Educating Health Professionals about Disability: A Review of Interventions

Health professionals need to understand the human rights and health needs of disabled people. This review of evidence on interventions demonstrates that a range of often innovative approaches have been trialled. Lectures by faculty are less effective in changing attitudes than contact with disabled people themselves. Existing examples of good practice need to be scaled up, and better and more long-term evaluations of impact are required

Embedding routine health checks for adults with intellectual disabilities in primary care: practice nurse perceptions

Background: Adults with intellectual disabilities (IDs) have consistently poorer health outcomes than the general population. There is evidence that routine health checks in primary care may improve outcomes. We conducted a randomised controlled trial of practice nurse led health checks. Here, we report findings from the nested qualitative study. Aim: To explore practice nurse perceptions and experience of delivering an anticipatory health check for adults with IDs. Design and Setting: Qualitative study in General Practices located in NHS Greater Glasgow and Clyde, Scotland, UK. Method: Eleven practice nurses from 11 intervention practices participated in a semi-structured interview. Analysis was guided by a framework approach. Results: Practice nurses reported initially feeling ‘swamped’ and ‘baffled’ by the prospect of the intervention, but early misgivings were not realised. Health checks were incorporated into daily routines with relative ease, but this was largely contingent on existing patient engagement. The intervention was thought most successful with patients already well known to the practice. Chronic disease management models are commonly used by practice nurses and participants tailored health checks to existing practice. It emerged that few of the nurses utilised the breadth of the check instead modifying the check to respond to individual patients' needs. As such, already recognised ‘problems’ or issues dominated the health check process. Engaging with the health checks in this way appeared to increase the acceptability and feasibility of the check for nurses. There was universal support for the health check ethos, although some questioned whether all adults with IDs would access the health checks, and as a consequence, the long-term benefits of checks. Conclusion: While the trial found the intervention to be dominant over standard health care, the adjustments nurses made may not have maximised potential benefits to patients. Increasing training could further improve the benefits that health checks provide for people with IDs

The hospital provision of reasonable adjustments for people with learning disabilities:Findings from Freedom of Information requests

Background:- The Equality Act 2010 places a duty on service providers to make “reasonable adjustments” for disabled people. The aim of this study was to explore key aspects relating to the provision of reasonable adjustments for people with learning disabilities in hospitals. Methods:- The research questions were explored using Freedom of Information (FOI) requests submitted to 206 CCGs and 141 hospital trusts in England. Results:- One hundred and eighty‐six CCGs reported that they included the requirement to provide equal access to services in their contracts with providers. Eight CCGs provided evidence about how they ensured reasonable adjustments were provided. One hundred and twelve of 132 responding hospital trusts provided information about the number of inpatients with learning disabilities; eighty‐three of 132 provided data about outpatients and 88 of 132 provided data about A&E. Sixty‐four of 125 responding trusts explicitly stated that they did not undertake audits of learning disability services or did not make any such reports publicly accessible. Conclusions:- The findings contribute to concern about the gap between legislation and guidance, and its practical application “on the ground.” If CCGs are not assessing contractual compliance to provide equitable access to services for people with learning disabilities, and trusts are not aware of the number of people with learning disabilities using their services, or their access requirements, this raises concerns about their compliance with the Equality Act 2010

Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment.

BACKGROUND: Annual health checks for adults with intellectual disability (ID) have been incentivised by National Health Service (NHS) England since 2009, but it is unclear what impact they have had on important health outcomes such as emergency hospitalisation. METHODS: An evaluation of a 'natural experiment', incorporating practice and individual-level designs, to assess the effectiveness of health checks for adults with ID in reducing emergency hospital admissions using a large English primary care database. For practices, changes in admission rates for adults with ID between 2009-2010 and 2011-2012 were compared in 126 fully participating versus 68 non-participating practices. For individuals, changes in admission rates before and after the first health check for 7487 adults with ID were compared with 46 408 age-sex-practice matched controls. Incident rate ratios (IRRs) comparing changes in admission rates are presented for: all emergency, preventable emergency (for ambulatory care sensitive conditions (ACSCs)) and elective emergency. RESULTS: Practices with high health check participation showed no change in emergency admission rate among patients with ID over time compared with non-participating practices (IRR=0.97, 95% CI 0.78 to 1.19), but emergency admissions for ACSCs did fall (IRR=0.74, 0.58 to 0.95). Among individuals with ID, health checks had no effect on overall emergency admissions compared with controls (IRR=0.96, 0.87 to 1.07), although there was a relative reduction in emergency admissions for ACSCs (IRR=0.82, 0.69 to 0.99). Elective admissions showed no change with health checks in either analysis. CONCLUSIONS: Annual health checks in primary care for adults with ID did not alter overall emergency admissions, but they appeared influential in reducing preventable emergency admissions

What do we know about the health and healthcare of people with intellectual disabilities from minority ethnic groups in the United Kingdom?:A systematic review

Background. People with from minority ethnic communities face inequalities in health and healthcare. This systematic review considers the question of what we know about the health and healthcare of children and adults with intellectual disabilities from ethnic minority communities in the UK. Method. Studies published from 1990 to 2018 were identified via electronic literature databases, email requests, and cross-citations. Studies were reviewed narratively in relation to identified themes. Results. 23 studies were identified, most commonly focusing on South Asian communities. Very little information was identified on physical health or physical healthcare, with the identified evidence tending to focus on mental health care, access to specialist intellectual disability services, and inpatient services. Conclusion. Little is known about the health status of people with intellectual disabilities from minority ethnic groups in the UK. It is clear that they may experience barriers to accessing specialist intellectual disability services and other forms of healthcare