1
|
Pouls KPM, Mastebroek M, Ligthart SJ, Assendelft WJJ, Leusink GL, Koks-Leensen MCJ. Primary mental healthcare for adults with mild intellectual disabilities: Patients' perspectives. Eur J Gen Pract 2024; 30:2354414. [PMID: 38757401 PMCID: PMC11104687 DOI: 10.1080/13814788.2024.2354414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND People with mild intellectual disabilities (MID) experience more mental health (MH) problems than the general population but often do not receive appropriate primary MH care. Primary MH care is essential in integrative MH care and, therefore, demands high quality. To improve primary MH care for this patient group, account must be taken of the experiences of people with MID. So far, their perspectives have been largely absent from primary MH care research. OBJECTIVES To explore patients' experiences, needs, and suggestions for improvement regarding primary MH care for people with MID. METHODS Qualitative study among adults with MID who visited their GP with MH problems in the previous 12 months. Semi-structured interviews were conducted using a guide based on Person-Centred Primary Care Measures. Transcripts were analysed thematically. RESULTS The 11 interviews that we conducted revealed four themes. The first theme, cumulative vulnerability, describes the vulnerability - instigated by the MID and reinforced by MH problems - experienced on a GP visit. The other themes (needs regarding the GP, needs regarding the network, self-determination) arise from this vulnerability. CONCLUSION People with both MID and MH problems are extra vulnerable in primary care but desire self-determination regarding their MH care trajectory. This requires investment in a good GP-patient relationship and the organisation of additional support to meet these patients' needs, for which collaborative care with the patient, the patient's network, and other (care) professionals is of utmost importance.
Collapse
Affiliation(s)
- Katrien PM. Pouls
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mathilde Mastebroek
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Suzanne J. Ligthart
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem JJ. Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Geraline L. Leusink
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Monique CJ. Koks-Leensen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
2
|
Nijhof K, Boot FH, Naaldenberg J, Leusink GL, Bevelander KE. Health support of people with intellectual disability and the crucial role of support workers. BMC Health Serv Res 2024; 24:4. [PMID: 38167137 PMCID: PMC10763292 DOI: 10.1186/s12913-023-10206-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/24/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND People with intellectual disability have a poorer health status than the general population. In The Netherlands, support workers play a key role in meeting health support needs of people with intellectual disability. Research on how people with intellectual disability and their support workers experience the support worker's role in preventing, identifying, and following up health needs of people with intellectual disability is scarce. To enhance health support of people with intellectual disability it is crucial that we understand how health support is delivered in everyday practice. Therefore, this study investigated experiences of people with intellectual disability and support workers with the health support of people with intellectual disability. METHOD Data collection consisted of six focus group (FG) discussions with between four and six participants (N = 27). The FGs consisted of three groups with support workers (n = 15), two groups with participants with mild to moderate intellectual disability (n = 8), and one group with family members as proxy informants who represented their relative with severe to profound intellectual disability (n = 4). The data was analysed thematically on aspects relating to health support. RESULTS We identified three main themes relevant to the health support of people with intellectual disability: 1) dependence on health support, 2) communication practices in health support, and 3) organizational context of health support. Dependence on health support adresses the way in which support workers meet a need that people with intellectual disability cannot meet themselves, and communication practices and organizational context are identified as systems in which health support takes place. CONCLUSION This study investigated experiences with the health support of people with intellectual disability from the perspectives of people with intellectual disability and support workers. We discuss the dependence of people with intellectual disability and the complexity of health support in everyday practice. We provide practical implications that can strengthen support workers in the provision of health support for people with intellectual disability in everyday practice. The findings of this study emphasize the need for intellectual disability care-provider organizations to establish policies around consistency in support staff to make it easier to identify and follow up health needs, and an environment where support staff can develop their expertise concerning communication practices, lifestyle choices, and identifying and following up health needs.
