Comprehensive Health Assessments for adults with

Intellectual Disability in Manitoba

CCDDA, 2014

Research TeamDr. Shahin Shooshtari, Faculty of Human

Ecology Dr. Beverley Temple, College of Nursing

Celeste Waldman, RA, MN Student, Nursing

Sneha Abraham, Trainee, Community Health Sciences

BackgroundOResearch from Canada and abroad

shows that:O Significant health disparities exist between

persons with and without ID (see Ouellette-Kuntz et al., 2005, for a comprehensive review).

O Despite poorer health and higher health-care needs, persons with ID experience more difficulty accessing proper health care than the general population [e.g., Janicki et al., 2002; Krahn, et al., 2006; Bigby, 1998; Robertson et al., 2011).

Your ExpectationsO How many of you have had an annual health

check/physical?

O Why do you have those ?

O What do you expect to accomplish by having a physical?

O What kinds of screening have you had? O Cancer checks – such as stool, colonoscopy, pap

tests, prostate checks, mammography?O Eye, hearing, dental?

BackgroundO Different strategies have been

suggested to reduce health disparities for persons with ID. For example: Comprehensive health assessments

O The CHAP, an Australian-developed tool, was designed to help minimize the barriers to access primary health care for persons with ID by prompting comprehensive health reviews.

BackgroundO The effectiveness of the CHAP was

established through well-designed studies [RCT; 450+ participants] (Lennox et al., 2007). O increased health promotion, disease prevention,

and case-finding activity in the intervention group, who received comprehensive health assessment based on the CHAP.

O 30-fold increase in hearing testing; 9-fold increase in rates of immunization; 8-fold increase in women’s health screening, and increased detection of new disease (e.g., diabetes, heart disease) by 1.6 times.

BackgroundO The CHAP is a two-part booklet O The caregiver will complete the first partO The GP will complete the second partO A list of conditions which are usually

unrecognized or poorly managed in populations with ID (Page 15).

O A chart of syndrome-specific comorbidity, which has proven useful for GPs (Page s 22-23).

Study AimO To determine the feasibility of

implementing the Comprehensive Health Assessment Program (CHAP) for adults with ID in the Province of Manitoba.

Study MethodOInterviews with

O General Practitioners (GPs)O Nurse Practitioners (NPs)O Frontline Support Workers O Family Members

Providers or FamiliesO Question areas include:

O Breathing system – e.g does the person cough?O Heart system – do they have chest pain? Ankles

swell?O Muscles and joints – do they have joint/back

pain?O Stomach and bowel – Lost weight, trouble

swallowing?O Urinary system – Pain when passing urine? Any

blood in urine?O Nervous system – are they unsteady on their

feet when walking?

Providers or FamiliesO Epilepsy?

O Types of seizuresO Drs. Seen for epilepsy

O AllergiesO Cause of Intellectual DisabilityO Human Relations – sexual activity?O Medications

O PrescriptionO Over the counter

Providers or FamiliesO Women’s health – menstrual cycles,

contraception, etcO Pap smear, mammograms?O Men’s health – discharge from penis,

undescended testes?O Problem BehavioursO Mental HealthO VisionO Hearing

Providers or FamiliesO DentalO Blood PressureO CigarettesO AlcoholO Thyroid, Vit D test, Bowel cancer testsO Activity and lifestyle – mobility changes, ?

exercise, diet?O Immunizations O Personal Medical history – e.g. surgeriesO Family History

Barriers and Facilitators

O Ideas of barriers to completing the CHAP

OWays to facilitate useO What would you need to assist

you to complete the 1st part?

Barriers and BenefitsFrom GPs and NPs, some initial ideas that have arisen include:Barriers• Time • PaymentBenefits• Assist practitioners to anticipate more

diseases to provide better care• Potential difficulty in completing the

action plan – or follow-ups.

Next StepsO We are organizing the ideas from all of the

interviews from Nurse Practitioners, and GPs O We will be recruiting family members and

direct support workers to discuss their ideas of using the CHAP

O Plan to meet with government to discuss reimbursement of GPs who would be willing to do the assessments

O Need to develop ways to measure success – improved health of people with ID if we have CHAP done.

Do you have questions?

Are you ready to help improve the health of people you support?

ReferencesO Bigby, C. (1998). Shifting responsibilities: The patterns of formal service use by

older people with intellectual disability in Victoria. Journal of Intellectual and Developmental Disability, 23(3), 97-109.

O Janicki, M., McCallions, P., & Dalton, A. (2002). Dementia-related care decision-making in group homes for persons with intellectual disabilities. Journal of Gerontological Social Work, 38(1/2), 179-195.

O Krahn, G., Hammond, L., & Turner, A. (2006). A cascade of disparities: health and health care access for people with intellectual disabilities. Mental Retardation and Developmental Disabilities Research Reviews,

O Lennox, N., Bain, C., Rey-Conde, T., Purdie, D., Bush, R., Pandeya, N. (2007). Effects of a comprehensive health assessment programme for Australian adults with intellectual disability: a cluster randomized trial. International Journal of Epidemiology, 36(1), 139-140.

O Ouellette-Kuntz, H., Garcin, N., Lewis, M., Minnes, P., Martin, C., Holden, J. (2005). Addressing health disparities through promoting equity for individuals with intellectual disability. Canadian Journal of Public Health, 96 (S2), S8-S22.

O Robertson, J., Roberts, H,. Emerson, E., Turner, S., Greig, R. (2011). The impact of health checks for people with intellectual disabilities: a systematic review of evidence. Journal of Intellectual Disability Research, 55(11), 1009-1019.