A Register for Patients with Learning Disabilities in General Practice

Abstract

The shift of people with learning disabilities out of the large mental handicap hospitals mainly into residential homes in the community is now almost complete. This means that almost all people with learning disabilities are registered with general practitioners, both those discharged from long-stay institutions, and those who have always lived with their families in the community. This present paper reports on a study undertaken to assess the amount of disability and the workload by comparing the annual consultation rates of those recently discharged from long-stay institutions with those always in the community, and also against matched controls in a large fundholding practice. This was achieved by the practice learning disability register being imported from the local community learning disability team’s special needs register and checked against the local social education centre and special school records and then with the practice held records. Those whose records showed that they had been discharged from either hospital or specialist school within the last10 years of the study end (April 1996) were assigned as a past long-stay institution group; the remaining patients formed a second group, and both were compared with a matched control group. The study found that out of a total practice list of 14,410 patients, 57 were identified as patients with a known learning disability and constituted the register. They consulted 1.7 times as often and were prescribed 1.8 times as many repeat prescription drugs as matched control patients. However, of the57, the10 patients from long-stay institutions consulted4.9 times as often and took 4.9 times as many repeat prescription drugs as controls. The patients with learning disability who had always lived in the community consulted and took repeat prescription drugs at rates similar to controls. Making a detailed register of patients with learning disabilities highlights the multiple associated disabilities of this patient population and reveals an increase in consultation rate and central nervous system drug consumption. This is mainly due to patients who formerly lived in long-stay institutions and who were discharged to this practice. Similar changes are likely to have occurred in other primary health care teams.