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Health checks have beneficial effects on health outcomes in adults with intellectual disability; however, little is known about their effect on people with Down syndrome. The aim of this study was to assess the effect of receiving a health check on the unmet health needs of people with Down syndrome. A pooled analysis of three randomized trials conducted by the same Australian research team was undertaken. The trials used the same tools but differed by participant source (adults in 24 h supported accommodation, adults in private dwellings, adolescents living with parents). The intervention was a one-off health check, and the comparator was usual care. Among 216 participants, health actions were more likely to occur for those allocated to receive health checks, including increased hearing (odds ratio = 4.4; 95% confidence interval: 1.2, 16.4), vision (2.7; 1.1, 6.7), and thyroid (2.3; 1.3, 4.2) testing, and weight recording (4.7; 2.5, 8.8). Health checks conducted at the primary-care level produced substantially increased attention to the health needs of people with Down syndrome. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disability have substantially more unidentified health needs than the general population. We systematically reviewed the effectiveness of primary healthcare interventions intended to increase health actions for people with intellectual disability. Methods: Electronic databases were searched on 16 September 2014. Randomised and non-randomised studies with a concurrent control group were identified. Study quality was assessed and, where possible, meta-analysis was undertaken. Results: Five studies (3 randomised controlled trials, 1 matched cohort study, and 1 cohort study) with a total of 1,570 participants were included. General practitioner-led health checks were the most effective intervention and resulted in significantly more clinical activities, such as vision testing (risk ratio [RR] = 3.3, 95% CI [2.3, 4.7]) and hepatitis B vaccinations (RR = 2.4, 95% CI [1.7, 3.4]). Conclusions: Health checks were the only intervention to significantly increase short-term health promotion and disease prevention activity. The long-term effect of any intervention remains unknown.

Adolescents with intellectual disability have substantial health needs. This retrospective analysis of data from the Ask Study describes reasons for primary care encounters and the prevalence and incidence of chronic physical and mental conditions among a cohort of community-dwelling adolescents with intellectual disability. Participants attended secondary schools in southern Queensland, Australia. Primary care data were extracted from primary care records. Demographic and health information was collected using carer-completed questionnaires. Reasons for primary care encounters, disease prevalence at age 16 years, and disease incidence through adolescence were reported. Data were obtained for 432 adolescents with intellectual disability (median follow-up: 4.1 years). Skin problems (29.4 per 100 encounters) were the most common reason patients presented for primary care, followed by psychological and behavioural problems (14.4 per 100 encounters) and musculoskeletal problems (13.8 per 100 encounters). Conditions with the highest prevalence were autism spectrum disorder (18.6%) and asthma (18.1%). The prevalence of epilepsy, visual impairment, and cerebral palsy were 14.7, 11.1, and 8.0%, respectively. Gastroesophageal reflux had the highest incidence (9.4 cases per 1000 person-years). Adolescents with intellectual disability have significant healthcare needs, which general practitioners need to be aware of and address. Study findings should inform the development of training programs for general practitioners. [ABSTRACT FROM AUTHOR]

Background: There is concern about widespread medication use by people with intellectual disability (ID), especially psychotropic and anticonvulsant agents. However, there is sparse information on prescribing patterns in Australia. Method: This cross-sectional study was conducted between 2000 and 2002 among adults with ID who live in the community in Brisbane, Australia. Medication data were extracted from a health screening tool. Demographic and medical data were collected from telephone interviews and medical records. Results: Of 117 participants, 35% were prescribed psychotropic medications, most commonly antipsychotics, and 26% anticonvulsants. Complementary medications (vitamins, minerals, amino acids, fish oil, and herbal products) were used by 29% of participants. After adjusting for potentially confounding variables, psychotropic medication use was significantly associated with having a psychiatric illness (adjusted odds ratio = 4.6, 95% CI [1.0, 20.6]) and challenging behaviours (4.4, [1.1, 17.3]). Conclusions: People with ID use a broad range of medications. Psychotropic medications continue to be the most predominant agents prescribed for this population. Psychotropic medication use is positively associated with having a psychiatric illness and challenging behaviours.

