Planning for community physician services prior to deinstitutionalization of mentally retarded persons.

Abstract

This study assessed the need for physician services among a group of institutionalized mentally retarded individuals in anticipation of their transfer to community residential facilities and subsequent management of their care by community-based physicians. The clients' personal physicians in the institution identified every chronic condition which required physician services, and recommended the kind of physician and frequency of visits for the management of each condition. Key informants reviewed these estimates and determined if there were sufficient physicians in their communities to provide this care. Thirty-two per cent of the conditions but only 8 per cent of the clients could be managed by a primary care physician. The most frequently required specialties IntroductionAn aspect of the deinstitutionalization of mentally retarded persons that has received little attention is the major change in their source of medical care. In the communitybased residential system that has developed as an alternative to institutions, the responsibility for the medical care of this population has been shifted from the segregated and self-contained health care systems within institutions to communitybased physicians and the loosely affiliated service networks which comprise the community health care system. This change is predicated upon more enlightened attitudes toward the mentally retarded population. The medically oriented care system which characterizes most large institutions is no longer considered appropriate for the majority of mentally retarded individuals because their principal needs are for educational, vocational, and social services and not necessarily for medical care. The utilization of services which are segregated within institutions is viewed as detrimental to optimal development, and community facilities are the preferred source of services.The new reliance upon community-based health provid-

Physical Illness, Pain, and Problem Behavior in Minimally Verbal People with Developmental Disabilities

“…With respect to assessment, our data suggest that it might be important to monitor pain indicators on a daily basis so that proactive steps could be taken to prevent the emergence of problem behavior related to ongoing pain and discomfort associated with illness. This practice might be especially important given that people with developmental disabilities are more prone to illness, both chronic and acute, than the general population (Cooper, 1998;Minihan, 1986). Of considerable significance is the fact that the main method typically used for ascertaining the presence and intensity of illness-related pain, namely, patient interview, is not applicable to many people with developmental disabilities owing to their poor communicative skills.…”

“…In fact, a number of studies have documented substantially higher rates of both chronic and acute medical conditions in people with developmental disabilities as compared to the general population. Thus, Minihan (1986) found that 99% of individuals in a state institution had at least one chronic medical condition requiring regular followup (e.g., cardiac conditions, diabetes, ulcers, chronic otitis media, recurrent pneumonia, and progressive renal failure). Asberg (1989) noted that 80% of people with developmental disabilities admitted to hospitals in Uppsala, Sweden had at least one chronic medical condition and that the rate of hospital admission for people with developmental disabilities was three times that of the general population.…”

On the need for a specialist service within the generic hospital setting for the adult patient with intellectual disability and physical health problems

“…Further, there is much evidence to show that among the population with ID, the average number of medical problems per person is about 5, which is many more than the figure for their peers in the general population (Beange et al, 1995;Wallace, 2001). Moreover, more than half of these medical conditions, if present in a patient without ID, would normally require the services of a specialised, hospital-based health professional (Beange et al, 1995;Kapell et al, 1998;Minihan, 1986).…”

The provision of services to persons with mental retardation and subsequent infection with human immunodeficiency virus (HIV).

“…1 A young adult with mild mental retardation had received residential and vocational services from a voluntary service agency for over 15 years. His homosexual behavior was accepted by the agency's administration because it did not adversely affect his eligibility to receive these services.…”