Health Checks for People with Learning Disabilities

It’s hiding in plain sight. Poor people live less long than those who are rich,1 and people with a learning disability are more likely to die sooner than people without.2...

Do Canada and the United States Differ in Prevalence of Depression and Utilization of Services?

Mary Codling and Jane Solomon share the findings of an audit conducted one year after the implementation of health action plans and health checks for people with learning disability in Berkshire. The findings suggest that plans and checks are being used effectively to identify and improve health

Accessible summary Many people with learning disabilities have poor health and die younger compared to the general population so having regular health checks is very important. Sometimes doctors (general practitioners or GPs) and nurses do not know a person has a learning disability so cannot offer them a suitable health check. We asked GPs and a nurse for their views on ways they can find out who has learning disabilities and whether those ways of finding people work We found that the doctors and the nurses did not use ways to find out who has learning disabilities very often, but thought they were a good idea. Finding people with learning disabilities meant they could be offered support to attend appointments more easily.

IntroductionThere is potential for health gain by Aboriginal and Torres Strait Islander people in Australia through better primary health service in urban areas. Preventive health care delivered with social sensitivity is critical to addressing chronic disease. In the mainstream urban general practice setting, three key linked processes of Indigenous identification, health checks and immunisation for Indigenous people should be improved.BackgroundThe history and current lived experience of Aboriginal and Torres Strait Islander people influence access to mainstream health care services. Known access facilitators in urban areas are low cost, convenience and delivery in a culturally safe setting by practitioners with compatible values and professional culture. In contrast to community controlled health services, mainstream general practices have few practitioners with Indigenous care experience, and low levels of Indigenous identification and Indigenous health check delivery.This thesis presents the development, implementation and evaluation of an intervention in Brisbane designed to address known and suspected barriers to Indigenous people’s access to preventive care in mainstream urban general practice.The following research questions were considered:1. Based on the best evidence, what intervention by Division of General Practice and Public Health Unit staff was appropriate and feasible to promote increased coverage of Indigenous health checks and immunisation in mainstream urban general practices?2. What were the effects of the intervention targeting mainstream practitioners on Indigenous identification, immunisation and health checks, and what were the other effects?3. How could existing barriers to immunisation and health checks in mainstream general practice be overcome?MethodsThe Promoting Indigenous Preventive Care in General Practice (PIPCGP) study used a realist-inspired framework of enquiry and a mixed methods approach. Division of General Practice and Public Health Unit staff used existing resources to provide intensive practice support through an educational workshop, package of activity support materials, progressive audit and feedback, and ongoing contact over twelve months. Seventeen General Practices in two intervention groups were enrolled. Audit data were gathered at the practice, returned to practices, and collated for evaluation purposes. In-depth interviews were conducted with 35 participants, including clinical and non-clinical staff of practices and Indigenous community members.ResultsThe inner suburban group had low attrition, showed a steep rise (78%) in Indigenous patient numbers, and increased health check delivery. Half the Indigenous children aged 2 to 5 years had immunisation data missing from their record prior to intervention, which was rectified. Child immunisation coverage for all vaccines, including Indigenous-specific vaccines, was 46% at the end of the period. The outer suburban group had a high attrition rate of 50%.Preventive care processes for over two thousand Indigenous patients were included in the study. Increased Indigenous identification came from both current and new patient groups. Practices with higher health check activity had staff experienced in Indigenous health, were already delivering checks prior to intervention, and increased their activity. Few low activity practices had previously undertaken checks, and half of these commenced. Difficulties reported were a low level of patient willingness to undergo a check, and organisational processes: poorly adapted electronic records, long consultation time, and uncertainty about sharing assessment components between team members.Indigenous identification was welcomed, was associated with acknowledgement of culture, and helped build relationships. Providers experienced in Indigenous health aligned with patients in emphasising the staff-patient relationship as a barrier to preventive care, and provided guidance on relationship building. Other providers focused solely on practical barriers. Most providers and community members expressed the need for links between practices, the Indigenous community, and Indigenous organisations.DiscussionThe PIPCGP study confirms that Indigenous identification can be quickly improved in mainstream General Practices, and highlights an additional range of practical and social issues to be addressed in increasing access to preventive care. These include knowledge of the Indigenous immunisation schedule, improved completeness of immunisation record keeping, and teamwork to plan adequate time and cooperation for health checks. Information system deficits exist in Indigenous identification recording, on-screen activity prompt and recall/ reminder. The success factor of staff experienced in Indigenous health enabled a patient relationship-building focus and influenced system change in the practice.ConclusionMainstream practice efforts to strengthen patient-centred care of chronic disease, should include Indigenous cultural and relationship-focused training for staff, Indigenous patient service planning and quality improvement. A continued dialogue and partnership between Community Controlled Health Services and Primary Health Networks, with the assistance of Public Health Services, is essential to support practices with concentrations of Indigenous patients. Supply of general practice information systems in Australia which support tailored care for Indigenous people could be another lever for change, as could more detailed activity monitoring linked to financial incentives to provide high quality preventive care.

