Can point‐of‐care testing improve access to diagnostic screening and testing for people with learning disabilities? Exploring perspectives to improve access and equity

Abstract

Funding information NHS England Chief Scientific Office Accessible summary• People with learning disabilities, like everyone else, need to have their health checked, but this can sometimes be difficult.• We asked people with learning disabilities and the people who look after them what they thought about how they have blood tests done or their hearing checked.• We found out the things that make it a positive experience.• We learnt that people with learning disabilities and the people who look after them thought point-of-care testing would be a good idea.• We learnt what things they thought should be put in place to make this type of testing work well for them. AbstractBackground: People with learning disabilities have an increased risk of diabetes, cardiovascular disease and hearing loss. This study explored service users' and health professionals' perspectives and experiences of adopting minimally invasive diagnostic and screening devices, known as point-of-care testing (POCT) as a means of improving access and engagement. Materials and Methods:Focus groups and semi-structured interviews were undertaken with attendees at a nonhealthcare day centre, specialist learning disability clinical network and national leads as well as researchers into learning disability and point-of-care issues. Thematic analysis of the data was undertaken.Results: There was a lack of awareness and experience of POCT across the users and health professionals. Despite this, on seeing the devices and discussing application there was strong support and acceptability across all participants for their use so long as individual needs were addressed. There was no consistent sense of where this testing should be done but support for the flexibility this could provide in terms of nonmedicalised locations and individual needs. Strategies for success included the use of specific adjustments such as the presence of a known carer, pretesting information in an appropriate format and taking into account each individual's preferences. Conclusions:POCT is considered a viable and useful method for improving access to testing for people with learning disabilities. Adoption barriers in implementation identified as specific to the field of learning disabilities included lack of POCT | 29 GILES Et aL. | CON CLUS IONThis evaluation has taken the first steps to explore the feasibility and acceptability of point-of-care testing for people with learning disabilities. Point-of-care testing was described as having the potential to enable access to a range of diagnostics for people with a learning disability; however, this needs to be with some adjustments. It has the potential to widen this access through both the uptake and ability to perform screening as well as increasing flexibility in where these could be undertaken.The findings raise questions and opportunities about how and where POCT could be used. Whilst the context of this study was about health checks and access to health assessments, our findings provide information that could be used to further explore...

An alternative approach for detecting hearing loss in adults with learning disabilities

“…Every individual who volunteered to take part completed the screen as fully as their ear health permitted, suggesting that hearing screening can be accepted by this population. A previous qualitative study (Giles et al., 2019) identified the importance of preparation and briefing in advance of screening, as a mechanism to assist with acceptance and engagement. We used briefing sessions prior to each pop‐up clinic to provide an opportunity for explanation and discussion.…”

“…Preparation and involvement of carers are important to ensure the success of point of care initiatives (Giles et al., 2019). Therefore, prior to each pop‐up clinic, briefing sessions were completed for prospective volunteers and their support workers, led by the local Learning Disability Health Promotion Team Manager (who is also a Learning Disability Nurse).…”

“…Sometimes referred to as “point of care testing”, Giles et al. (2019) describe the potential of such a screening model for use with people with learning disabilities and suggest it as a possible alternative to the current annual health check for hearing. However, the authors identified a general lack of awareness of point of care testing capabilities for hearing loss and recommended further work to explore feasibility and benefit.…”

“…Bauer et al., 2019; Byrne et al., 2016) suggests that annual health checks have met these aims for certain health needs. However, there are continued concerns regarding uptake and access (Giles et al., 2019) and variability in implementation, of annual health checks (Chauhan et al., 2012).…”