Does risk and urgency of requested out-of-hours general practitioners care differ for people with intellectual disabilities in residential settings compared with the general population in the Netherlands? A cross-sectional routine data-based study

Abstract

ObjectivesTo investigate whether people with intellectual disabilities (ID) in residential setting were more likely than people from the general population to request out-of-hours general practitioner (GP) care and whether these requests had a similar level of urgency.DesignCross-sectional routine data-based study.SettingTwo GP cooperatives providing out-of-hours primary care in an area in the Netherlands.Population432 582 persons living in the out-of-hours service areas, of which 1448 could be identified as having an ID.Main outcome measuresGP cooperative records of all contacts in 2014 for people with and without ID were used to calculate the relative risk of requesting care and the associated level of urgency.ResultsOf the people with ID (448/1448), 30.9% requested out-of-hours GP care, whereas for the general population this was 18.4% (79 206/431 134), resulting in a relative risk of 1.7 (95% CI 1.6 to 1.8). We found a different distribution of urgency level for people with and without ID. Generally, requests for people with ID were rated as less urgent.ConclusionPeople with ID in residential setting were more likely to request out-of-hours GP care than the general population. The distribution of the urgency level of requests differed between the two groups. The high percentage of demands relating to people with ID requesting counselling and advice suggests that some out-of-hours GP care may be avoidable. However, more insight is needed into the nature of out-of-hours primary care requests of people with ID to direct structural and reasonable adjustments towards the improvement of health information exchange in and around-the-clock access to primary care for people with ID.

Unscheduled healthcare for children with intellectual disabilities: A systematic scoping review

“…Children with developmental delays were found to have fewer check‐ups with their primary care provider, however, had more medical conditions on record (Nachshen et al, 2009). In relation to out‐of‐hours services, children with intellectual disability were more likely to request out of hours care compared to those without and their requests were often rated as less urgent (Huetmekers et al, 2017).…”

“…Administrative datasets were widely used to describe healthcare utilisation and/or disparities for this population compared to the general population. Administrative records can be enormously valuable tools for health research as they are cost‐effective and less demanding (Huetmekers et al, 2017), however, there are inherent limitations and biases to using such data for research purposes (Emerson & Hatton, 2013). Misclassification, poor coding, and a lack of disclosure by people with intellectual disability and their families are some of the challenges of this approach.…”

Healthcare utilisation and unmet health needs in children with intellectual disability: a propensity score matching approach using longitudinal cohort data

“…Administrative health records can provide valuable data (Heutmekers et al . 2017); however, there are inherent limitations and biases to using such data for research purposes (Emerson and Hatton 2013), particularly for paediatric research. Children with ID are often underrepresented in research using administrative databases due to poor coding of ID in routine data and low rates of disclosure from caregivers when seeking health care (Emerson et al .…”

Health inequities in unscheduled healthcare for children with intellectual disabilities in Ireland: a study protocol

“…A systems level approach to research would strengthen primary care and improve equitable service for people with intellectual disabilities 15 . Much of the research makes use of health records and administrative datasets to describe healthcare utilization which can be highly informative and cost-effective 21 , however, children with intellectual disabilities are frequently under-represented in such research due to misclassification and poor coding 13 , 22 – 24 . National longitudinal data can provide appropriate evidence to address the limitations of administrative datasets for assessing healthcare utilisation 22 .…”