To compare children with mental and physical health problems regarding (1) perceived disease severity; (2) the impact of their condition on their families; (3) their utilization of health care services (including satisfaction with care); and (4) parents' health literacy about their child's condition and its treatment. Furthermore, we examined whether parents' health literacy differs between types of mental health condition. Parental reports about their 9- to 14-year-old children with mental (n=785) or physical health problems (n=475) were analyzed from the population-based National Survey of Children with Special Health Care Needs in Switzerland. Mental health problems were perceived as being more severe (p<0.001) and exerting a larger impact upon the family (e.g., financial impact) than physical health problems. Furthermore, fewer parents of children with a mental health problem mentioned having a particular person or place to contact if they needed information or advice regarding the child's condition (p=0.004) and were satisfied with the health care services their child received (p<0.001). The odds of low health literacy was higher among parents with children suffering from mental health problems vs. parents of children with physical health problems (OR in the adjusted model=1.92; 95% CI 1.47-2.50; p<0.001); this finding held generally for mental health problem (although only a trend was observable for internalizing problems). The large impact of children's mental health conditions on themselves and their families might be reduced by adapting the provision of health care and by increasing parents' health literacy.

How to be good

The aim of the present paper was to examine general practitioners' (GPs') beliefs about: the demands made on the primary care team by people with learning disability; their confidence in meeting health care needs and perceived training requirements; attitudes towards specialist or generic health service provision, and current contact with specialist teams; and attitudes towards screening in people with learning disability. A postal questionnaire was sent to a randomly selected partner from 95% of the practices in the Southampton and South‐west Hampshire Health District. Forty‐eight (75%) GPs responded and few were undecided about the demands placed on primary care teams, but beliefs were mixed. Most GPs were confident in dealing with the medical care needs of people with learning disability and the majority felt that training courses would not be worthwhile, except to learn more about specialist services where contact was very low and a ‘link worker’ scheme had had little apparent impact. Most respondents agreed that GPs should meet the medical needs of people with learning disability as part of general medical services and approximately half had a positive attitude towards providing regular health checks. Respondents were cautious about offering cervical cancer screening to women with learning disability. A small minority suggested that they would take no action to follow up a non‐attendance for mammography. As a heterogeneous population, it is not surprising that GPs' attitudes vary widely. Further research is required to establish the nature and scale of demands made on primary health care teams, and to evaluate systematic means of addressing health care needs of people with learning disability.

BackgroundLow participation rates among ethnic minorities in preventive healthcare services are worrisome and not well understood. The objective of this study was to explore how adults of Turkish and Moroccan origin living in the Netherlands, aged 45 years and older, can be reached to participate in health checks for cardio-metabolic diseases and follow-up (lifestyle) advice.MethodsThis mixed-methods study used a convergent parallel design, to combine data of one quantitative study and three qualitative studies. Questionnaire data were included of 310 respondents, and interview data from 22 focus groups and four individual interviews. Participants were recruited via a research database, general practitioners and key figures. Quantitative data were analysed descriptively and qualitative data were analysed using a thematic approach.ResultsRegarding health checks, 50 % (95 % CI 41;59) of the Turkish questionnaire respondents and 66 % (95 % CI 57;76) of the Moroccan questionnaire respondents preferred an invitation from their general practitioner. The preferred location to fill out the health check questionnaire was for both ethnic groups the general practitioner’s office or at home, on paper. Regarding advice, both groups preferred to receive advice at individual level rather than in a group, via either a physician or a specialised healthcare professional. It was emphasised that the person who gives lifestyle advice should be familiar with the (eating) habits of the targeted individual. Sixty-one percent (95 % CI 53;69) of the Turkish respondents preferred to receive information in their native language compared to 37 % (95 % CI 29;45) of the Moroccan respondents. Several participants mentioned a low proficiency in the local language as an explanation for their preference to fill out the health check questionnaire at home, to receive advice from an ethnic-matched professional, and to receive information in their native language.ConclusionsThe general practitioner is considered as a promising contact to reach adults of Turkish and Moroccan origin for health checks or (lifestyle) advice. It might be necessary to provide information in individuals’ native language to overcome language barriers. In addition, (lifestyle) advice must be tailored. The obtained insight into preferences of Turkish and Moroccan adults regarding reach for preventive healthcare services could help professionals to successfully target these groups.

