID and PID. METHODS After an evaluation of the emergency visits made by adults with PID and by people without ID, patients in both groups requiring one or more hospitalisations were subsequently followed up for 18 months. The appropriateness of the decision to hospitalise was assessed using the ambulatory care-sensitive conditions index. RESULTS There were no differences in the proportion of people with PID and controls admitted to hospital after their emergency visit. The median hospital stay was higher for PIDs: 7.5 vs. 4 days for controls. People with PID were admitted more than controls for respiratory reasons and somewhat less for other somatic causes unrelated to the nervous system. There were no admissions for psychiatric causes in the group with PID other than unspecified conduct disorders. There were no differences in other diagnostic groups. The rate of inappropriate admissions was similar in the two study groups. CONCLUSIONS In contrast to previous results reported for the group with ID as a whole, patients with PID consulting the emergency service were not admitted to hospital more frequently than the general population nor did they present a higher rate of inappropriate admissions. These results support the utility of maintaining two distinct groups of people with ID: mild-moderate and severe-profound.
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Affiliation(s)
- A Amor-Salamanca
- Department of Psychiatry, Fundación Vallparadís, Mutua Terrassa University Hospital, Barcelona, Spain
| | - J M Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona. Cibersam, Barcelona, Spain
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10
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Carey IM, Hosking FJ, Harris T, DeWilde S, Beighton C, Cook DG. An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
People with intellectual disability (ID) have poorer health than the general population; however, there is a lack of comprehensive national data describing their health-care needs and utilisation. Annual health checks for adults with ID have been incentivised through primary care since 2009, but only half of those eligible for such a health check receive one. It is unclear what impact health checks have had on important health outcomes, such as emergency hospitalisation.
Objectives
To evaluate whether or not annual health checks for adults with ID have reduced emergency hospitalisation, and to describe health, health care and mortality for adults with ID.
Design
A retrospective matched cohort study using primary care data linked to national hospital admissions and mortality data sets.
Setting
A total of 451 English general practices contributing data to Clinical Practice Research Datalink (CPRD).
Participants
A total of 21,859 adults with ID compared with 152,846 age-, gender- and practice-matched controls without ID registered during 2009–13.
Interventions
None.
Main outcome measures
Emergency hospital admissions. Other outcomes – preventable admissions for ambulatory care sensitive conditions, and mortality.
Data sources
CPRD, Hospital Episodes Statistics and Office for National Statistics.
Results
Compared with the general population, adults with ID had higher levels of recorded comorbidity and were more likely to consult in primary care. However, they were less likely to have long doctor consultations, and had lower continuity of care. They had higher mortality rates [hazard ratio (HR) 3.6, 95% confidence interval (CI) 3.3 to 3.9], with 37.0% of deaths classified as being amenable to health-care intervention (HR 5.9, 95% CI 5.1 to 6.8). They were more likely to have emergency hospital admissions [incidence rate ratio (IRR) 2.82, 95% CI 2.66 to 2.98], with 33.7% deemed preventable compared with 17.3% in controls (IRR 5.62, 95% CI 5.14 to 6.13). Health checks for adults with ID had no effect on overall emergency admissions compared with controls (IRR 0.96, 95% CI 0.87 to 1.07), although there was a relative reduction in emergency admissions for ambulatory care-sensitive conditions (IRR 0.82, 95% CI 0.69 to 0.99). Practices with high health check participation also showed a relative fall in preventable emergency admissions for their patients with ID, compared with practices with minimal participation (IRR 0.73, 95% CI 0.57 to 0.95). There were large variations in the health check-related content that was recorded on electronic records.
Limitations
Patients with milder ID not known to health services were not identified. We could not comment on the quality of health checks.
Conclusions
Compared with the general population, adults with ID have more chronic diseases and greater primary and secondary care utilisation. With more than one-third of deaths potentially amenable to health-care interventions, improvements in access to, and quality of, health care are required. In primary care, better continuity of care and longer appointment times are important examples that we identified. Although annual health checks can also improve access, not every eligible adult with ID receives one, and health check content varies by practice. Health checks had no impact on overall emergency admissions, but they appeared influential in reducing preventable emergency admissions.