Collapse
Affiliation(s)
- Kim Nijhof
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
- Academic collaborative Intellectual Disability and Health - Sterker op Eigen Benen (SOEB), Nijmegen, The Netherlands.
| | - Fleur H Boot
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
- Academic collaborative Intellectual Disability and Health - Sterker op Eigen Benen (SOEB), Nijmegen, The Netherlands.
| | - Jenneken Naaldenberg
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Academic collaborative Intellectual Disability and Health - Sterker op Eigen Benen (SOEB), Nijmegen, The Netherlands
| | - Geraline L Leusink
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Academic collaborative Intellectual Disability and Health - Sterker op Eigen Benen (SOEB), Nijmegen, The Netherlands
| | - Kirsten E Bevelander
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Academic collaborative Intellectual Disability and Health - Sterker op Eigen Benen (SOEB), Nijmegen, The Netherlands
| |
Collapse
|
3
|
Mayer B, Elbing U, Ostermann T. Trauma treatment using Narrative Exposure Therapy adapted to persons with intellectual disabilities or severe chronic mental disorders - a randomised controlled pilot study with an embedded observational study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1096-1112. [PMID: 37582663 DOI: 10.1111/jir.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Despite an increased likelihood of experiencing traumatic events and increased vulnerability, there are only few publications on trauma therapy for persons with intellectual disabilities (IDs). This pilot study for the first time investigates the feasibility and effectiveness of Narrative Exposure Therapy (NET) within this target group modified by Plain Language. METHODS A group of n = 10 participants with ID dual diagnoses and another group of n = 5 participants with severe and chronic mental disorders were separately stratified and randomised, then forming together an intervention group (n = 7) and a waiting list control group (n = 8). All participants were treated with NET attuned to their communication abilities by using Plain Language. Primary outcome was the post-traumatic stress measured with the Post-Traumatic Symptom Scale-10 before and after the intervention. In addition, the Adverse Childhood Experience Index was used for diagnostic purposes. Data were analysed using t-test for repeated measures and analysis of covariance. RESULTS Narrative Exposure Therapy and the randomised controlled trial study proved to be successfully conductible with participants with IDs in a congregated residential service. Although the corresponding effect size was high (partial eta square = 0.188), the between-group difference was not significant (P = 0.12). Analysis of the observational study resulted in a highly significant improvement for participants with IDs (P < 0.001; Hedges' g = 2.36) and in a significant improvement in participants with severe and chronic mental disorders (P < 0.013; Hedges' g = 1.52). Additionally, the participants with IDs show a significantly better reduction of symptom burden (P = 0.03; partial eta square = 0.327). CONCLUSIONS The results provide a first evidence for a possible and successful implementation of NET modified in Plain Language for persons with IDs and complex mental health support needs. Completeness in responding to the items of Post-Traumatic Symptom Scale-10 and Adverse Childhood Experience Index indicates the suitability of these instruments for both groups of participants. Although the group difference in the randomised controlled trial failed to achieve statistical significance mainly due to the small sample size, the results of the embedded observational study are promising for the conduct of further studies with the modified NET.
Collapse
Affiliation(s)
- B Mayer
- Residence Tilia Rheinau, Rheinau, Switzerland
| | - U Elbing
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - T Ostermann
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| |
Collapse
|
4
|
Turnbull H, Dark L, Carnemolla P, Skinner I, Hemsley B. A systematic review of the health literacy of adults with lifelong communication disability: Looking beyond accessing and understanding information. PATIENT EDUCATION AND COUNSELING 2023; 106:151-162. [PMID: 36283904 DOI: 10.1016/j.pec.2022.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To determine the a) extent to which people with lifelong communication disability are included in health literacy research, b) level of health literacy of people with lifelong communication disability, c) methods applied to measure the health literacy of people with lifelong communication disability, d) barriers and facilitators mediating the health literacy of people with lifelong communication disability, and e) outcomes of health literacy interventions for people with lifelong communication disability. METHODS We searched for studies relating to health literacy, people with lifelong communication disability, and key areas of the Sørensen et al. (2012) health literacy model (i.e., accessing, understanding, appraising, applying health information, personal/environmental/systemic barriers and facilitators). RESULTS Analysis of 60 studies demonstrated that this population is not well represented. Insufficient research exists to inform statements on level of health literacy or methods used to measure health literacy of this population. Barriers and facilitators appear consistent with those applicable to the general population. Health literacy intervention outcomes were variable. CONCLUSION Significant gaps exist in the research which has primarily focused on people with intellectual disability accessing and understanding health information. PRACTICE IMPLICATIONS Findings can inform policies, practice, and future research on health literacy and people with lifelong communication disability.
