Search

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.

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]

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.