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Haque M, Gaspari S, Bobbette N, Walker M, Bartels SA. "Pain is not typically taken into consideration due to him being nonverbal"- emergency department experiences among persons with disabilities: a mixed methods study in Kingston, Ontario. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1353120. [PMID: 39119263 PMCID: PMC11306198 DOI: 10.3389/fresc.2024.1353120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 07/15/2024] [Indexed: 08/10/2024]
Abstract
Background Persons with disabilities (PWD) are more likely to visit the emergency department (ED) and often have complex health needs when accessing care in the ED. Yet there is limited understanding of ED care experiences among PWD, especially in a Canadian context. The aim of this study was to examine the ED care experiences of PWD in contrast to a comparison group in Kingston, Ontario to better understand their health care needs. Methods A mixed-methods study with a community-based participatory approach examining participants' past ED care experiences (within 24 months) was conducted in Kingston, ON. Quantitative data from those with disabilities and those from the comparison group were compared using chi squared tests to identify differences between groups. An inductive and deductive thematic analysis approach was used to identify themes in the shared qualitative data. Convergence of findings across quantitative and qualitative data was undertaken. Results A total of 175 participants identified as having a disability. In contrast with the comparison group (N = 949), PWD were more likely to report being given too little attention to their needs (p < 0.001), that it was more important to be treated with kindness/respect than to receive the best possible medical care (p < 0.001), to report feelings of disrespect and/or judgement (p < 0.001), and that better understanding of personal identity/situation/culture and better communication would improve ED care. Qualitative analysis highlighted the following themes: poor communication between PWD and health care providers (HCP), compassionate medical care received, perceived HCP negative attitudes/beliefs related to having a disability and substance misuse, and perceived HCP lack of knowledge/skill to treat the unique health needs of PWD. Conclusion Findings highlight the need to improve ED care for PWD. Future quality improvement initiatives should focus on incorporating a deeper understanding of disability into medical education and emergency medicine (EM) residency education, designing curricula that emphasize cultural humility, and implementing community-based placements providing opportunities for health professionals to work with and learn from PWD.
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Affiliation(s)
- Minha Haque
- Department of Emergency Medicine, Queen’s University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Sierra Gaspari
- Department of Emergency Medicine, Queen’s University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Nicole Bobbette
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Melanie Walker
- Department of Emergency Medicine, Queen’s University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Susan A. Bartels
- Department of Emergency Medicine, Queen’s University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada
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Ergui I, Griffith N, Salama J, Ebner B, Dangl M, Vincent L, Razuk V, Marzouka G, Colombo R. In-Hospital Outcomes in Patients With Non-ST Segment Elevation Myocardial Infarction and Concomitant Neurodevelopmental Disorders in the United States: Insights From the National Inpatient Sample 2011-2020. Cureus 2024; 16:e60289. [PMID: 38746481 PMCID: PMC11093150 DOI: 10.7759/cureus.60289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 05/16/2024] Open
Abstract
Patients with neurodevelopmental disorders (NDDs) encounter significant barriers to receiving quality health care, particularly for acute conditions such as non-ST segment elevation myocardial infarction (NSTEMI). This study addresses the critical gap in knowledge regarding in-hospital outcomes and the use of invasive therapies in this demographic. By analyzing data from the National Inpatient Sample database from 2011 to 2020 using the International Classification of Diseases, Ninth Edition (ICD-9) and Tenth Edition (ICD-10) codes, we identified patients with NSTEMI, both with and without NDDs, and compared baseline characteristics, in-hospital outcomes, and the application of invasive treatments. The analysis involved a weighted sample of 7,482,216 NSTEMI hospitalizations, of which 30,168 (0.40%) patients had NDDs. There were significantly higher comorbidity-adjusted odds of in-hospital mortality, cardiac arrest, endotracheal intubation, infectious complications, ventricular arrhythmias, and restraint use among the NDD cohort. Conversely, this group exhibited lower adjusted odds of undergoing left heart catheterization, percutaneous coronary intervention, or coronary artery bypass graft surgery. These findings underscore the disparities faced by patients with NDDs in accessing invasive cardiac interventions, highlighting the need for further research to address these barriers and improve care quality for this vulnerable population.