Collapse
Affiliation(s)
- Harmony Turnbull
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia.
| | - Leigha Dark
- Communication & Inclusion Resource Centre (CIRC), Scope Australia, Hawthorn, Australia.
| | - Phillippa Carnemolla
- School of Built Environment, University of Technology Sydney, Ultimo, Australia.
| | - Ian Skinner
- School of Allied Health Exercise & Sports Sciences, Charles Sturt University, Port Macquarie, Australia.
| | - Bronwyn Hemsley
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia; Faculty of Education and the Arts, The University of Newcastle, Newcastle, Australia.
| |
Collapse
|
5
|
Breuer MEJ, Bakker-van Gijssel EJ, Vlot-van Anrooij K, Tobi H, Leusink GL, Naaldenberg J. Exploring views on medical care for people with intellectual disabilities: an international concept mapping study. Int J Equity Health 2022; 21:99. [PMID: 35854317 PMCID: PMC9295354 DOI: 10.1186/s12939-022-01700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background Medical care for people with intellectual and developmental disabilities (IDD) is organized differently across the globe and interpretation of the concept of medical care for people with IDD may vary across countries. Existing models of medical care are not tailored to the specific medical care needs of people with IDD. This study aims to provide an improved understanding of which aspects constitute medical care for people with IDD by exploring how international researchers and practitioners describe this care, using concept mapping. Methods Twenty-five experts (researchers and practitioners) on medical care for people with IDD from 17 countries submitted statements on medical care in their country in a brainstorming session, using an online concept mapping tool. Next, they sorted all collected statements and rated them on importance. Results Participants generated statements that reflect current medical and health care practice, their ideas on good practice, and aspirations for future medical and health care for people with IDD. Based on the sorting of all statements, a concept map was formed, covering 13 aspects that characterize medical and health care for people with IDD across nations. The 13 aspects varied minimally in importance ratings and were grouped into five overarching conceptual themes: (i) active patient role, (ii) provider role, (iii) context of care, (iv) consequences of care for people with IDD, and (v) quality of care. Conclusions The themes, clusters and statements identified through this explorative study provide additional content and context for the specific patient group of people with IDD to the dimensions of previous models of medical care. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01700-w.
Collapse
Affiliation(s)
- Marian E J Breuer
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, The Netherlands.
| | - Esther J Bakker-van Gijssel
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, The Netherlands
| | - Kristel Vlot-van Anrooij
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, The Netherlands
| | - Hilde Tobi
- Biometrics, Wageningen University & Research, Wageningen, The Netherlands
| | - Geraline L Leusink
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, The Netherlands
| | - Jenneken Naaldenberg
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
6
|
Heutmekers M, Naaldenberg J, Mastebroek M, Assendelft WJJ, van Schrojenstein Lantman-de Valk HMJ, Leusink GL. Out-of-hours primary care for people with intellectual disabilities: interviews in general practice. Fam Pract 2022; 39:106-111. [PMID: 34159369 DOI: 10.1093/fampra/cmab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Out-of-hours primary care for people with intellectual disabilities (ID) involves different groups of health care professionals, who are often not familiar to one another nor to the specific health care needs of this vulnerable population. It is not known to what extend these specific health care needs or organizational factors influence the delivery of out-of-hours primary care for people with ID. OBJECTIVE The objective of this study is to explore the experiences of health care professionals regarding the medical content and the organizational context of out-of-hours primary care for people with ID. METHODS Semi-structured interviews were conducted with daily care professionals, triage nurses and general practitioners (GPs) involved in out-of-hours primary care for people with ID in the Netherlands. Interviews were thematically analysed for medical content and organizational context. RESULTS The analysis resulted in four interconnected themes: (i) uncertainties in the triage assessment of ID patients; (ii) confusion about inter-professional responsibilities; (iii) impact on routines and workflow concerning ID patients and (iv) constraints in the decision-making process. All issues raised were related to the organizational context. CONCLUSIONS Health care professionals involved in out-of-hours primary care for people with ID indicate that the quality of this care is more influenced by the organizational context than by the medical content. We recommend out-of-hours GP services and care provider services for people with ID to set standards for roles and responsibilities in order to facilitate health care professionals in delivering accessible and high-quality care to this vulnerable population.
