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

Cooper, Sally‐Ann; Morrison, Jill; Allan, Linda; McConnachie, Alex; Greenlaw, Nicola; Melville, Craig; Baltzer, M.; McArthur, Laura; Lammie, Claire; Martin, Gordon M.; Grieve, Eleanor; Fenwick, Elisabeth

doi:10.1016/s2215-0366(14)00078-9

Cited by 38 publications

(43 citation statements)

References 19 publications

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“…We have not attempted to make any economic costing of the effectiveness of the health check scheme. A small Scottish trial of nurse delivered health checks for adults with ID demonstrated cost-effectiveness compared with standard care 17. However, they did not include hospitalisation costs, except accident and emergency attendances, which may have led to them underestimating potential economic savings.…”

Section: Discussionmentioning

confidence: 99%

Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment

Carey

Hosking

DeWilde

et al. 2016

J Epidemiol Community Health

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BackgroundAnnual health checks for adults with intellectual disability (ID) have been incentivised by National Health Service (NHS) England since 2009, but it is unclear what impact they have had on important health outcomes such as emergency hospitalisation.MethodsAn evaluation of a ‘natural experiment’, incorporating practice and individual-level designs, to assess the effectiveness of health checks for adults with ID in reducing emergency hospital admissions using a large English primary care database. For practices, changes in admission rates for adults with ID between 2009–2010 and 2011–2012 were compared in 126 fully participating versus 68 non-participating practices. For individuals, changes in admission rates before and after the first health check for 7487 adults with ID were compared with 46 408 age-sex-practice matched controls. Incident rate ratios (IRRs) comparing changes in admission rates are presented for: all emergency, preventable emergency (for ambulatory care sensitive conditions (ACSCs)) and elective emergency.ResultsPractices with high health check participation showed no change in emergency admission rate among patients with ID over time compared with non-participating practices (IRR=0.97, 95% CI 0.78 to 1.19), but emergency admissions for ACSCs did fall (IRR=0.74, 0.58 to 0.95). Among individuals with ID, health checks had no effect on overall emergency admissions compared with controls (IRR=0.96, 0.87 to 1.07), although there was a relative reduction in emergency admissions for ACSCs (IRR=0.82, 0.69 to 0.99). Elective admissions showed no change with health checks in either analysis.ConclusionsAnnual health checks in primary care for adults with ID did not alter overall emergency admissions, but they appeared influential in reducing preventable emergency admissions.

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Section: Discussionmentioning

confidence: 99%

Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment

Carey

Hosking

DeWilde

et al. 2016

J Epidemiol Community Health

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“…The large variation in recording procedures across practices for health checks needs to be better understood to enable better cost estimates of health checks on a large scale. Both in the UK 158,159 and internationally, 160 small trials of health check intervention have suggested that there were no associated higher costs in terms of service use compared with standard care. 158,159 However, these studies may not have fully accounted for longer-term hospitalisation costs, which in turn could have led to an underestimation of any potential economic savings.…”

Section: Health Checks and Process Measuresmentioning

confidence: 99%

“…Both in the UK 158,159 and internationally, 160 small trials of health check intervention have suggested that there were no associated higher costs in terms of service use compared with standard care. 158,159 However, these studies may not have fully accounted for longer-term hospitalisation costs, which in turn could have led to an underestimation of any potential economic savings. 159 Therefore, costs implications and benefits of health checks remain unclear and require further evaluation.…”

Section: Health Checks and Process Measuresmentioning

confidence: 99%

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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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“…In Australia and the UK, GPs are encouraged by their governments to carry out health assessments on people with ID. 17,18 GPs experience difficulties in the care of these patients. Lack of knowledge and time constraints are among the most important difficulties for GPs.…”

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

Abstract: SummaryBackground Adults with intellectual disabilities have substantial health inequalities and poor access to health care. We assessed whether practice nurse-delivered health checks could improve the health of adults with intellectual disabilities compared with standard care.

Cited by 38 publications

References 19 publications

Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment

Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment

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

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

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