2 research outputs found
Trends in hospital admissions during transition from paediatric to adult services for young people with learning disabilities or autism: Population-based cohort study
Summary
Background Transition from paediatric to adult health care may disrupt continuity of care, and result in unmet health
needs. We describe changes in planned and unplanned hospital admission rates before, during and after transition
for young people with learning disability (LD), or autism spectrum disorders (ASD) indicated in hospital records, who
are likely to have more complex health needs.
Methods We developed two mutually exclusive cohorts of young people with LD, and with ASD without LD, born
between 1990 and 2001 in England using national hospital admission data. We determined the annual rate of
change in planned and unplanned hospital admission rates before (age 10β15 years), during (16β18 years) and after
(19β24 years) transition to adult care using multilevel negative binomial regression models, accounting for area-level
deprivation, sex, birth year and presence of comorbidities.
Findings The cohorts included 51,291 young people with LD, and 46,270 autistic young people. Admission rates at
ages 10β24 years old were higher for young people with LD (54 planned and 25 unplanned admissions per 100
person-years) than for autistic young people (17/100 and 16/100, respectively). For young people with LD, planned
admission rates were highest and constant before transition (rate ratio [RR]: 0.99, 95% confidence interval [CI]
0.98β0.99), declined by 14% per year of age during (RR: 0.86, 95% CI: 0.85β0.88), and remained constant after
transition (RR: 0.99, 95% CI: 0.99β1.00), mainly due to fewer admissions for non-surgical care, including respite
care. Unplanned admission rates increased by 3% per year of age before (RR: 1.03, 95% CI: 1.02β1.03), remained
constant during (RR: 1.01, 95% CI: 1.00β1.03) and increased by 3% per year after transition (RR: 1.03, 95% CI:
1.02β1.04). For autistic young people, planned admission rates increased before (RR: 1.06, 95% CI: 1.05β1.06),
decreased during (RR: 0.95, 95% CI: 0.93β0.97), and increased after transition (RR: 1.05, 95%: 1.04β1.07).
Unplanned admission rates increased most rapidly before (RR: 1.16, 95% CI: 1.15β1.17), remained constant
during (RR: 1.01, 95% CI: 0.99β1.03), and increased moderately after transition (RR: 1.03, 95% CI: 1.02β1.04).
Interpretation Decreases in planned admission rates during transition were paralleled by small but consistent increases
in unplanned admission rates with age for young people with LD and autistic young people. Decreases in non-surgical
planned care during transition could reflect disruptions to continuity of planned/respite care or a shift towards provision
of healthcare in primary care and community settings and non-hospital arrangements for respite care.
Funding National Institute for Health Research Policy Research Programme
How to get care right for people with learning disabilities in the emergency department : ask and engage
Healthcare professionals are legally obliged to make reasonable adjustments to ensure that people, including those with learning disabilities, can access appropriate and timely care. However, although people with learning disabilities are high users of general health services, staff have little understanding of learning disability with a negative effect on patient experience and outcomes. This article explores some of the challenges experienced by people with learning disabilities in the emergency department (ED). Each section focuses on a different aspect of how to adjust the delivery of healthcare to meet their needs, along with exercises to ensure those adjustments have been understood and to provide practical learning outcomes. Personal stories are also used to identify examples of when and where these adjustments could have been used to provide equal healthcare in the ED. [Abstract copyright: Β© 2021 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.