Future work
No formal cost-effectiveness analysis of annual health checks was performed, but this could be attempted in relation to our estimates of a reduction in preventable emergency admissions.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Iain M Carey
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Fay J Hosking
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Tess Harris
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Stephen DeWilde
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Carole Beighton
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George’s, University of London, London, UK
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11
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Hosking FJ, Carey IM, DeWilde S, Harris T, Beighton C, Cook DG. Preventable Emergency Hospital Admissions Among Adults With Intellectual Disability in England. Ann Fam Med 2017; 15:462-470. [PMID: 28893817 PMCID: PMC5593730 DOI: 10.1370/afm.2104] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 03/02/2017] [Accepted: 03/27/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Adults with intellectual disabilities experience poorer physical health and health care quality, but there is limited information on the potential for reducing emergency hospital admissions in this population. We describe overall and preventable emergency admissions for adults with vs without intellectual disabilities in England and assess differences in primary care management before admission for 2 common ambulatory care-sensitive conditions (ACSCs). METHODS We used electronic records to study a cohort of 16,666 adults with intellectual disabilities and 113,562 age-, sex-, and practice-matched adults without intellectual disabilities from 343 English family practices. Incident rate ratios (IRRs) from conditional Poisson regression were analyzed for all emergency and preventable emergency admissions. Primary care management of lower respiratory tract infections and urinary tract infections, as exemplar ACSCs, before admission were compared in unmatched analysis between adults with and without intellectual disabilities. RESULTS The overall rate for emergency admissions for adults with vs without intellectual disabilities was 182 vs 68 per 1,000 per year (IRR = 2.82; 95% CI, 2.66-2.98). ACSCs accounted for 33.7% of emergency admissions among the former compared with 17.3% among the latter (IRR = 5.62; 95% CI, 5.14-6.13); adjusting for comorbidity, smoking, and deprivation did not fully explain the difference (IRR = 3.60; 95% CI, 3.25-3.99). Although adults with intellectual disability were at nearly 5 times higher risk for admission for lower respiratory tract infections and urinary tract infections, they had similar primary care use, investigation, and management before admission as the general population. CONCLUSIONS Adults with intellectual disabilities are at high risk for preventable emergency admissions. Identifying strategies for better detecting and managing ACSCs, including lower respiratory and urinary tract infections, in primary care could reduce hospitalizations.
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Affiliation(s)
- Fay J Hosking
- Population Health Research Institute, St George's University of London, United Kingdom
| | - Iain M Carey
- Population Health Research Institute, St George's University of London, United Kingdom
| | - Stephen DeWilde
- Population Health Research Institute, St George's University of London, United Kingdom
| | - Tess Harris
- Population Health Research Institute, St George's University of London, United Kingdom
| | - Carole Beighton
- Population Health Research Institute, St George's University of London, United Kingdom
| | - Derek G Cook
- Population Health Research Institute, St George's University of London, United Kingdom
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Chronic Respiratory Disorders and Their Treatment among Older People with Intellectual Disability and/or Autism Spectrum Disorder in Comparison with the General Population. Healthcare (Basel) 2017; 5:healthcare5030040. [PMID: 28763010 PMCID: PMC5618168 DOI: 10.3390/healthcare5030040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 02/08/2023] Open
Abstract
Respiratory disorders are common among people with intellectual disabilities (ID). However, few studies have investigated these disorders among older people with ID. We identified 7936 people, aged 55+ years, with ID and a reference cohort from the general population. Data on diagnoses of chronic respiratory disorders, with a focus on asthma and chronic obstructive pulmonary disease (COPD), were collected, as was information on health care visits due to such disorders. We also added data on the prescription of drugs for obstructive airway diseases. Whereas the risk of having at least one diagnosis of asthma during the study period was similar in the two cohorts, people with ID were less likely than the general population to have been diagnosed with COPD. The same was found for health care visits due to asthma and COPD, respectively. The patterns of drug prescription were similar among people with ID and the general population, with the exception of adrenergics for systemic use, which were more commonly prescribed to people with ID. Thus, older people with ID do not seem to have an increased risk of asthma or COPD. Moreover, the indications are that when diagnosed with any of these disorders, they receive treatment adapted to their particular needs.