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Affiliation(s)
- Ian Ergui
- Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - Nayrana Griffith
- Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - Joshua Salama
- Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - Bertrand Ebner
- Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - Michael Dangl
- Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - Louis Vincent
- Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - Victor Razuk
- Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - George Marzouka
- Cardiology, Miami Department of Veterans Affairs, Miami, USA
| | - Rosario Colombo
- Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
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3
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Ding J, Keagan-Bull R, Tuffrey-Wijne I. It is up to healthcare professionals to talk to us in a way that we can understand: informed consent processes in people with an intellectual disability. BMJ Qual Saf 2024; 33:277-279. [PMID: 38290810 DOI: 10.1136/bmjqs-2023-016830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Jonathon Ding
- Kingston University, London, UK
- King's College London, London, UK
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Wallace RA. A system for developing reasonable adjustments to the application of the National Safety and Quality Health Service Standards for adult patients with intellectual disability in Australian hospital settings. Intern Med J 2024; 54:503-510. [PMID: 38251817 DOI: 10.1111/imj.16321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
The Australian Commission of Safety and Quality in Health Care mandates the application of the eight National Safety and Quality Health Service Standards to minimise high-risk adverse events in hospital settings for all Australian patients. It acknowledges that adults with intellectual disability require reasonable adjustments to the application of the standards to optimise the impact of the quality and safety measures for this group. The paper proposes a system whereby reasonable adjustments can be developed for this population. First, particular criteria, items or actions of a standard are selected for the formulation of reasonable adjustments. Second, the adjustments are broken down into categories of alterations to usual knowledge, process, content and organisation involved in compliance with the chosen aspect of the standard. Third, the categories of reasonable adjustments are simultaneously influenced and shaped by aspects of living with intellectual disability, disability supports and a health-disability sectoral interface.
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Affiliation(s)
- Robyn A Wallace
- Calvary Lenah Valley Hospital, Hobart, Tasmania, Australia
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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5
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Wythe H, Attavar R, Jones J, Kelly J, Palmer C, Jenkins L, Dekker R, Fearns D, Watkins S, Hunt A, Pattison N. Evaluating the usefulness of a wordless picture book for adults with intellectual disabilities about the COVID-19 vaccination programme using co-production: The CAREVIS study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13203. [PMID: 38369311 DOI: 10.1111/jar.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/06/2023] [Accepted: 01/12/2024] [Indexed: 02/20/2024]
Abstract
AIM To explore the usefulness of a co-designed wordless book showing processes of receiving COVID-19 vaccines designed by, and for, adults with intellectual disabilities. METHODS A qualitative evaluation of the resource using mixed methods. Semi-structured interviews were conducted with people with intellectual disabilities, carers and health professionals about resource content, and use. This was analysed thematically. A survey was circulated to intellectual disabilities networks to understand resource need, use, sharing and content. RESULTS Understanding the COVID-19 vaccine was a process, not a single event using one resource. A visual resource had a place in facilitating conversations about vaccines between people with intellectual disabilities and carers. Differing perspectives were expressed regarding personal needs, existing awareness of vaccine programmes and communication preferences. Changes were suggested to improve the suggested storyline and relevance around COVID-19 restrictions changing. CONCLUSION A visual resource may help conversations about the COVID-19 vaccine for people with intellectual disabilities.
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Affiliation(s)
- Helena Wythe
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Raj Attavar
- Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK
| | - Julia Jones
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Jackie Kelly
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | | | | | | | - Debra Fearns
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Scott Watkins
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Anne Hunt
- Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
- East and North Hertfordshire NHS Trust, Hertfordshire, UK
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Furukawa S, Nawa N, Yamaoka Y, Fujiwara T. Concerns and needs of people with intellectual disabilities and their caregivers during the COVID-19 pandemic in Japan. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024; 28:137-156. [PMID: 36286242 PMCID: PMC9606640 DOI: 10.1177/17446295221135274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Background: People with intellectual disabilities (IDs) and their caregivers face difficulties during the COVID-19 pandemic. However, limited studies have comprehensively investigated their challenges, especially in Japan. We aimed to clarify the concerns and needs of people with IDs and their caregivers during the COVID-19 pandemic in Japan. Method: From March to August 2021, 27 in-depth interviews were conducted with principal caregivers of people with moderate to profound IDs in Japan. We then transcribed the interviews and conducted deductive coding using predetermined codes focused on their daily life difficulties. Inductive coding was used to ensure that no important themes were overlooked. Results: We found four concerns and four needs among people with IDs and their caregivers as significant themes. Conclusions: Our results provide useful information for supporting people with IDs and their caregivers, especially among those who need medical or social care in accordance with the infection control and social-distancing policies.