The authors review available data on Australians from a non-English speaking background (NESB) with intellectual disability (ID). They find that intellectual disability in the Australian NESB community has received limited attention in terms of both qualitative and quantitative research. The existing literature is over 10 years old and is relevant only to other countries. This dearth of Australian research propagates the invisibility of this population. Greater understanding of the intersecting social determinants of health, poverty, prevalence, and ethnicity is imperative, particularly given that ethnicity co-occurs with disadvantage. Without adequate and accurate quantitative data on people from NESB with ID, Australian Government and state/territory policy on disability is deficient. This ultimately hinders appropriate resource and service planning to address the needs of Australia's multicultural population now, and into the future. Quality national datasets would allow for trends to be monitored over time. With a cogent evidence base, a sustainable, equitable, responsive disability service system for all Australians could be developed, including the proposed National Disability Insurance Scheme, and may further contribute to Australia's progressive realisation of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) and Millennium Development Goals.

Background: People with intellectual disability often have poor health which may be improved through better health advocacy and enhanced communication with their general practitioner. To this end, we examined the use of the Comprehensive Health Assessment Program (CHAP) and the "Ask" health diary previously developed for adults with intellectual disability and trialled their use in adolescents attending a Special School. Materials and methods: A CHAP health review completed by both carers and General Practitioners was used to collect information about adolescents' health. An "Ask" health diary was used in school to learn health advocacy and communication skills. Thirty students, their parents and their eight teachers participated in the trial. Results: The CHAP health review resulted in a mean of 5.2 health conditions being found, and 1.4 planned actions by the general practitioner per adolescent. The "Ask" health diary was highly accepted by the students and teachers. There did not appear to be any increase in communication skills of the students after using the diary in the school for one term. Conclusion: The CHAP health review and "Ask" health diary have the potential to improve the health of adolescents with intellectual disability.

This study compared the patient demographics and reasons for encounter in general practice for patients <25 years with and without an autism spectrum disorder identified as a reason for encounter and/or problem managed. The Bettering the Evaluation and Care of Health programme collected information about clinical activities in Australian general practice. Each year, the programme recruited a random sample of 1000 general practitioners, each of whom collected data for 100 consecutive consultations (encounters). Encounters with patients <25 years, where at least one autism spectrum disorder was recorded as a reason for encounter and/or a problem managed (n = 579), were compared with all other encounters (n = 281,473) from April 2000 to March 2014 inclusive. Data were age–sex standardised. Patients at autism spectrum disorder encounters (compared to non-autism spectrum disorder encounters) were more likely to be younger and male. There was a dramatic rise in the number of general practitioner consultations at autism spectrum disorder encounters from 2000 to 2013. More reasons for encounter were recorded at autism spectrum disorder encounters than at non-autism spectrum disorder encounters (156.4 (95% confidence interval: 144.0–168.8) and 140.5 (95% confidence interval: 140.0–141.0), respectively). At autism spectrum disorder (vs non-autism spectrum disorder) encounters, there were more psychological, general and unspecified, and social reasons for encounter and fewer preventive and acute health reasons for encounter. People with an autism spectrum disorder have complex health care needs that require a skilled general practice workforce. [ABSTRACT FROM AUTHOR]

Objectives: To determine the rates at which people recently released from prison attend general practitioners, and to describe service users and their encounters.Design, Participants and Setting: Prospective cohort study of 1190 prisoners in Queensland, interviewed up to 6 weeks before expected release from custody (August 2008 - July 2010); their responses were linked prospectively with Medicare and Pharmaceutical Benefits Scheme data for the 2 years after their release. General practice attendance was compared with that of members of the general Queensland population of the same sex and in the same age groups.Main Outcome Measures: Rates of general practice attendance by former prisoners during the 2 years following their release from prison.Results: In the 2 years following release from custody, former prisoners attended general practice services twice as frequently (standardised rate ratio, 2.04; 95% CI, 2.00-2.07) as other Queenslanders; 87% of participants visited a GP at least once during this time. 42% of encounters resulted in a filled prescription, and 12% in diagnostic testing. Factors associated with higher rates of general practice attendance included history of risky opiate use (incidence rate ratio [IRR], 2.09; 95% CI, 1.65-2.65), having ever been diagnosed with a mental disorder (IRR, 1.32; 95% CI, 1.14-1.53), and receiving medication while in prison (IRR, 1.82; 95% CI, 1.58-2.10).Conclusions: Former prisoners visited general practice services with greater frequency than the general Queensland population. This is consistent with their complex health needs, and suggests that increasing access to primary care to improve the health of former prisoners may be insufficient, and should be accompanied by improving the quality, continuity, and cultural appropriateness of care. [ABSTRACT FROM AUTHOR]