The central place of psychiatry in health care worldwide.

BackgroundCompared with the general population, autistic adults experience higher rates of physical and mental health conditions, premature morbidity and mortality, and barriers to health care. A health check for autistic people may improve their health outcomes.AimTo establish the views of autistic people towards a primary care health check for autistic people.Design & settingCross-sectional questionnaire study in England and Wales.MethodA questionnaire was sent to autistic adults with physical health conditions in England and Wales. A total of 458 people (441 autistic adults and 17 proxy responders) completed the questionnaire.ResultsMost responders (73.4%, n = 336) thought a health check is needed for all autistic people. Around half of the participants thought a health check should be offered from childhood and the health check appointment should last between 15 and 30 minutes. Autistic people were positive about providing primary care staff with contextual information regarding their health and the reasonable adjustments they would like before their health check appointment. Training about autism and the health check was considered important, alongside adequate time for discussions in the health check appointment (all by over 70% of responders). The clinician’s autism knowledge, seeing a familiar clinician, environmental adaptations, appropriate information, and accessible appointments were considered particularly important in making a health check accessible.ConclusionAutistic people and relatives were supportive of a primary care health check for autistic people. Information gathered was used to support the design of a primary care health check for autistic adults.

BackgroundDespite the known health and healthcare costs of untreated chlamydia infection and the efforts of the National Chlamydia Screening Programme (NCSP) to control chlamydia through early detection and treatment of asymptomatic infection, the rates of screening are well below the 2010-2011 target rate of 35%. General Practitioner (GP) surgeries are a key venue within the NCSP however; previous studies indicate that GP surgery staff are concerned that they may offend their patients by offering a screen. This study aimed to identify the attitudes to, and preferences for, chlamydia screening in 15-24 year old men and women attending GP surgeries (the target group).MethodsWe undertook 36 interviews in six surgeries of differing screening rates. Our participants were 15-24 year olds attending a consultation with a staff member. Data were analysed thematically.ResultsGP surgeries are acceptable to young people as a venue for opportunistic chlamydia screening and furthermore they think it is the duty of GP surgery staff to offer it. They felt strongly that it is important for surgery staff to have a non-judgemental attitude and they did not want to be singled out as 'needing' a chlamydia screen. Furthermore, our sample reported a strong preference for being offered a screen by staff and providing the sample immediately at the surgery rather than taking home a testing kit. The positive attitude and subjective norms demonstrated by interviewees suggest that young peoples' behaviour would be to accept a screen if it was offered to them.ConclusionYoung people attending GP surgeries have a positive attitude towards chlamydia screening and given the right environment are likely to take up the offer in this setting. The right environment involves normalising screening by offering a chlamydia screen to all 15-24 year olds at every interaction with staff, offering screening with a non-judgemental attitude and minimising barriers to screening such as embarrassment. The GP surgery is the ideal place to screen young people for chlamydia as it is not a threatening place for them and our study has shown that they think it is the normal place to go to discuss health matters.

BackgroundDuring the COVID‐19 pandemic in the United Kingdom, many health services were withdrawn from people with learning disabilities, with negative impacts on people's health. What has happened to people's health and healthcare as we move beyond the pandemic?MethodsAccess to health services and health status were tracked for 550 UK adults with learning disabilities, using structured online interviews with people with learning disabilities and online surveys with family members or paid carers. Information was provided four times, from Wave 1 (in the winter 2020/2021 ‘lockdown’) to Wave 4 (autumn 2022, over a year after public health protections stopped).FindingsBy Wave 4, most people with learning disabilities had had COVID‐19, although high vaccination rates limited the number of people hospitalised. There was little evidence that use of GP services, community nurses, other therapists or annual health checks had increased over time, and at Wave 4 more people were having difficulty getting their medicines. People's health did not substantially improve over time. People with profound and multiple learning disabilities had poorer health and were less likely to be accessing health services.ConclusionsImprovements in access to health services for people with learning disabilities after the pandemic have not yet happened.

