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Tyrer F, Morriss R, Kiani R, Gangadharan SK, Kundaje H, Rutherford MJ. Comparing the number and length of primary care consultations in people with and without intellectual disabilities and health needs: observational cohort study using electronic health records. Fam Pract 2024; 41:501-509. [PMID: 36440948 PMCID: PMC11324320 DOI: 10.1093/fampra/cmac135] [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] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In the United Kingdom, 15-min appointments with the general practitioner (GP) are recommended for people with complex health conditions, including intellectual disabilities and health needs, but we do not know whether this happens. AIMS We compared number and length of primary care consultations (GP, nurse, other allied health, other) for people with and without intellectual disabilities and health needs. METHODS Linked primary care data from the Clinical Practice Research Datalink (CPRD) in England were used to investigate face-to-face and telephone primary care consultations in 2017-2019. Health needs investigated were: epilepsy; incontinence; severe visual/hearing impairments; severe mobility difficulties; cerebral palsy; and percutaneous endoscopic gastrostomy feeding. Age and gender-standardized consultation rates per year (Poisson), duration of consultations, and the proportion of "long consultations" (≥15 min) were reported. RESULTS People with intellectual disabilities (n = 7,794) had 1.9 times as many GP consultations per year as those without (n = 176,807; consultation rate ratio = 1.87 [95% confidence interval 1.86-1.89]). Consultation rates with nurses and allied healthcare professionals were also twice as high. Mean GP consultation time was 9-10 min regardless of intellectual disability/health need status. Long GP consultations were less common in people with intellectual disabilities (18.2% [17.8-18.7] vs. 20.9% [20.8-21.0]). Long consultations with practice nurses were more common in people with health needs, particularly severe visual loss. CONCLUSIONS People with intellectual disabilities and/or health needs tend to have more, rather than longer, GP consultations compared with the rest of the population. We recommend further investigation into the role of practice nurses to support people with intellectual disabilities and health needs.
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Affiliation(s)
- Freya Tyrer
- Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Reza Kiani
- Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicestershire Learning Disability Services (Psychiatry), Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Satheesh K Gangadharan
- Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicestershire Learning Disability Services (Psychiatry), Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Harish Kundaje
- Lakeside Healthcare, NHS General Practice, Corby, United Kingdom
| | - Mark J Rutherford
- Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
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Vestesson EM, De Corte KLA, Crellin E, Ledger J, Bakhai M, Clarke GM. Consultation Rate and Mode by Deprivation in English General Practice From 2018 to 2022: Population-Based Study. JMIR Public Health Surveill 2023; 9:e44944. [PMID: 37129943 DOI: 10.2196/44944] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/03/2023] [Accepted: 03/14/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a significant impact on primary care service delivery with an increased use of remote consultations. With general practice delivering record numbers of appointments and rising concerns around access, funding, and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and modes (ie, face-to-face versus remote). OBJECTIVE This paper describes trends in consultation rates in general practice in England for key demographics before and during the COVID-19 pandemic. We explore the use of remote and face-to-face consultations with regard to socioeconomic deprivation to understand the possible effect of changes in consultation modes on health inequalities. METHODS We did a retrospective analysis of 9,429,919 consultations by general practitioners, nurses, or other health care professionals between March 2018 and February 2022 for patients registered at 397 general practices in England. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national data sets. Negative binomial models were used to predict consultation rates and modes (ie, remote versus face-to-face) by age, sex, and socioeconomic deprivation over time. RESULTS Overall consultation rates increased by 15% from 4.92 in 2018-2019 to 5.66 in 2021-2022 with some fluctuation during the start of the COVID-19 pandemic. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups, but the extent varies by age. Consultation rates increased with increasing levels of deprivation. Socioeconomic differences in consultation rates, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18, indicating more consultations in the most deprived), effectively narrowing relative differences between deprivation quintiles. This trend remains when stratified by sex, but the difference across deprivation quintiles is smaller for men. The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultation rates compared to the least deprived. CONCLUSIONS The substantial increases in consultation rates observed in this study imply an increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas.