Collapse
Affiliation(s)
- Marloes Heutmekers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Jenneken Naaldenberg
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Mathilde Mastebroek
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | | | - Geraline L Leusink
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| |
Collapse
|
7
|
Craig LE, Chen ZE, Barrie J. Disability, sexual and reproductive health: a scoping review of healthcare professionals' views on their confidence and competence in care provision. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:7-15. [PMID: 33737315 DOI: 10.1136/bmjsrh-2020-200967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The sexual and reproductive needs of people with disabilities are often unmet. Healthcare professionals play an important role in meeting these needs. OBJECTIVE To explore the views of healthcare professionals on their confidence and competence in providing sexual and reproductive healthcare to people with disabilities. METHODOLOGY Two databases were searched yielding 14 studies included in the review. Studies detailing healthcare professionals' experiences working in the subject area were included alongside results and evaluations of staff training/workshops within the area. Search results were screened for eligibility by the first and second authors and any discrepancies were resolved by the third author. All subsequent stages were carried out by the first author and reviewed by the second and third authors. RESULTS The study's findings indicate that there is a lack of training, guidelines, patient contact, time, teamwork and collaboration between staff, and a lack of awareness/access to resources within this area. Evaluations of training programmes/workshops showed an increase in knowledge, comfort and skills surrounding the subject. Continuous training would be beneficial to ensure these are maintained at a high level. CONCLUSIONS Overall healthcare professionals felt they lack confidence and competence in providing sexual and reproductive healthcare to people with disabilities. Further research in this area is recommended to assess this in more depth. Development of guidelines, multidisciplinary training programmes and further resources for both staff and patients are recommended.
Collapse
Affiliation(s)
- Lucy Emma Craig
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | | | - Joanne Barrie
- Central Sexual Health, NHS Forth Valley, Stirling, UK
| |
Collapse
|
8
|
Oosterveld-Vlug M, Oldenkamp M, Mastebroek M, Boeije H. What difficulties do people with mild intellectual disabilities experience when seeking medical help from their GP? A qualitative study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:178-189. [PMID: 32924273 DOI: 10.1111/jar.12796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with intellectual disabilities often have low health literacy as a result of their limited language comprehension. The aim of this study was to explore the difficulties Dutch people with intellectual disabilities experience during the process of considering and seeking medical help from their GP. The study was intended as input for an online intervention supporting health literacy. METHODS A qualitative study, in which 12 semi-structured interviews were conducted with people with mild intellectual disabilities and 4 with relatives of people with mild intellectual disabilities. The interviews were analysed following the principles of thematic analysis. RESULTS Difficulties were experienced in the following activities: assessing and proactively reacting to health complaints, processing health information, communicating with a GP and retaining information from the consultation. Support workers and relatives play an important role in all these activities. CONCLUSIONS To increase the capacity of people with intellectual disabilities to manage their health and seek care from their GP, it is important to support them in the activities they find difficult. Recommendations resulting from the study have been incorporated in an online intervention.
Collapse
Affiliation(s)
| | - Marloes Oldenkamp
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Mathilde Mastebroek
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hennie Boeije
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| |
Collapse
|
9
|
Bakker-van Gijssel EJ, Lucassen PLBJ, Olde Hartman TC, Assendelft WJJ, van Schrojenstein Lantman-de Valk HMJ. "Constructing a health assessment questionnaire for people with intellectual disabilities: A cognitive interview study". JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:345-353. [PMID: 31602729 DOI: 10.1111/jar.12676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Health assessment instruments can help to raise awareness among general practitioners of specific health problems in people with intellectual disabilities (PID). The present authors developed a health assessment questionnaire using the cognitive interview technique (CI) to improve the comprehensibility. The utility of this approach to questionnaire development involving PID is assessed. METHOD A qualitative approach using the CI was employed. The study included PID and their caregivers. The present authors interviewed 14 participants in 5 subsequent rounds. After each round, the questionnaire was adjusted until saturation was reached. RESULTS Three hundred and sixty three identified problems led to 316 changes to the questionnaire. Most problems (102) concerned the comprehension of the question, followed by problems in the "missing answer categories" and "inaccurate instruction" section. CONCLUSION The comprehensible health assessment questionnaire can help PID to take an active role in communication with their GP. The use of CI helped to improve the questionnaire. CI is a usable and valuable procedure for PID.
