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

Lennox, Nicholas; Ware, Robert S.; Bain, Chris; Gomez, Miriam Taylor; Cooper, Sally‐Ann

doi:10.3399/bjgp11x561186

Cited by 40 publications

(66 citation statements)

References 9 publications

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“…In the UK, for example, a small Scottish trial of an annual intervention for adults with ID 32 reported large increases in the performance of vision and hearing tests, 155 similar to our findings of increased recording in these areas for patients with health checks compared with those without. However, many of the studies in the review are now 10-20 years old, and the additional beneficial gains seen historically may not necessarily apply to English primary care, in which the recording of such conditions is now incentivised.…”

Section: Health Checks and Process Measuressupporting

confidence: 79%

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

Carey

Hosking

Harris

et al. 2017

Health Serv Deliv Res

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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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Section: Health Checks and Process Measuressupporting

confidence: 79%

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

Carey

Hosking

Harris

et al. 2017

Health Serv Deliv Res

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“…Con todo, se han llevado a cabo diferentes programas de promoción de la salud orientados a cubrir las necesidades de las personas con TDI con resultados positivos, 44 aunque, debido a su heterogeneidad, resulta difícil comparar y contrastar resultados. 45 …”

Section: Atención Sanitariaunclassified

Nuevas consideraciones sobre la salud de las personas con trastornos del desarrollo intelectual

et al. 2017

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La literatura reciente indica que las personas con trastornos del desarrollo intelectual (TDI) presentan diferencias respecto de la población general en cuanto a la prevalencia de determinadas enfermedades y a la atención sanitaria que reciben. El conocimiento actual con base en la evidencia es aún muy escaso en países no anglosajones. Los proyectos europeos POMONA-I y POMONA-II tenían el objetivo de recoger información sobre el estado de salud de las personas con TDI en Europa. Actualmente, el proyecto POMONAESP en España pretende recoger dicha información en una muestra amplia y representativa de personas con TDI. También se están llevando a cabo otros estudios sobre la necesidad de contar con servicios especializados y sobre la formación que reciben los profesionales sanitarios sobre TDI. En este artículo se revisan las últimas evidencias sobre la salud de las personas con TDI y se exponen las principales actividades de investigación y asistencia sanitaria sobre este tema.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Gijssel

Hartman²,

Mareeuw

et al. 2016

Br J Gen Pract

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

Cited by 40 publications

References 9 publications

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

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

Nuevas consideraciones sobre la salud de las personas con trastornos del desarrollo intelectual

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

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