Abstract
People with intellectual disabilities (ID) have many comorbidities but experience inequities in access to health care. National Health Service England uses an opt-in incentive scheme to encourage annual health checks of patients with ID in primary care. We investigated whether the first 3 years of the programme had improved health care of people with ID. We did a longitudinal cohort study that used data from The Health Improvement Network primary care database. We did multivariate logistic regression to assess associations between various characteristics and whether or not practices had opted in to the incentivised scheme. We assessed data for 8692 patients from 222 incentivised practices and those for 918 patients in 48 non-incentivised practices. More blood tests (eg, total cholesterol, odds ratio [OR] 1·88, 95% CI 1·47-2·41, p<0·0001) general health measurements (eg, smoking status, 6·0, 4·10-8·79, p<0·0001), specific health assessments (eg, hearing, 24·0, 11·5-49·9, p<0·0001), and medication reviews (2·23, 1·68-2·97, p<0·0001) were done in incentivised than in non-incentivised practices, and more health action plans (6·15, 1·41-26·9, p=0·0156) and secondary care referrals (1·47, 1·05-2·05, p=0·0256) were made. Identification rates were higher in incentivised practices for thyroid disorder (OR 2·72, 95% CI 1·09-6·81, p=0·0323), gastrointestinal disorders (1·94, 1·03-3·65, p=0·0390), and obesity (2·49, 1·76-3·53, p<0·0001). Targeted annual health checks for people with ID in primary care could reduce health inequities. National Institute for Health Research.
Highlights
Intellectual disability (ID), known as learning disability in the UK, is defined as substantial impairments of intellectual function and social or adaptive functioning present from childhood.[1]
The total number of patients with intellectual disabilities (ID) in individual practices was the only variable significantly associated with opting into the LD-DES scheme after controlling for other practicelevel covariates
Our results suggest that annual health checks for people with ID could contribute to a reduction in the excess of avoidable deaths
Summary
Intellectual disability (ID), known as learning disability in the UK, is defined as substantial impairments of intellectual function and social or adaptive functioning present from childhood.[1]. Whether any routine general health checks for middleaged patients in primary care are effective is debated.[10] identification and management of health issues in other populations with complex needs, such as the frail elderly, gives some support for the effectiveness of comprehensive health assessments (anticipatory care).[11] The ID population is disadvantaged, with many inequalities in terms of provision of physical and mental health care and limited access to health professionals. Small-scale studies of primary care health checks have reported increases in health-promotion activities and management of long-term disorders that have led to improved identification of health needs.[12,13,14] These steps are crucial to improving health outcomes
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