Collapse
Affiliation(s)
- Esther J Bakker-van Gijssel
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Siza, residential care facility for people with disabilities, Arnhem, The Netherlands
| | - Peter L B J Lucassen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | |
Collapse
|
10
|
Shankar R, Wilcock M. Improving knowledge of psychotropic prescribing in people with Intellectual Disability in primary care. PLoS One 2018; 13:e0204178. [PMID: 30216381 PMCID: PMC6138382 DOI: 10.1371/journal.pone.0204178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/03/2018] [Indexed: 01/02/2023] Open
Abstract
Purpose People with Intellectual disability (ID) are likely to be prescribed psychotropic medication particularly antipsychotics without a clear clinical indication. This has given rise to a national initiative in the UK to stop overprescribing medication in this vulnerable population. While the goals are simple it is unclear if specialist ID services or primary care services in the UK should look to lead. Further, it is uncertain if primary care practitioners (GPs) can be systematically educated of the latest good practice developments and concerns in this specialised area. This study surveyed the knowledge level of a sample of GPs in Cornwall UK (county of 538,000) post a structured tutorial on psychotropic medication and people with ID. Methods A 21 item questionnaire was delivered in meetings organised for all the county GPs a year after a talk given to the same demographic. The questionnaire conducted an assessment of the knowledge of national guidance on use of psychotropic medication in ID based on the subjects covered in the tutorial. Results Of the 60 expected GP participants the tutorial was attended by 44 GPs (73%) and the follow up meeting by 42 (70%). Ninety percent GPs in the follow up meeting filled the questionnaire. For 16 questions, more than 80% GPs gave correct responses whereas five questions attracted a correct answer from less than 80%. Majority of the GPs felt psychotropic medication management in people with ID should be specialist led. Conclusions GPs’ knowledge of issues relevant to prescribing in people with ID benefitted from the tutorial. However a clear need for the psychotropic medication management to be delivered via specialist care emerged. This raises issues of resource allocation and debate on whether people with ID require specialist provision due to lack of ability in main stream primary care to manage their needs.
Collapse
Affiliation(s)
- Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, United Kingdom
- University of Exeter Medical School, Exeter, United Kingdom
- * E-mail:
| | - Mike Wilcock
- Royal Cornwall Hospitals Trust, Truro, United Kingdom
| |
Collapse
|
11
|
Vrijmoeth C, Echteld MA, Assendelft P, Christians M, Festen D, van Schrojenstein Lantman-de Valk H, Vissers K, Groot M. Development and applicability of a tool for identification of people with intellectual disabilities in need of palliative care (PALLI). JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31:1122-1132. [DOI: 10.1111/jar.12472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 03/27/2018] [Accepted: 04/19/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Cis Vrijmoeth
- Intellectual Disabilities and Health; Department of Primary and Community Health Care; Radboudumc Nijmegen; Nijmegen The Netherlands
- Advisium Apeldoorn; ‘s Heeren Loo the Netherlands
| | - Michael A. Echteld
- Prisma Foundation Biezenmortel; Biezenmortel The Netherlands
- Avans University of Applied Sciences; Breda The Netherlands
| | - Pim Assendelft
- Department of Primary and Community Health Care; Radboudumc Nijmegen; Nijmegen The Netherlands
| | - Milou Christians
- Intellectual Disabilities and Health; Department of Primary and Community Health Care; Radboudumc Nijmegen; Nijmegen The Netherlands
| | - Dederieke Festen
- Intellectual Disability Medicine; Department of General Practice; Erasmus MC Rotterdam; Rotterdam The Netherlands
| | | | - Kris Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine; Radboudumc Nijmegen; Nijmegen The Netherlands
| | - Marieke Groot
- Department of Anaesthesiology, Pain and Palliative Medicine; Radboudumc Nijmegen; Nijmegen The Netherlands
| |
Collapse
|
12
|