People with intellectual disability experience inadequate health care and have unmet health needs that can go unidentified or be poorly managed. Health assessments have been shown to significantly increase short-term clinical activity for people with intellectual disability. The aim of this study was to more accurately quantify the effect of health assessments for people with intellectual disability by comparing health actions recorded in health assessment booklets to actions recorded in general practitioners' (GPs) records in the 12-month period following the health assessment. Participants were people with intellectual disability who had received a Comprehensive Health Assessment Program (CHAP), living in the community. The CHAP is a health assessment that is demonstrated to significantly increase health actions, compared with usual care, for people with intellectual disability. Data collected from three randomised controlled trials conducted in South-East Queensland, Australia, from 2000 to 2010 were pooled and analysed. The health assessment booklet contained significantly more information on health actions than GPs' records. Notably, hearing tests (risk ratio (RR) = 5.9; 95% confidence interval (CI) = 4.7-7.4), breast checks (RR = 3.9; 95% CI = 2.7-5.7), and skin examinations (RR = 7.9; 95% CI = 5.9-10.7) were more likely to be recorded in the CHAP booklet. Health assessments increase health actions for people with intellectual disability to a significantly greater extent than previously demonstrated. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) infection is common among prisoners, particularly those with a history of injecting drug use (IDU). Incarcerated people who inject drugs frequently report high-risk injecting practices both in prison and in the community. In spite of rising morbidity and mortality, utilisation of HCV-related services in Australia has been persistently low. This study aimed to describe the incidence, prevalence and correlates of HCV seropositivity in a large cohort of prisoners who have injected drugs, and to identify correlates of receiving confirmation of active infection. Methods: Data-linkage to a State-wide statutory notifiable diseases surveillance system was used to investigate the incidence of notified HCV seropositivity, seroconversion and confirmed HCV infection in a cohort of 735 prisoners with a history of IDU, over 14 years of follow up. Hepatitis C test results from prison medical records were used to identify correlates of testing positive in prison. Results: The crude incidence of HCV notification was 5.1 cases per 100 person-years. By the end of follow up, 55.1% of the cohort had been the subject of a HCV-related notification, and 47.4% of those tested in prison were HCV seropositive. In multivariable analyses, injecting in prison was strongly associated with HCV seropositivity, as was opioid use compared to injection of other drugs. The rate of reported diagnostic confirmation among those with notified infections was very low, at 6.6 confirmations per 100 seropositive participants per year. Conclusions: Injecting drugs in prison was strongly associated with HCV seropositivity, highlighting the need for increased provision of services to mitigate the risk of transmission within prisons. Once identified as seropositive through screening, people with a history of IDU and incarceration may not be promptly receiving diagnostic services, which are necessary if they are to access treatment. Improving access to HCV-related services will be of particular importance in the coming years, as HCV-related morbidity and mortality is increasing, and next generation therapies are becoming more widely available. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study that examined the association of intellectual disability and prevalence of co-occurring mental disability among prisoners. Out of the 1,279 subject prisoners on the Hayes Ability Screening Index (HASI), 24 percent scored below the recommended cut off for more diagnostic assessment of intellectual disability. It concluded that prisoners with intellectual disability have elevated rates of psychiatric comorbidity and unmet treatment needs.

The aim of this study was to investigate general practitioners’ (GPs) beliefs about the importance of addressing nine health care issues for people with intellectual disabilities, and their roles in providing this care. GPs’ current level and intended future level of addressing these health care issues were also determined. Questionnaires were mailed to 912 GPs Australia wide, with a 58% response rate. The vast majority of respondents agreed that the nine issues are important health care issues for people with an intellectual disability. Most respondents also agreed that it is the GPs’ role to facilitate or ensure these health issues are addressed. Although having broad attitudes about their roles, GPs indicated significant deficiencies in their current level of health care provision for many of the health issues. However, they also indicated their intentions to increase the frequency of addressing these health issues in the future as a result of issues raised in previous questions on the questionnaire. This response to simply increasing GPs’awareness of their practice behaviour has a variety of important implications for training and ongoing education. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the people who were identified by Australia's National Health and Hospitals Reform Commission as facing health inequalities.