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Axmon A, Björne P, Nylander L, Ahlström G. Psychiatric care utilization among older people with intellectual disability in comparison with the general population: a register study. BMC Psychiatry 2016; 16:389. [PMID: 27829383 PMCID: PMC5103447 DOI: 10.1186/s12888-016-1094-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with intellectual disability have been found to have higher prevalence of psychiatric disorders than the general population. However, they do not seem to have a corresponding increase in psychiatric care utilization. The aim of the present study was to investigate psychiatric care utilization among older people with intellectual disability. METHODS We used a cohort of people with intellectual disability, 55+ years in 2012 (n = 7936), and an equally sized age and sex matched reference cohort from the general population. Psychiatric care utilization was measured using registrations in the Swedish National Patient register during 2002-2012, where each registration corresponds to a psychiatric care occasion. RESULTS About 20 % of those with intellectual disability had at least one registration during the study period, compared to some 6 % in the general population sample. In the whole cohort as well as stratified by sex, people with intellectual disability were 3-4 times more likely than those in the general population sample to have had at least one registration during the study period. The effect was, however, only consistent in age groups comprising people younger than 65 years. Among people with intellectual disability, men were more likely than women to have had at least one registration, and people living in special housing (group home or service home) during the entire study period were less likely than those who only lived in special housing for parts of the study or not at all. People with intellectual disability had longer stays per inpatient registration compared with the general population sample. When stratifying on sex, the effect was found only among men, although there were no sex differences within the cohort of people with intellectual disability. Among people with intellectual disability, living in special housing during the entire study period was associated with shorter stays per inpatient registration. CONCLUSIONS Although people with intellectual disability had higher psychiatric care utilization than the general population during the 11 year study period, it does not correspond to the high prevalence of psychiatric disorders in this population. Future research is required to establish if the level of care utilization is appropriate among older people with intellectual disability.
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Affiliation(s)
- A. Axmon
- Department of Occupational and Environmental Medicine, Lund University, SE-221 00 Lund, Sweden
| | - P. Björne
- Research and Development Unit, City Office, City of Malmö, SE-205 80 Malmö, Sweden
| | - L. Nylander
- Department of Clinical Sciences/Psychiatry, Lund University, SE-221 00 Lund, Sweden ,Gillberg Neuropsychiatry Centre, University of Gothenburg, SE-411 19 Göteborg, Sweden
| | - G. Ahlström
- Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden
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Sandberg M, Ahlström G, Axmon A, Kristensson J. Somatic healthcare utilisation patterns among older people with intellectual disability: an 11-year register study. BMC Health Serv Res 2016; 16:642. [PMID: 27829424 PMCID: PMC5103402 DOI: 10.1186/s12913-016-1880-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 10/30/2016] [Indexed: 12/02/2022] Open
Abstract
Background People with intellectual disabilities (ID) are known to have more diseases and are believed to start aging earlier than the general population. The population of older people with ID is growing, but knowledge about their use of healthcare is limited. This study aimed to explore somatic healthcare utilisation patterns among people with ID living in Sweden, in comparison with the general population from 2002 to 2012. Methods Participants were a group of people with ID (n = 7936) aged 55 years and older in 2012, and an equal-sized, birth year and sex matched, general population sample (n = 7936). Participants were divided into age groups of 5-year intervals. Data regarding in- and outpatient care were collected from the Swedish National Patient Register. Results In the younger age groups, the ID group had higher healthcare utilisation compared with the general population sample, with higher risks for planned and unplanned somatic in- and outpatient care, particularly for unplanned inpatient registrations. Decreasing patterns were seen with age; with lower risks in the ID group for the oldest age groups. This was most evident in planned somatic in- and outpatient care. In those with at least one registration, the ID group had a longer unplanned length of stay in the younger age groups, but fewer planned visits to physicians in somatic outpatient care compared with the control group. Conclusions Compared with the general population, people with ID show higher healthcare utilisation in younger age groups. Healthcare utilisation decreases with age, and in old age, fewer people with ID use healthcare compared with the general population. The barriers to accessing planned healthcare for older people with ID need more investigation. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1880-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Magnus Sandberg
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
| | - Anna Axmon
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.,Department of Occupational and Environmental Medicine, Lund University, SE-221 85, Lund, Sweden
| | - Jimmie Kristensson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.,Department of Health, Blekinge Institute of Technology, SE-371 45, Karlskrona, Sweden
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