Medical Conditions and Healthcare Utilization among Adults with Intellectual Disabilities Living in Group Homes in New York City

Levy, Joel M.; Botuck, Shelly; Damiani, Marco R.; Levy, Philip H.; Dern, Thomas A.; Freeman, Stephen E.

doi:10.1111/j.1741-1130.2006.00079.x

Cited by 6 publications

(6 citation statements)

References 34 publications

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“…Based on evidence-based guidelines, practices can systematically identify high-risk patients. In the case of PHC, the most common primary diagnoses were diabetes, hypertension, and hyperlipidemia, a finding that is consistent with prior research related to individuals with IDDs (Levy et al, 2006;Tyler, Schramm, Karafa, Tang, & Jain, 2010). Having such knowledge allows health care providers to identify at-risk patients who could benefit from more intense, evidence-based interventions.…”

Section: Identifying and Managing Patient Populationssupporting

confidence: 72%

Patient-Centered Medical Homes for Patients with Disabilities

Hernández

Damiani

Wang

et al. 2015

Journal of Social Work in Disability & Rehabilitation

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The patient-centered medical home is an innovative approach to improve health care outcomes. To address the unique needs of patients with intellectual and developmental disabilities (IDDs), a large health care provider reevaluated the National Committee for Quality Assurance's 6 medical home standards: (a) enhance access and continuity, (b) identify and manage patient populations, (c) plan and manage care, (d) provide self-care and community support, (e) track and coordinate care, and (f) measure and improve performance. This article describes issues to consider when serving patients with IDDs.

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Section: Identifying and Managing Patient Populationssupporting

confidence: 72%

Patient-Centered Medical Homes for Patients with Disabilities

Hernández

Damiani

Wang

et al. 2015

Journal of Social Work in Disability & Rehabilitation

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“…90 The pooled prevalence of T2DM was 7.6%. The prevalence of any diabetes was 8.7%; this ranged from 2% 84 to 11% 95,102,117 (data not presented).…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 93%

“…Primarily, the included studies were cross-sectional observational (n = 31 81,82,98,[100][101][102]104,106,[109][110][111]114,116,119,121,124,[126][127][128][129][130][131][132][133][134][135]137,139,142,143,145 ). The remaining studies involved retrospective database or medical records data (n = 22 [83][84][85][86][87][88][89]94,95,99,107,113,115,117,118,120,122,123,136,…”

Section: Study Characteristicsmentioning

confidence: 99%

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

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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.

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“…Studies have shown that people with intellectual disabilities have a high prevalence of overweight and obesity (Rimmer & Wang, 2005;Yamaki, 2005). Several factors may contribute to this pattern, including living in community versus institutional settings (Krauss & Seltzer, 1986;Janicki & Jacobson, 1986;Levy et al, 2006); engaging in high-risk behaviors, such as adopting poor diets and physical activity patterns (Pitetti, Rimmer, & Fernhall, 1993;Draheim, McCubbin, & Williams, 2002;Draheim, Williams, & McCubbin, 2002a;Draheim, Williams, & McCubbin, 2002b); and being treated with certain psychotropic medications (Spreat, Conroy, & Fullerton, 2004). However, few studies have explored these and other clinical and behavioral characteristics as potential risk factors for obesity and CHD in samples of people with ID with different levels of intellectual impairment and origin of impairment (Merriman, Haw, Kirk, & Stubbs, 2005;Draheim et al, 2002).…”

Section: Abstract Cardiovascular Disease Obesity Primary Carementioning

confidence: 98%

Factors Associated with Obesity and Coronary Heart Disease in People with Intellectual Disabilities

Sohler

Lubetkin

Levy

et al. 2009

Social Work in Health Care

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Advances in health care for people with intellectual disabilities (ID) that have resulted in increased longevity also force health care providers, researchers, and policymakers to question the adequacy of chronic disease management for the growing number of middle aged and elderly persons in this population. We report on sociodemographic and clinical factors associated with obesity, hypertension, hypercholesterolemia, and diabetes mellitus in an ethnically/racially diverse sample of people with ID in New York City. Administrative and chart review data were collected from a community-based specialty medical practice for people with intellectual disabilities. Adult subjects were included if they had an intellectual disability, lived in the community either independently or with relatives, received all of their planned, outpatient health care services though this practice, and had a primary care visit within the study period. One hundred twenty-six (43.0%) persons were obese, 58 (19.9%) had hypertension, 77 (26.5%) had hypercholesterolemia, and 13 (4.5%) had diabetes mellitus. Age, gender, and BMI (for the latter three conditions) were the most consistent risk factors. Intellectual functioning and behavioral problems were not associated with greater odds of these conditions. This study provides crucial information for improving community-based primary care for people with intellectual disabilities. Specifically, these findings highlight the importance of constructing innovative strategies to mitigate chronic disease risk factors in this population that involve community-based case management service providers who can help adults with ID and their families adopt needed lifestyle and behavior changes.

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Medical Conditions and Healthcare Utilization among Adults with Intellectual Disabilities Living in Group Homes in New York City

Cited by 6 publications

References 34 publications

Patient-Centered Medical Homes for Patients with Disabilities

Patient-Centered Medical Homes for Patients with Disabilities

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

Factors Associated with Obesity and Coronary Heart Disease in People with Intellectual Disabilities

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