Primary health care for people with an intellectual disability: an exploration of consultations, problems identified, and their management in Australia

Weise, Janelle; Pollack, Allan; Britt, Helena; Trollor, Julian N.

doi:10.1111/jir.12352

Cited by 26 publications

(35 citation statements)

References 21 publications

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“…If selection of people from primary health care into specialist health care is such that referred patients with ID have more severe anxiety than referred patients from the general population, this could partly explain the differences in prescription. However, previous studies have reported that people with ID are less, not more, likely to be referred to specialist health care [18]. Instead, the increased prescription of anxiolytics among those with behaviour impairment and both anxiolytics and GABA-agonists among those with MSP ID suggest that it is not the anxiety per se that causes the discrepancy between people with ID and the general population, but rather a behaviour that may be considered difficult and problematic for caregivers.…”

Section: Discussionmentioning

confidence: 99%

Pharmacotherapy for mood and anxiety disorders in older people with intellectual disability in comparison with the general population

et al. 2019

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Background People with intellectual disability (ID) have high prevalence of psychiatric disorders, but even higher rates of prescription of psychotropic drugs. Methods Using Swedish national registers, we identified a group of older people with ID and diagnosis of mood disorders (ICD-10 codes F32-F39) and/or anxiety (ICD-10 code F4) during 2006–2012 ( n = 587) and a referent group of people from the general population with the same diagnoses during the same time period ( n = 434). For both groups, we collected information on prescription of anxiolytics, hypnotics and sedatives, antidepressants, and GABA-agonists. Results Among those with a diagnosis of anxiety, people with ID were more likely than those in the general population to be prescribed anxiolytics (Relative Risk 1.32 [95% Confidence Interval 1.19–1.46]) and GABA-agonists (1.10 [1.08–1.31]). Moreover, among those with anxiety but without mood disorders, ID was associated with increased prescription of antidepressants (1.20 [1.03–1.39]). Within the ID cohort, behaviour impairment and MSP (i.e. moderate, severe, or profound) ID was associated with increased prescription of anxiolytics, both among those with anxiety (1.15 [1.03–1.30] for behaviour impairment and 1.23 [1.10–1.38] for MSP ID) and among those with mood disorders (1.14 [0.97–1.35] for behaviour impairment and 1.26 [1.04–1.52] for MSP ID). Moreover, MSP ID was associated with increased prescription of GABA-agonists among those with anxiety (1.23 [1.10–1.38]). Conclusions The excess prescription of anxiolytics but not antidepressants may suggest shortages in the psychiatric health care of older people with intellectual disability and mood and anxiety disorders.

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Section: Discussionmentioning

confidence: 99%

Pharmacotherapy for mood and anxiety disorders in older people with intellectual disability in comparison with the general population

et al. 2019

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“…Access to appropriate health care and inclusion in cancer screening programmes is often loaded with barriers for people with intellectual disability. Significant differences in approaches to primary care between people with and without intellectual disability in consultation types and length, treatments and referrals, highlight the need for a more nuanced approach to this population within mainstream services (Weise, Pollack, Britt, & Trollor, ). For instance, reimbursements through Medicare allowing for extended consultations to address complex health needs and practice models supporting interdisciplinarity could help reducing access barriers.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with death in people with intellectual disability

Reppermund

Srasuebkul

Dean

et al. 2019

Research Intellect Disabil

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Background People with intellectual disability (ID) experience higher mortality than the general population. This study examines factors contributing to deaths in people with intellectual disability. Method Linked administrative data spanning ten years for 49,947 people with intellectual disability receiving disability services were analysed to assess the impact of demographic variables, comorbidities and health service utilization on the risk of death using Cox proportional hazard models. Results People admitted for cancer were 8 times more likely to die within the study period compared to people not admitted for cancer. Down syndrome, cerebral palsy and heart disease also increased the risk of death. Emergency department presentations and/or mental health admissions increased the risk of death 4 times. Conclusions Our findings provide a basis for policy changes and public health interventions. Cancer screening, mental health interventions, inclusion of people with intellectual disability in health policy and improved health care are needed to meet the needs of this population.

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“…Australia has a similar health care system to Sweden in that primary health care and the GP are the first contact for the population for non-emergency health care [ 29 ]. Another study from Australia reports that people with ID are getting fewer referrals to specialist care compared to people without ID from their GPs in primary health care [ 30 , 31 ]. Weise and colleagues identified from previous research several barriers of access to the health care system [ 29 ] for people with ID.…”

Section: Discussionmentioning

confidence: 99%

“…This high number of unplanned visits cannot solely be explained by economic factors, as the health care in Sweden is mainly financed by taxes. Instead, we would like to propose two alternative explanations: 1) a lack of awareness in the health care system, as well as among supporting social service staff, of issues related to ageing adults with DS, which has been identified in interviews with managers and staff in intellectual disability services [ 42 , 54 , 55 ], and 2) difficulties in obtaining adequate health care for older people with DS and with, among other disabilities, communication difficulties [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Health care utilisation among older people with Down syndrome compared to specific medical guidelines for health surveillance: a Swedish national register study

Ahlström

Axmon

Sandberg

et al. 2020

BMC Health Serv Res

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Background Specific medical guidelines for health surveillance exist for people with Down syndrome (DS) since 25 years but knowledge of adherence to the guidelines is lacking. The guidelines were developed to avoid unnecessary suffering from preventable conditions. The aims of the study were to investigate 1) planned health care visits in relation to the co-morbidities described in specific medical guidelines as a measure of adherence, 2) unplanned health care visits as a measure of potentially unmet health care needs and 3) gender differences in health care utilisation among older people with DS. Methods This register-based study includes people with DS (n = 472) from a Swedish national cohort of people with intellectual disability (n = 7936), aged 55 years or more, and with at least one support according to the disability law, in 2012. Data on inpatient and outpatient specialist health care utilisation were collected from the National Patient Register for 2002–2012. Results A total of 3854 inpatient and outpatient specialist health care visits were recorded during the 11 years, of which 54.6% (n = 2103) were planned, 44.0% (n = 1695) unplanned and 1.4% (n = 56) lacked information. More than half of the visits, 67.0% (n = 2582) were outpatient health care thus inpatient 33% (n = 1272). Most planned visits (29.4%, n = 618) were to an ophthalmology clinic, and most unplanned visits to an internal medicine clinic (36.6%, n = 621). The most common cause for planned visits was cataract, found at least once for 32.8% in this cohort, followed by arthrosis (8.9%), epilepsy (8.9%) and dementia (6.6%). Pneumonia, pain, fractures and epilepsy each accounted for at least one unplanned visit for approximately one-fourth of the population (27.1, 26.9, 26.3 and 19.7% respectively). Men and women had similar numbers of unplanned visits. However, women were more likely to have visits for epilepsy or fractures, and men more likely for pneumonia. Conclusions Increased awareness of existing specific medical guidelines for people with DS is vital for preventive measures. The relatively few planned health care visits according to the medical guidelines together with a high number of unplanned visits caused by conditions which potentially can be prevented suggest a need of improved adherence to medical guidelines.

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Primary health care for people with an intellectual disability: an exploration of consultations, problems identified, and their management in Australia

Cited by 26 publications

References 21 publications

Pharmacotherapy for mood and anxiety disorders in older people with intellectual disability in comparison with the general population

Pharmacotherapy for mood and anxiety disorders in older people with intellectual disability in comparison with the general population

Factors associated with death in people with intellectual disability

Health care utilisation among older people with Down syndrome compared to specific medical guidelines for health surveillance: a Swedish national register study

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