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Affiliation(s)
- Emma Maria Vestesson
- The Health Foundation, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | | | | | - Jean Ledger
- National Health Service England, London, United Kingdom
| | - Minal Bakhai
- National Health Service England, London, United Kingdom
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Shepherd V, Hood K, Wood F. Unpacking the 'black box of horrendousness': a qualitative exploration of the barriers and facilitators to conducting trials involving adults lacking capacity to consent. Trials 2022; 23:471. [PMID: 35668460 PMCID: PMC9167903 DOI: 10.1186/s13063-022-06422-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Trials involving adults who lack capacity to consent encounter a range of ethical and methodological challenges, resulting in these populations frequently being excluded from research. Currently, there is little evidence regarding the nature and extent of these challenges, nor strategies to improve the design and conduct of such trials. This qualitative study explored researchers’ and healthcare professionals’ experiences of the barriers and facilitators to conducting trials involving adults lacking capacity to consent. Methods Semi-structured interviews were conducted remotely with 26 researchers and healthcare professionals with experience in a range of roles, trial populations and settings across the UK. Data were analysed using thematic analysis. Results A number of inter-related barriers and facilitators were identified and mapped against key trial processes including during trial design decisions, navigating ethical approval, assessing capacity, identifying and involving alternative decision-makers and when revisiting consent. Three themes were identified: (1) the perceived and actual complexity of trials involving adults lacking capacity, (2) importance of having access to appropriate support and resources and (3) need for building greater knowledge and expertise to support future trials. Barriers to trials included the complexity of the legal frameworks, the role of gatekeepers, a lack of access to expertise and training, and the resource-intensive nature of these trials. The ability to conduct trials was facilitated by having prior experience with these populations, effective communication between research teams, public involvement contributions, and the availability of additional data to inform the trial. Participants also identified a range of context-specific recruitment issues and highlighted the importance of ‘designing in’ flexibility and the use of adaptive strategies which were especially important for trials during the COVID-19 pandemic. Participants identified a need for better training and support. Conclusions Researchers encountered a number of barriers, including both generic and context or population-specific challenges, which may be reinforced by wider factors such as resource limitations and knowledge deficits. Greater access to expertise and training, and the development of supportive interventions and tailored guidance, is urgently needed in order to build research capacity in this area and facilitate the successful delivery of trials involving this under-served population.
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Affiliation(s)
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Fiona Wood
- PRIME Centre Wales, Cardiff, UK.,Division of Population Medicine, Cardiff University, Cardiff, UK
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Tyrer F, Morriss R, Kiani R, Gangadharan SK, Kundaje H, Rutherford MJ. Health Needs and Their Relationship with Life Expectancy in People with and without Intellectual Disabilities in England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6602. [PMID: 35682186 PMCID: PMC9180100 DOI: 10.3390/ijerph19116602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/04/2022]
Abstract
Health needs are common in people living with intellectual disabilities, but we do not know how they contribute to life expectancy. We used the Clinical Practice Research Datalink (CPRD) linked with hospital/mortality data in England (2017-2019) to explore life expectancy among people with or without intellectual disabilities, indicated by the presence or absence, respectively, of: epilepsy; incontinence; severe visual loss; severe visual impairment; severe mobility difficulties; cerebral palsy and PEG feeding. Life expectancy and 95% confidence intervals were compared using flexible parametric methods. At baseline, 46.4% (total n = 7794) of individuals with intellectual disabilities compared with 9.7% (total n = 176,807) in the comparison group had ≥1 health need. Epilepsy was the most common health need (18.7% vs. 1.1%). All health needs except hearing impairment were associated with shorter life expectancy: PEG feeding and mobility difficulties were associated with the greatest loss in life years (65-68% and 41-44%, respectively). Differential life expectancy attenuated but remained (≈12% life years lost) even after restricting the population to those without health needs (additional years expected to live at 10 years: 65.5 [60.3, 71.1] vs. 74.3 [73.8, 74.7]). We conclude that health needs play a significant role but do not explain all of the differential life expectancy experienced by people with intellectual disabilities.
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Affiliation(s)
- Freya Tyrer
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK;
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham NG7 2TU, UK;
| | - Reza Kiani
- Leicestershire Learning Disability Services (Psychiatry), Leicestershire Partnership NHS Trust, Leicester LE4 8PQ, UK; (R.K.); (S.K.G.)
- Mental Health, Ageing, Public Health and Primary Care Research Group, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Satheesh K. Gangadharan
- Leicestershire Learning Disability Services (Psychiatry), Leicestershire Partnership NHS Trust, Leicester LE4 8PQ, UK; (R.K.); (S.K.G.)