McNeil K, Gemmill M, Abells D, Sacks S, Broda T, Morris CR, Forster-Gibson C. Circles of care for people with intellectual and developmental disabilities: Communication, collaboration, and coordination. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:S51-S56. [PMID: 29650745 PMCID: PMC5906783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To review health information exchange (HIE) processes that affect the health of people with intellectual and developmental disabilities (IDD) and to suggest practical tips and strategies for communicating, collaborating, and coordinating in the primary care setting. SOURCES OF INFORMATION The "Primary care of adults with intellectual and developmental disabilities. 2018 Canadian consensus guidelines" literature review and interdisciplinary input. MAIN MESSAGE Disparities exist between the provision of health care for the general population and that for people with IDD. These disparities are due in part to gaps in HIE. Health information exchange involves documenting, collecting, and disseminating a patient's health information. In exploring ways to improve HIE for people with IDD, the communication skills of the family physician are considered in the context of the triad that includes the patient, his or her caregivers, and the family physician. The framework of the Patient's Medical Home is used in exploring these processes, and various strategies are offered for communicating, collaborating, and coordinating health care that can be implemented by family physicians in order to narrow the gaps in care that exist for people with IDD. CONCLUSION Improvements in HIE by communicating, collaborating, and coordinating health care better will improve health outcomes for people with IDD.
Collapse
Affiliation(s)
- Karen McNeil
- Assistant Professor in the Department of Family Medicine at Dalhousie University in Halifax, NS.
| | - Meg Gemmill
- Assistant Professor in the Department of Family Medicine at Queen's University in Kingston, Ont
| | - Dara Abells
- Family physician at Forest Hill Family Health Centre in Toronto, Ont, and the Integrated Services for Autism and Neurodevelopmental Disorders, and Lecturer in the Department of Family and Community Medicine at the University of Toronto
| | - Samantha Sacks
- Clinical Faculty Lecturer in the Department of Family Medicine at McGill University in Montreal, Que, and a family physician at the See Things My Way Centre for Innovation in Autism and Intellectual Disabilities
| | - Terry Broda
- Advanced practice nurse at the See Things My Way Centre and a faculty member of the Ingram School of Nursing at McGill University
| | - Catherine R Morris
- Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont
| | - Cynthia Forster-Gibson
- Assistant Professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto
| |
Collapse
|
13
|
Vrijmoeth C, Groot CM, Christians MGM, Assendelft WJJ, Festen DAM, van der Rijt CCD, van Schrojenstein Lantman-de Valk HMJ, Vissers KCP, Echteld MA. Feasibility and validity of a tool for identification of people with intellectual disabilities in need of palliative care (PALLI). RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:67-78. [PMID: 29107852 DOI: 10.1016/j.ridd.2017.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 09/18/2017] [Accepted: 10/19/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND There is a need for a specific tool that supports healthcare professionals in timely identifying people with intellectual disabilities (ID) in need of palliative care. Therefore, we developed PALLI: a tool for screening deteriorating health, indicative of a limited life expectancy. AIMS We evaluated feasibility, construct validity and predictive validity of PALLI. METHODS 190 people with ID likely to be in need of palliative care were included. Physicians and daily care professionals (DCPs) completed PALLI and provided information on health outcomes at baseline, after 5-6 months and after 10-12 months. Linear Mixed Models and Generalized Linear Mixed Models were used to test validity. RESULTS Feasibility was adequate: physicians and DCPs were able to answer most items with 'yes' or 'no' and within a short amount of time. Construct validity was promising: a higher PALLI score at baseline was related to a higher level of decline in health, a higher symptom burden, a lower quality of life and more ADL-dependency at baseline. Predictive validity: only a higher physician-reported PALLI score at baseline significantly increased risk of death within 12 months. CONCLUSIONS PALLI shows promising feasibility and validity and has potential as a tool for timely identifying people with ID who may benefit from palliative care.
