Cluster Randomized‐Controlled Trial of Interventions to Improve Health for Adults with Intellectual Disability Who Live in Private Dwellings

Abstract

Background People with intellectual disability who live in the community often have poor health and healthcare, partly as a consequence of poor communication, recall difficulties and incomplete patient health information. Materials and Methods A cluster randomized‐controlled trial with 2 × 2 factorial design was conducted with adults with intellectual disability to investigate two interventions to enhance interactions among adults with intellectual disability, their care providers and general practitioners (GPs). The interventions were the Comprehensive Health Assessment Program (CHAP), a one‐off health review tool, and the Ask health diary, designed for ongoing use. Follow‐up was for 12 months post‐intervention. Evidence of health promotion, disease prevention and case‐finding activities were extracted from GPs clinical records. Results Increased health promotion, disease prevention and case‐finding activity were found in the intervention groups using the CHAP. It had a positive impact on Pneumococcus vaccination (OR 7.4; 95% CI: 1.5–37.1), hearing testing (4.5; 1.9–10.7), Hepatitis A vaccinations (5.4; 1.8–16.3), vision testing (3.4; 1.4–8.3), and weight measurement (3.1; 1.5–6.4). There were no strong changes in the measured outcomes in the group who used the Ask health diary alone. Conclusions The use of the CHAP increased health promotion, disease prevention and case‐finding activity in adults with intellectual disability living in the community and confirms the previously demonstrated benefits of the CHAP can be extended to less formal residential settings. The use of the Ask health diary did not improve the measured healthcare activity, at least in the short term, although it may contribute in other ways towards better health.

Effects of health screening for adults with intellectual disability: a pooled analysis

“…To be included, the study population had to be adults with intellectual disability, include a prospective intervention with a comparison group, and have allocation occurring at GP level or higher, to guard against carry-over effects within general practice. Two randomised trials were found, 6,7 and one cohort study. 5 One study investigating the effect of repeated screens was excluded due to allocation occurring within general practice.…”

“…[1][2][3] Barriers to providing satisfactory health care include difficulties gaining access, short consultation times, and communication difficulties. 4 Beneficial effects of health screening in adults with intellectual disability have been reported; [5][6][7] however, recruitment in this population is difficult, 4,8 and individual studies have been small and effect estimates unstable. This study has addressed this by conducting a pooled analysis to assess the overall benefits of health screening for adults with intellectual disability.…”

Practice nurse health checks for adults with intellectual disabilities: a cluster-design, randomised controlled trial

“…20,22 These noted a non-significant trend towards new disease detection after 1 year, but they did not report the extent to which needs had been met or obtain data about health monitoring needs. Unlike our trial, they showed an increase in health-promotion activity, especially with testing of vision and hearing, giving tetanus boosters, and checking hepatitis B serology; in our trial the nurses enquired about vision difficulties and testing, then directed people towards an optometrist, rather than directly testing vision, and the health check did not include hepatitis B serology, so data are not similar.…”

“…21 Results from another Australian cluster trial that randomly assigned 272 participants to combined health advocacy with the GP-delivered health assessment, or standard care, showed no additional benefits for the intervention. 22 The extent of health actions from these checks was greater than that recorded in GP records. 23 However, the health-care system in Australia differs from the that in the UK (eg, patients do not register with a GP), and many organisations provide paid support, so results might not be generalisable.…”

GPs’ opinions of health assessment instruments for people with intellectual disabilities: a qualitative study

“…5,6 Applying health assessments by means of questionnaires, focusing on highly prevalent diseases for people with ID, have proven to be an effective method to detect health needs, and can play an important role in health monitoring and health promotion. [7][8][9][10][11] Research has shown increased disease detection, as well as an increase in prevention and health promotion activities. [7][8][9][10] Most patients with ID valued the use of health assessment instruments positively.…”