Primary Health Care for People with a Learning Disability

Abstract

The delivery of health care to people with a learning disability living in the community has come under increasing scrutiny. Concerns have been raised over both the current quality of this care and its future organisation. In this article we review the evidence on current practice focusing on epidemiology, health status and policy directives affecting primary health care. Four specific areas for service developments are identified: an individual focus within an epidemiological framework, the evaluation of the effectiveness of current therapies, practice organisation and the awareness of health within social care. It is proposed that an effective model of primary health care is possible, supported by research, training, inter-service collaboration and purchasing guidelines.People with a learning disability and their families look to the general practitioner as the linchpin of health care provision. Indeed general practitioners, and by inference the primary health care team, are the most frequently contacted professionals by individuals with a learning disability (Evans et al., 1994). This central role is confirmed by general practitioners themselves (Kerr ef al., 1996). While the current move from hospital to community residential provision has focused attention on the role of the general practitioner as a generic primary provider, it is not a new position for them to occupy as the majority of people with a learning disability have always lived in the community with their families (DHSS, 1971). However, people with learning disabilities constitute only a small proportion of any general practitioner's list and their particular health care needs, therefore, require special highlighting or organisation to be dealt with effectively. In addition, people with learning disabilities are significant consumers of other professional services and social care support. A means of producing and reviewing co-ordinated health, education and social care packages is essential if services are to be responsive to the needs of individuals throughout their life span. This paper reviews the scientific and policy evidence to discuss how primary health services can best be organised within such a framework to maximise the health of people with a learning disability.

A cascade of disparities: Health and health care access for people with intellectual disabilities

“…The unmet health care needs of people with ID were starkly illustrated in the early 1990s by the work of Helen Beange, Michael Kerr, and other researchers [Beange et al, 1995;Kerr et al, 1996;Whitfield et al, 1996]. Much of the research conducted subsequently has been reviewed elsewhere.…”

Study of Physical Health Needs of People with Learning Disabilities Living in the Community

“…Though the sample in the project was small (n = 15) it confirms that people with a learning disability have a high prevalence of physical disorder (Kere et al, 1996). In this sample more than half have sensory impairments, and 40% (n = 6) have epilepsy in addition to other physical health problems.…”

“…Epilepsy, cerebral palsy, psychiatric illness and behavioural problems occur more frequently in people with a learning disability than in the general population. Certain syndromes that cause learning disability such as Downs syndrome are associated with increased risk of cardiovascular disease, respiratory disease, eye disorders, Alzheimers disease, leukaemia and hypothyroidism (Kere et al, 1996).…”

Care, communication and educational needs of primary care nurses to treat disabled patients

“…Moreover, PCN should be trained to employ strategies in order to engage DP in their treatment. [29][30][31] Focusing on the educational needs, there is no significant difference between PCN who do (not) exclusively treat PD at home. When interpreting these data, it is important to take into account that these 'groups' of PCN were constructed and compared in a case-controlled, retrospective manner.…”