Exploring person-centred support in adults with intellectual disabilities and challenging behaviour supported by paid carers in the community

Background: Deinstitutionalisation and the movement of people with intellectual disabilities (ID) to the community have seen the emergence of care philosophies aimed at tailoring services to individuals’ needs. Person-centred support has been widely advocated and considered synonymous of good care. It is useful to investigate if day-to-day support provided by paid carers in the community is person-centred. / Aims: 1. To explore person-centred support and choice in adults with ID and challenging behaviour. 2. To investigate correlates of person-centred support, including challenging behaviour. 3. To investigate whether the results of self-report questionnaires and direct- observations are comparable. / Methods: 1. Self-report measures of person-centred support typically used by staff supporting older adults with dementia were adapted for use by staff supporting adults with ID and challenging behaviour. A measure of choice availability was also updated. 2. A cross-sectional study of 109 paid carers supporting adults with mild to severe ID was conducted to address aims 1 and 2. 3. Naturalistic observations of eighteen participants with ID were conducted to complement the results of the cross-sectional study. Data was collected using momentary time-sampling and narrative descriptions. / Results: Paid carers reported high levels of person-centred support and choice availability for service-users. No significant associations were found between person-centred support and characteristics of the living environments, however choice availability was significantly higher in supported living compared to residential care homes and in living environments with fewer residents. Carers who reported higher levels of person-centred support experienced less subjective burden in their jobs. There was an association between choice and service-users’ adaptive behaviour. No association was found between person-centred support/choice and global challenging behaviour; stereotyped behaviour however was negatively associated with autonomy and carers’ knowledge of individuals with ID. The findings from the observations showed lower levels of person-centred support than those reported by paid carers, suggesting desirability effects in carers’ responses. Low levels of engagement in meaningful activities, assistance and contact from staff were observed, although there was much variability at the individual level. There were few instances of challenging behaviours and these mostly consisted of stereotyped/repetitive movements which were prevalent in disengaged participants. / Implications: The support for people with ID and challenging behaviour requires improvement but quality evaluation criteria adopted by inspectors and regulators may need to be reconsidered. Improvements in day-to-day support could reduce stereotyped behaviour but input from skilled professionals may be required for other types of challenging behaviour

Discrimination and Other Barriers to Accessing Health Care: Perspectives of Patients with Mild and Moderate Intellectual Disability and Their Carers

Background People with intellectual disability have a higher prevalence of physical health problems but often experience disparities in accessing health care. In England, a number of legislative changes, policies and recommendations have been introduced to improve health care access for this population. The aim of this qualitative study was to examine the extent to which patients with intellectual disability and their carers experience discrimination or other barriers in accessing health services, and whether health care experiences have improved over the last decade years. Method and Main Findings Twenty nine participants (14 patient and carer dyads, and one carer) took part in semi-structured interviews. The interviews were audio-taped and transcribed and analysed using thematic analysis. Eight themes were identified. Half the participants thought that the patient had been treated unfairly or had been discriminated against by health services. There were accounts of negative staff attitudes and behaviour, and failure of services to make reasonable adjustments. Other barriers included problems with communication, and accessing services because of lack of knowledge of local services and service eligibility issues; lack of support and involvement of carers; and language problems in participants from minority ethnic groups. Most participants were able to report at least one example of good practice in health care provision. Suggestions for improving services are presented. Conclusion Despite some improvements to services as a result of health policies and recommendations, more progress is required to ensure that health services make reasonable adjustments to reduce both direct and indirect discrimination of people with intellectual disability

Clinical and cost evaluation of intensive support team (IST) models for adults with intellectual disabilities who display challenging behaviour: a comparative cohort study protocol

Introduction: Approximately 17% of adults with intellectual disabilities (ID) living in the community display behaviours that challenge. Intensive support teams (ISTs) have been recommended to provide high-quality responsive care aimed at avoiding unnecessary admissions and reducing lengthy inpatient stays in England. We have identified two models of ISTs (model 1: enhanced provision and model 2: independent provision). This study aims to investigate the clinical and cost-effectiveness of the two models of ISTs. Methods and analysis: A cohort of 226 adults with ID displaying behaviour that challenges who receive support from ISTs from each model will be recruited and assessed at baseline and 9 months later to compare the clinical and cost-effectiveness between models. The primary outcome is reduction in challenging behaviour measured by the Aberrant Behaviour Checklist-Community (ABC-C). The mean difference in change in ABC score between the two IST models will be estimated from a multilevel linear regression model. Secondary outcomes include mental health status, clinical risk, quality of life, health-related quality of life, level of functioning and service use. We will undertake a cost-effectiveness analysis taking both a health and social care and wider societal perspective. Semistructured interviews will be conducted with multiple stakeholders (ie, service users, paid/family carers, IST managers/staff) to investigate the experience of IST care as well as an online survey of referrers to capture their contact with the teams. Ethics and dissemination: The study was approved by the London–Bromley Research Ethics Committee (REC reference: 18/LO/0890). Informed consent will be obtained from the person with ID, or a family/nominated consultee for those lacking capacity and from his/her caregivers. The findings of the study will be disseminated to academic audiences, professionals, experts by experience and arm’s-length bodies and policymakers via publications, seminars and digital platforms. Trial registration number: ClinicalTrials.gov Registry (NCT03586375)