This study compared the patient demographics and reasons for encounter in general practice for patients <25 years with and without an autism spectrum disorder identified as a reason for encounter and/or problem managed. The Bettering the Evaluation and Care of Health programme collected information about clinical activities in Australian general practice. Each year, the programme recruited a random sample of 1000 general practitioners, each of whom collected data for 100 consecutive consultations (encounters). Encounters with patients <25 years, where at least one autism spectrum disorder was recorded as a reason for encounter and/or a problem managed (n = 579), were compared with all other encounters (n = 281,473) from April 2000 to March 2014 inclusive. Data were age-sex standardised. Patients at autism spectrum disorder encounters (compared to non-autism spectrum disorder encounters) were more likely to be younger and male. There was a dramatic rise in the number of general practitioner consultations at autism spectrum disorder encounters from 2000 to 2013. More reasons for encounter were recorded at autism spectrum disorder encounters than at non-autism spectrum disorder encounters (156.4 (95% confidence interval: 144.0-168.8) and 140.5 (95% confidence interval: 140.0-141.0), respectively). At autism spectrum disorder (vs non-autism spectrum disorder) encounters, there were more psychological, general and unspecified, and social reasons for encounter and fewer preventive and acute health reasons for encounter. People with an autism spectrum disorder have complex health care needs that require a skilled general practice workforce.

Background: Health assessments have beneficial effects on health outcomes for people with intellectual disability living in the community. However, the effect on medical costs is unknown., Methods: We utilised Medicare Australia data on consultations, procedures and prescription drugs (including vaccinations) from all participants in a randomised control trial during 2002-03 that examined the effectiveness of a health assessment. Government health costs for adults with intellectual disability who did or did not receive an assessment were compared. Bootstrapping statistics (95% confidence interval) were employed to handle the right-skewed cost data., Results: Over 12 months, patients receiving health assessments incurred total costs of $4523 (95% CI: $3521 to $5525) similar to those in usual care $4466 (95% CI: $3283 to $5649). Costs were not significantly higher compared with the 12 month pre-intervention period., Discussion: Health assessments for adults with intellectual disability living in the community are encouraged as they produce enhanced patient care but do not increase overall consultation or medication costs.

Background: Sexual abuse and abusive relationships are known to be especially common in people with intellectual disability. This study explored how women with intellectual disability understand sex, relationships and sexual abuse, the effects of sexual abuse on their lives, and how successfully they protect themselves from abuse., Methods: Semistructured narrative interviews with nine women with mild intellectual disability in Queensland, Australia. Interviews were audio recorded, transcribed, coded and analysed qualitatively., Results: Major themes that emerged were: sexual knowledge and sources of knowledge; negotiating sexual relationships; declining unwanted sexual contact; self protection strategies; sexual abuse experiences; and sequelae of sexual abuse., Discussion: Most participants reported unwanted or abusive sexual experiences. They described sequelae such as difficulties with sex and relationships, and anxiety and depression. They described themselves as having inadequate self protection skills and difficulty reporting abuse and obtaining appropriate support. Their understanding of sex was limited and they lacked the literacy and other skills to seek information independently. It is important for general practitioners to be aware of the possibility of sexual abuse against women with intellectual disability, and to offer appropriate interventions.

Background: In recent decades people with intellectual disability have moved from institutional care into the community and are now reliant on general practice services for their primary medical care. Their complex health needs present a considerable challenge to the general practitioner., Objective: This article aims to outline the common physical and psychiatric conditions found in adults with intellectual disability, and the need for a structured approach to health care in patients with limited communication skills., Discussion: Adults with intellectual disability frequently have undiagnosed health problems. In many cases these will only be identified by specific examination and testing. Health assessment tools offer a useful guide to which conditions to look out for. Early identification and treatment enhances quality of life for both people with intellectual disability and their carers.