Assessment of an incentivised scheme to provide annual health checks in primary care for adults with intellectual disability: a longitudinal cohort study

Buszewicz, Marta; Welch, Catherine; Horsfall, Laura; Nazareth, Irwin; Osborn, David; Hassiotis, Angela; Glover, Gyles; Chauhan, Umesh; Hoghton, Matthew; Cooper, Sally‐Ann; Moulster, Gwen; Hithersay, Rosalyn; Hunter, Rachael; Heslop, Pauline; Courtenay, Ken; Strydom, André

doi:10.1016/s2215-0366(14)00079-0

Cited by 61 publications

(81 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19,20,83,[88][89][90][91][92] These have shown high levels of comorbidity, although direct comparisons of estimated prevalence with the general population has generally been difficult owing to population selection and disease definition. Only a recent Scottish study in primary care of 8014 adults with ID has been able to provide comprehensive standardised prevalence rates by age groups, 92 and produced findings for 2007 similar to our own published findings for 2012.…”

Section: Disease Prevalencementioning

confidence: 99%

“…90 Although the systematic reviews by Robertson et al 12,147 showed the effectiveness of health checks in detecting unrecognised health needs in people with ID, they highlighted the lack of evidence regarding whether or not the provision of health checks translated into important longer-term benefits, such as a reduction in avoidable hospitalisations or mortality. For health checks among the general population (for 40-to 74-year-olds), a recent study 148 using CPRD data showed that their introduction increased the identification of cardiovascular risk factors, but an earlier Cochrane systematic review 149 for similar general health checks failed to find evidence that they reduced mortality, hospitalisation or disability.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Disease Prevalencementioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…12,13 Locally, for practices within Leicester City, East Leicestershire and Rutland, and West Leicestershire CCGs, the total number of adults (aged ≥ 18 years) on general practice registers with an identified ID is estimated to be around 4300 (based on figures provided by LPT).…”

Section: Definition Of Intellectual Disability and Case Identificationmentioning

confidence: 99%

“…The suggested prevalence of diagnosed diabetes in people with ID in England is around 6-7%, but estimates are unable to distinguish between T2DM and other forms of diabetes. 13,51 Similarly, the prevalence of CVD among people with ID is reported to be greater than that among the general population, but the overall prevalence is unclear. 52 Further information on the current prevalence of T2DM, CVD and related risk factors in the ID population is presented in the systematic review in Chapter 2.…”

Section: Type 2 Diabetes and Impaired Glucose Regulationmentioning

confidence: 99%

“…55 However, the proportion who additionally have bloods taken as part of the health check, including HbA 1c (7%) and cholesterol (30%), is extremely low. 13 only non-invasive risk factors, which would be known by members of the public) or (2) a population (e.g. in primary care, for which software is used to calculate the score using routine data from electronic medical records) and then screening invitations can be sent to those at highest risk.…”

Section: Diabetes Screeningmentioning

confidence: 99%

See 1 more Smart Citation

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Dunkley

Tyrer

Spong

et al. 2017

Programme Grants Appl Res

Self Cite

View full text Add to dashboard Cite

BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

show abstract

Association of Dementia With Mortality Among Adults With Down Syndrome Older Than 35 Years

et al. 2019

Self Cite

View full text Add to dashboard Cite

Key Points Question How does dementia status influence mortality in people with Down syndrome? Findings In a longitudinal study including 211 adults with Down syndrome 36 years and older, 27 people died during follow-up (mean, 28; range, 1-65 months), and dementia was the proximate cause of death in 70% of cases. Crude mortality rates were 5 times higher in those with dementia than those without. Meaning Nearly all older adults with Down syndrome now have dementia when they die, making this a vital population for researching disease progression, modifying factors, and potential treatments.

show abstract

Assessment of an incentivised scheme to provide annual health checks in primary care for adults with intellectual disability: a longitudinal cohort study

Abstract: National Institute for Health Research.

Cited by 61 publications

References 15 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

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Association of Dementia With Mortality Among Adults With Down Syndrome Older Than 35 Years

Contact Info

Product

Resources

About