Alcances y limitaciones de la teleconsulta en pandemia de covid-19: relatos de profesionales de la salud del primer nivel de atención de la Ciudad Autónoma de Buenos Aires

The aim was to explore the scope and limitations of teleconsultation during the pandemic from the perspective of primary care physicians at the Hospital Italiano de Buenos Aires, a private institution located in the Autonomous City of Buenos Aires. A qualitative study was conducted with ten individual semi-structured interviews between January and April 2022. The three major emerging topics were the transition to virtuality, accessibility, and the new care model. Obstacles were related to the massive, forced, and unplanned implementation of teleconsultations. The main benefits included providing care during isolation-distancing and addressing epidemiological doubts. Changes were highlighted in care strategies, consultation frameworks, exchange among colleagues, referral criteria, requests for complementary studies, and in the profiles of those seeking consultations. A misuse of the system by individuals and a trivialization of the consultation moment emerged. The rise of communication and information technologies undoubtedly allowed the continuity of healthcare processes, but it does not replace in-person care, and normative guidelines are needed for its continuity.El objetivo fue explorar alcances y limitaciones de la teleconsulta en pandemia, desde la perspectiva de médicos y médicas del primer nivel de atención del Hospital Italiano de Buenos Aires, una institución privada ubicada en la Ciudad Autónoma de Buenos Aires. Se realizó un estudio cualitativo con diez entrevistas semiestructuradas individuales entre enero y abril de 2022. Los tres grandes tópicos emergentes fueron la transición a la virtualidad, la accesibilidad y el nuevo modelo de atención. Los obstáculos se relacionaron con la implementación masiva, forzada y no planificada de las teleconsultas. Los principales beneficios fueron brindar atención durante el aislamiento-distanciamiento y evacuar dudas epidemiológicas. Se destacan cambios en estrategias de atención, encuadre de las consultas, intercambio entre colegas, criterios de derivación y de pedido de estudios complementarios, y en los perfiles de consultantes. Surgió un sobreuso del sistema por parte de las personas, y una banalización del momento de la consulta. El auge de las tecnologías de la comunicación e información indudablemente permitió dar continuidad a los procesos asistenciales en salud, pero no reemplaza la presencialidad y se requieren lineamientos normativos para su continuidad

Os impactos da transição das aulas presencias para o modo remoto no processo saúde-doença do docentes

A pandemia do COVID-19 modificou grandemente as metodologias de ensino em todo o país, o que culminou na substituição do modelo das aulas presenciais para o modo remoto emergencial. Essa modificação rápida pode ter sido uma experiência causadora de malefícios no processo saúde-doença de seus profissionais, assim como é evidenciado pelo mal-estar docente (malaise enseignant). Este trabalho visou analisar os diversos impactos na saúde dos professores participantes de tal transição, considerando efeitos mentais, físicos e profissionais. Para isso, foi efetuada uma revisão literária, a qual perpassou o conceito de mal-estar docente, sua origem e ramificações, além da aplicação de um questionário, ora presencialmente ora via plataforma de Formulários do Google,  para professores de duas instituições de ensino superior (IES), Universidade Cesumar (Maringá – PR) e Universidade do Oeste Paulista (Presidente Prudente – SP), escolhidos segundo o critério de ter obtido a experiência de trabalho tanto  no modelo presencial quanto no remoto. Então, os dados foram analisados e tabulados por meio de estatística simples por Excel. Após análises dos resultados, comprovou-se que houve uma alteração no processo saúde-doença no que tange a sinais e sintomas como aumento do estresse, ansiedade, dores musculares, nas articulações e diminuição da acuidade da visão, além da diminuição da satisfação e qualidade laboral

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria