Search

Background Annual health checks for adults with intellectual disability (ID) have been incentivised by National Health Service (NHS) England since 2009, but it is unclear what impact they have had on important health outcomes such as emergency hospitalisation. Methods An evaluation of a ‘natural experiment’, incorporating practice and individual-level designs, to assess the effectiveness of health checks for adults with ID in reducing emergency hospital admissions using a large English primary care database. For practices, changes in admission rates for adults with ID between 2009–2010 and 2011–2012 were compared in 126 fully participating versus 68 non-participating practices. For individuals, changes in admission rates before and after the first health check for 7487 adults with ID were compared with 46 408 age-sex-practice matched controls. Incident rate ratios (IRRs) comparing changes in admission rates are presented for: all emergency, preventable emergency (for ambulatory care sensitive conditions (ACSCs)) and elective emergency. Results Practices with high health check participation showed no change in emergency admission rate among patients with ID over time compared with non-participating practices (IRR=0.97, 95% CI 0.78 to 1.19), but emergency admissions for ACSCs did fall (IRR=0.74, 0.58 to 0.95). Among individuals with ID, health checks had no effect on overall emergency admissions compared with controls (IRR=0.96, 0.87 to 1.07), although there was a relative reduction in emergency admissions for ACSCs (IRR=0.82, 0.69 to 0.99). Elective admissions showed no change with health checks in either analysis. Conclusions Annual health checks in primary care for adults with ID did not alter overall emergency admissions, but they appeared influential in reducing preventable emergency admissions.

Background It is widely recognised that people with intellectual disability (ID) experience poorer health, access to healthcare and life expectancy. However there is limited accurate population-based information on their mortality, which is crucial to forming strategies to reduce premature deaths. We examined mortality in a large unselected group of adults with ID, with a focus on those deaths considered potentially avoidable. Potentially avoidable deaths are widely used as a means of assessing healthcare systems, as they are deaths which could have been avoided by good quality healthcare (sub-defined as amenable) or public health interventions (sub-defined as preventable). Methods We described the mortality experience of adults with ID compared to the general population using novel linkage of two national databases, namely general practice data from the Clinical Practice Research Datalink (CPRD) and ONS mortality data. We used a matched cohort study from 343 English general practices between 2009 and 2013. 16,666 adults with ID (656 deaths) aged 18–84 were compared to 113,562 age, sex and practice matched controls (1,358 deaths). Outcomes of all-cause and cause specific mortality as well as deaths considered potentially avoidable, were examined using stratified Cox regression in SAS. Results Adults with ID had higher mortality rates than controls (Hazard Ratio (HR) = 3.6, 95% CI = 3.3–3.9) which remained high after adjusting for co-morbidities, smoking and deprivation (HR = 3.1, 2.7–3.4). The higher mortality rate compared to controls was greater among ID adults with Down’s syndrome (HR = 9.2, 7.2–11.8) and epilepsy (HR = 6.0, 5.0–7.2). Almost all cause specific rates were higher for ID adults, with greatest increases (HR > 10) for genitourinary and nervous system diseases/disorders. While potentially avoidable deaths constituted similar percentages of overall mortality in both the ID group (46.3%) and controls (47.5%), the contribution from deaths classified as amenable was very different; 37.0% of all deaths in the ID group compared to 22.5% in the controls. This difference was reflected in the HR for deaths amenable to healthcare (HR = 5.1, 4.5–5.8) in contrast to the other subcategory of avoidable deaths (Preventable deaths HR = 1.7, 1.49–2.0). Conclusion Mortality among adults with ID is markedly elevated compared to the general population. This disparity is particularly prominent in deaths which are considered potentially avoidable through good quality healthcare. This mortality disparity may be an indicator of healthcare inequality and effectiveness; therefore strategies are needed to improve access and quality of healthcare for people with ID.