- Mental Health, Ageing, Public Health and Primary Care Research Group, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Harish Kundaje
- Lakeside Healthcare, Cottingham Road, Corby NN17 2UR, UK;
| | - Mark J. Rutherford
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK;
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Ali A, Brown E, Tsang W, Spector A, Aguirre E, Hoare S, Hassiotis A. Individual cognitive stimulation therapy (iCST) for people with intellectual disability and dementia: a feasibility randomised controlled trial. Aging Ment Health 2022; 26:698-708. [PMID: 33393364 DOI: 10.1080/13607863.2020.1869180] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To examine the feasibility, acceptability and fidelity of individual Cognitive Stimulation Therapy (iCST) in people with intellectual disability (ID) and dementia. METHOD We aimed to recruit forty dyads (carer and individual with dementia and ID) who were randomised to iCST or a waiting list control group. Both groups received treatment as usual. Family and paid carers delivered the manualised intervention (40 sessions over 20 weeks). Recruitment and retention of participants, intervention adherence, fidelity and acceptability were assessed. Outcome measures of cognition, adaptive functioning, quality of life (QoL) and carer outcomes were collected at baseline, midpoint (11 weeks) and at 21 weeks. Qualitative interviews were conducted with six carers about their experience of iCST. RESULTS Forty dyads were recruited over 10 months from 12 National Health Service trusts. One dyad dropped out and 87.5% and 97.5% completed the midpoint and end-point assessments respectively. Assessment of fidelity indicated that the correct session structure was not followed; 70% completed at least 20 sessions and there was a high level of satisfaction with iCST. QoL was significantly higher in the iCST arm at 21 weeks (adjusted mean difference: 3.11; 95% CI: 0.64 to 5.58). There were no differences in the other outcome measures. CONCLUSION The intervention was feasible and acceptable. A full-scale trial is warranted but some modifications are needed, including improved training and supervision for carers to improve fidelity.
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Affiliation(s)
- Afia Ali
- Division of Psychiatry, University College London, London, UK
| | - Emma Brown
- Division of Psychiatry, University College London, London, UK
| | - Winnie Tsang
- Division of Psychiatry, University College London, London, UK
| | - Aimee Spector
- Clinical, Education and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Elisa Aguirre
- Talking Therapies, Barking & Dagenham IAPT, North East London NHS Foundation Trust, London, UK
| | - Sarah Hoare
- Community Learning Disabilities Team, North East London NHS Foundation Trust, London, UK
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Gannon BS, Gregg A, Wang H, Marshall ME, Yerby LG, Jenkins C, Parton JM. A medical home for children in foster care reduces expenditures. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2039146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Brian S. Gannon
- College of Community Health Sciences, Pediatrics, The University of Alabama, Tuscaloosa, AL, USA
| | - Abbey Gregg
- College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL, USA
| | - Hui Wang
- College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL, USA
| | | | - Lea G. Yerby
- College of Community Health Sciences, Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL, USA
| | - Caroline Jenkins
- Institute of Data and Analytics, The University of Alabama, Tuscaloosa, AL, USA
| | - Jason M. Parton
- Institute of Data and Analytics, The University of Alabama, Tuscaloosa, AL, USA
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Dharampuriya PR, Abend SL. Roadmap for Creating Effective Communication Tools to Improve Health Equity for Persons With Intellectual and Developmental Disabilities. FRONTIERS IN HEALTH SERVICES 2022; 2:859008. [PMID: 36925890 PMCID: PMC10012612 DOI: 10.3389/frhs.2022.859008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022]
Abstract
Persons with intellectual and developmental disabilities (IDD) live 20 fewer years than the average person and almost 40% of their deaths are from preventable causes. They suffer from well-documented disparities in health and healthcare, and much of this inequity is rooted in information transfer failures between patients, their caregivers, and their healthcare providers. Tools to improve communication between these stakeholders, such as health checks and hand-held health records, or health passports, have been implemented in Europe, Australia and Canada with mixed results, and there are no standard information tools currently in widespread use in the U.S. We review the evidence of the effectiveness of these tools, as well as their barriers to adoption, to inform proposed development of next-generation information transfer tools most useful to patients with IDD and their healthcare providers. The repair of health information transfer failures will be a major step toward achieving health equity for this population.