Research highlights a child's environment and experiences during the first 2000days has a lasting impact on their health, development and wellbeing. In NSW, it is recommended that all children under 5years of age have free routine health and developmental checks, promoting optimal childhood development and shaping future health outcomes. There appears to be a strong indication that parents do not return for their checks. Between 2019 and 2020, a qualitative study was undertaken aiming to identify and better understand the key factors driving parents' disengagement from child family health nursing (CFHN) services after contact in their baby's first year. Moreover, having a greater understanding of key factors driving parents' early service disengagement may help to reshape service delivery. During the study period, parents of infants who had received the 1-4-week health check with CFHN services were informed about the study and invited to participate. A total of 104 families gave consent to take part in phone interviews. These interviews were transcribed and analysed using straightforward thematic analysis. Qualitative data were gathered to explore families' experiences with the CFHN services. Less than 35% of families utilised CFHN services, whereas >62% visited their general practitioners. Barriers identified included the presence of multiple services, established relationships with current health professionals, limited accessibility, convenience factors and parents' lack of knowledge regarding CFHN services. On a positive note, half of the participants reported experiencing no barriers. This study emphasises the need for better awareness and accessibility to CFHN services. The findings are concerning, because children missing health screenings may experience delays in early identification and intervention before starting school.

A national programme of health checks to identify risk of cardiovascular disease (CVD) is being rolled out but is encountering difficulties because of low uptake. To evaluate the effectiveness of an enhanced invitation method using the question-behaviour effect (QBE), with or without the offer of a financial incentive to return the QBE questionnaire, at increasing the uptake of health checks. The research went on to evaluate the reasons for the low uptake of invitations and compare the case mix for invited and opportunistic health checks. Three-arm randomised trial and cohort study. All participants invited for a health check from 18 general practices. Individual participants were randomised. (1) Standard health check invitation only; (2) QBE questionnaire followed by a standard invitation; and (3) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by a standard invitation. The primary outcome was completion of the health check within 6 months of invitation. A p-value of 0.0167 was used for significance. In the cohort study of all health checks completed during the study period, the case mix was compared for participants responding to invitations and those receiving 'opportunistic' health checks. Participants were not aware that several types of invitation were in use. The research team were blind to trial arm allocation at outcome data extraction. In total, 12,459 participants were included in the trial and health check uptake was evaluated for 12,052 participants for whom outcome data were collected. Health check uptake was as follows: standard invitation, 590 out of 4095 (14.41%); QBE questionnaire, 630 out of 3988 (15.80%); QBE questionnaire and financial incentive, 629 out of 3969 (15.85%). The increase in uptake associated with the QBE questionnaire was 1.43% [95% confidence interval (CI) -0.12% to 2.97%; p = 0.070] and the increase in uptake associated with the QBE questionnaire and offer of financial incentive was 1.52% (95% CI -0.03% to 3.07%; p = 0.054). The difference in uptake associated with the offer of an incentive to return the QBE questionnaire was -0.01% (95% CI -1.59% to 1.58%; p = 0.995). During the study period, 58% of health check cardiovascular risk assessments did not follow a trial invitation. People who received an 'opportunistic' health check had greater odds of a ≥ 10% CVD risk than those who received an invited health check (adjusted odds ratio 1.70, 95% CI 1.45 to 1.99; p < 0.001). Uptake of a health check following an invitation letter is low and is not increased through an enhanced invitation method using the QBE. The offer of a £5 incentive did not increase the rate of return of the QBE questionnaire. A high proportion of all health checks are performed opportunistically and not in response to a standard invitation letter. Participants receiving opportunistic checks are at higher risk of CVD than those responding to standard invitations. Future research should aim to increase the accessibility of preventative medical interventions to increase uptake. Research should also explore the wider use of electronic health records in delivering efficient trials. Current Controlled Trials ISRCTN42856343. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 84. See the NIHR Journals Library website for further project information.