Collapse
Affiliation(s)
- C Vrijmoeth
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - C M Groot
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - M G M Christians
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - W J J Assendelft
- Department of Primary and Community Health Care, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - D A M Festen
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - C C D van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam, PO Box 5201, 3008 AE Rotterdam, The Netherlands.
| | | | - K C P Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - M A Echteld
- Prisma Foundation Biezenmortel, Hooghoutseweg 3, 5074 NA Biezenmortel, The Netherlands.
| |
Collapse
|
14
|
Heutmekers M, Naaldenberg J, Verheggen SA, Assendelft WJJ, Lantman - de Valk HMJVS, Tobi H, Leusink GL. Does risk and urgency of requested out-of-hours general practitioners care differ for people with intellectual disabilities in residential settings compared with the general population in the Netherlands? A cross-sectional routine data-based study. BMJ Open 2017; 7:e019222. [PMID: 29101152 PMCID: PMC5695369 DOI: 10.1136/bmjopen-2017-019222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/23/2017] [Accepted: 10/05/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To investigate whether people with intellectual disabilities (ID) in residential setting were more likely than people from the general population to request out-of-hours general practitioner (GP) care and whether these requests had a similar level of urgency. DESIGN Cross-sectional routine data-based study. SETTING Two GP cooperatives providing out-of-hours primary care in an area in the Netherlands. POPULATION 432 582 persons living in the out-of-hours service areas, of which 1448 could be identified as having an ID. MAIN OUTCOME MEASURES GP cooperative records of all contacts in 2014 for people with and without ID were used to calculate the relative risk of requesting care and the associated level of urgency. RESULTS Of the people with ID (448/1448), 30.9% requested out-of-hours GP care, whereas for the general population this was 18.4% (79 206/431 134), resulting in a relative risk of 1.7 (95% CI 1.6 to 1.8). We found a different distribution of urgency level for people with and without ID. Generally, requests for people with ID were rated as less urgent. CONCLUSION People with ID in residential setting were more likely to request out-of-hours GP care than the general population. The distribution of the urgency level of requests differed between the two groups. The high percentage of demands relating to people with ID requesting counselling and advice suggests that some out-of-hours GP care may be avoidable. However, more insight is needed into the nature of out-of-hours primary care requests of people with ID to direct structural and reasonable adjustments towards the improvement of health information exchange in and around-the-clock access to primary care for people with ID.
Collapse
Affiliation(s)
- Marloes Heutmekers
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jenneken Naaldenberg
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sabine A Verheggen
- General Practitioner Cooperative Nijmegen and Boxmeer, Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Hilde Tobi
- Wageningen University and Research, Biometris, Wageningen, The Netherlands
| | - Geraline L Leusink
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
15
|
Mastebroek M, Naaldenberg J, Tobi H, van Schrojenstein Lantman-de Valk HMJ, Lagro-Janssen ALM, Leusink GL. Priority-setting and feasibility of health information exchange for primary care patients with intellectual disabilities: A modified Delphi study. PATIENT EDUCATION AND COUNSELING 2017; 100:1842-1851. [PMID: 28515025 DOI: 10.1016/j.pec.2017.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/22/2017] [Accepted: 04/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Accurate health information exchange (HIE) is fragile in healthcare for patients with intellectual disabilities (ID), threatening the health outcomes for this patient group. In conjunction with a group of experts, we aimed to identify the principal actions and organisational factors facilitating HIE for primary care patients with ID and to assess their perceived feasibility in daily practice. METHODS We conducted a two-round modified Delphi study with Dutch GPs (n=22), support workers (n=18) and ID physicians (n=20). In an extensive set of 61 items covering actions and organisational factors, experts ranked items in order of importance and rated their feasibility. RESULTS Agreement was reached on the importance of 22 actions and eight organisational factors, of which 82% were deemed (very) feasible in daily practice. Experts stressed the importance of listed actions and factors being implemented simultaneously and remarked that further priority should be based on contextual demands. CONCLUSION AND PRACTICE IMPLICATIONS This study indicates the principal actions and organisational factors for HIE regarding primary care patients with ID. The set can be used as a practical guide to optimise inter-professional cooperation and arrange the distribution of HIE roles and responsibilities in relation to this patient group.
Collapse
Affiliation(s)
- Mathilde Mastebroek
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Jenneken Naaldenberg
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Hilde Tobi
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands; Biometris, Wageningen University & Research, Wageningen, The Netherlands.
| | | | - Antoine L M Lagro-Janssen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Geraline L Leusink
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| |
Collapse
|