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Affiliation(s)
- Priyanka R Dharampuriya
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Knoxville, TN, United States.,The Right Care Now Project, Inc., Westborough, MA, United States
| | - Susan L Abend
- The Right Care Now Project, Inc., Westborough, MA, United States
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9
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Tyrer F, Morriss R, Kiani R, Gangadharan SK, Rutherford MJ. Mortality disparities and deprivation among people with intellectual disabilities in England: 2000-2019. J Epidemiol Community Health 2021; 76:168-174. [PMID: 34244310 DOI: 10.1136/jech-2021-216798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/03/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The effect of policy initiatives and deprivation on mortality disparities in people with intellectual disabilities is not clear. METHODS An electronic health record observational study of linked primary care data in England from the Clinical Practice Research Datalink and the Office for National Statistics deaths data from 2000 to 2019 was undertaken. All-cause and cause-specific mortality for people with intellectual disabilities were calculated by gender and deprivation status (index of multiple deprivation quintile) using direct age-standardised mortality rates (all years) and ratios (SMR; 2000-2009 vs 2010-2019). RESULTS Among 1.0 million patients (n=33 844 with intellectual disability; n=980 586 general population without intellectual disability), differential mortality was consistently higher in people with intellectual disabilities and there was no evidence of attenuation over time. There was a dose-response relationship between all-cause mortality and lower deprivation quintile in the general population which was not observed in people with intellectual disabilities. Cause-specific SMR were consistent in both the 2000-2009 and 2010-2019 calendar periods, with a threefold increased risk of death in both males and females with intellectual disabilities (SMR ranges: 2.91-3.51). Mortality was highest from epilepsy (SMR ranges: 22.90-52.74) and aspiration pneumonia (SMR ranges: 19.31-35.44). SMRs were disproportionately high for people with intellectual disabilities living in the least deprived areas. CONCLUSIONS People with intellectual disabilities in England continue to experience significant mortality disparities and there is no evidence that the situation is improving. Deprivation indicators may not be effective for targeting vulnerable individuals.
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Affiliation(s)
- Freya Tyrer
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Reza Kiani
- Intellectual Disability Psychiatry Department, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Satheesh K Gangadharan
- Intellectual Disability Psychiatry Department, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Mark J Rutherford
- Department of Health Sciences, University of Leicester, Leicester, UK
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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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Cuccu Z, Bourne T, Abi-Aad G, Bennett S. Linked data analysis of learning disability health checks and emergency hospital admissions in the Kent Integrated Dataset. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:211-217. [PMID: 33012026 DOI: 10.1111/jar.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND People with learning disabilities have higher rates of admitted patient care than the general population. This study explored emergency hospital admissions during 2018/19 in association with learning disability health check recording in general practice within the Kent Integrated Dataset during 2016/17 to 2018/19. METHODS Multiple logistic regression evaluated the odds of emergency hospital admission by sex, age, deprivation, residence, risk score, long-term conditions, severe health needs and health check. During 2018/19, one or more emergency hospital admissions were recorded for 10.9% of the 5,759 persons recorded with learning disability. RESULTS There were lower odds of emergency hospital admission in persons having had learning disability health check in the past 3 years even after adjustment. CONCLUSIONS Comparison to nationally representative research suggests a consistent finding of benefit from learning disability health check on indicators of unplanned care use, supporting the view that learning disability health checks facilitate the addressing of key health needs.
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12
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Alfageh BH, Man KKC, Besag FMC, Alhawassi TM, Wong ICK, Brauer R. Psychotropic Medication Prescribing for Neuropsychiatric Comorbidities in Individuals Diagnosed with Autism Spectrum Disorder (ASD) in the UK. J Autism Dev Disord 2019; 50:625-633. [PMID: 31724119 PMCID: PMC6994549 DOI: 10.1007/s10803-019-04291-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Autism spectrum disorder (ASD) is a lifelong disorder. In the UK, risperidone is the only psychotropic medication approved for the management of the behavioural symptoms that may accompany autism. This is a population-based study aimed to provide an evaluation of the changing trend in the incidence and prevalence of ASD and to analyse the pattern of psychotropic medication prescribing in the UK. 20,194 patients with ASD were identified. The prevalence increased 3.3-fold from 0.109 per 100 persons in 2009 to 0.355 per 100 persons in 2016. Approximately one-third of the identified cohort was prescribed at least one psychotropic medication. Although the medications approved to manage the symptoms of ASD are limited, the prescribing of such medications is increasing.
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Affiliation(s)
- Basmah H Alfageh
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.,College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Kenneth K C Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.,Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank M C Besag
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.,East London Foundation NHS Trust, Bedfordshire, UK.,Maudsley Hospital & Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tariq M Alhawassi
- College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ian C K Wong
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ruth Brauer
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
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