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Affiliation(s)
- Sawako Furukawa
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobutoshi Nawa
- Department of Medical Education Research and Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yui Yamaoka
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
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Ong N, Lucien A, Long J, Weise J, Burgess A, Walton M. What do parents think about the quality and safety of care provided by hospitals to children and young people with an intellectual disability? A qualitative study using thematic analysis. Health Expect 2024; 27:e13925. [PMID: 38014873 PMCID: PMC10768875 DOI: 10.1111/hex.13925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Children with intellectual disability experience patient safety issues resulting in poor care experiences and health outcomes. This study sought to identify patient safety issues that pertain to children aged 0-16 years with intellectual disability admitted to two tertiary state-wide children's hospitals and a children's palliative care centre; to describe and understand these factors to modify the Australian Patient Safety Education Framework to meet the particular needs for children and young people with intellectual disability. DESIGN, SETTING AND PARTICIPANTS Parents of children with intellectual disability from two paediatric hospitals and a palliative care unit participated in semi-structured interviews to elicit their experiences of their child's care in the context of patient safety. Thirteen interviews were conducted with parents from various backgrounds with children with intellectual, developmental and medical diagnoses. RESULTS Eight themes about safety in hospital care for children and young people with intellectual disability emerged from thematic analyses: Safety is not only being safe but feeling safe; Negative dismissive attitudes compromise safety, quality and care experience; Parental roles as safety advocates involve being heard, included and empowered; Need for purposeful and planned communication and care coordination to build trust and improve care; Systems, processes and environments require adjustments to prevent patient safety events; Inequity in care due to lack of resources and skills, Need for training in disability-specific safety and quality issues and Core staff attributes: Kindness, Patience, Flexibility and Responsiveness. Parents highlighted the dilemma of being dismissed when raising concerns with staff and being required to provide care with little support. Parents also reported a lack of comprehensive care coordination services. They noted limitations within the healthcare system in accommodating reasonable adjustments for a family and child-centred context. CONCLUSIONS The development of an adapted Patient Safety Education Framework for children with intellectual disability should consider ways for staff to transform attitudes and reduce bias which leads to adaptations for safer and better care. In addition, issues that apply to quality and safety for these children can be generalised to all children in the hospital. PATIENT AND PUBLIC CONTRIBUTION Parent advocates in the project advisory team were shown the questions to determine their appropriateness for the interviews.
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Affiliation(s)
- Natalie Ong
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
- Child Development Unit, Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Abbie Lucien
- UNSW Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Janet Long
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Annette Burgess
- Medical Education, Education Office, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Merrilyn Walton
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
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8
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Ong N, Gee BL, Long JC, Zieba J, Tomsic G, Garg P, Lapointe C, Silove N, Eapen V. Patient safety and quality care for children with intellectual disability: An action research study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:885-911. [PMID: 35657332 DOI: 10.1177/17446295221104619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Children with intellectual disability experience significant challenges in accessing and receiving high-quality healthcare leading to poorer health outcomes and negative patient experiences. Families of these children often report a need for healthcare staff to better understand, communicate, and collaborate for better care while staff acknowledge a lack of training. To address this, we utilised an action research framework with a pre- and post- survey to evaluate an integrated continuing professional development and quality improvement program combining strategies from education, behavioural psychology and quality improvement that was delivered in two departments within a tertiary children's Hospital in Metropolitan Sydney in 2019-2020. Parents reported noticeable changes in the clinical practice of staff, and staff acknowledged and attributed their shift in behaviour to raising awareness and discussions around necessary adaptations. The program demonstrates a novel method for knowledge translation to practice and systems improvements.
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Affiliation(s)
- Natalie Ong
- Child Development Unit, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Brendan Loo Gee
- Academic Unit of Child Psychiatry South West Sydney (AUCS), UNSW Sydney & Ingham Institute, Sydney, NSW, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Jerzy Zieba
- Academic Unit of Child Psychiatry South West Sydney (AUCS), UNSW Sydney & Ingham Institute, Sydney, NSW, Australia and Department of Psychology, University of Rzeszow, Poland
| | - Gail Tomsic
- Child Development Unit, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Pankaj Garg
- Specialist Disability Health Team, Department of Community Paediatrics, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Caleb Lapointe
- The KidsSim Centre, Children's Hospital at Westmead, Sydney, NSW, Australia
- The KidsSim Centre, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Natalie Silove
- Child Development Unit, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Valsamma Eapen
- Academic Unit of Child Psychiatry South West Sydney (AUCS), UNSW Sydney & Ingham Institute, Sydney, Australia
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Gréaux M, Moro MF, Kamenov K, Russell AM, Barrett D, Cieza A. Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services. Int J Equity Health 2023; 22:236. [PMID: 37957602 PMCID: PMC10644565 DOI: 10.1186/s12939-023-02035-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion. METHODS We conducted a scoping review following the methodological framework proposed by Arksey and O'Malley, Int J Soc Res Methodol 8:19-32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article. RESULTS Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities. CONCLUSION Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations' needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.
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Affiliation(s)
- Mélanie Gréaux
- Faculty of Education, University of Cambridge, Cambridge, UK.
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Kelleher E, Martin AM, Caples M, Wills T. Acute service and disability service providers experiences of joint working to improve health care experiences of people with an intellectual disability compared to non-joint working: A mixed-method systematic review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231209345. [PMID: 37864518 DOI: 10.1177/17446295231209345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Persons with intellectual disabilities require frequent access to acute services. Many also access disability services within the community. Reports and enquiries have highlighted the sub-optimal healthcare provided to this group when accessing healthcare in acute services. Joint working between acute and disability services has been identified as a measure to improve healthcare for this group. A mixed method systematic review was undertaken to explore current evidence of joint working between both service providers. Twelve publications were included, and the data were analysed using thematic analysis. Confusion around responsibility and limited training in acute services prevented joint working from occurring. Information-sharing is pivotal in promoting joint-working, but measures which facilitated it were not always used. Albeit acute services demonstrated a strong commitment to deliver quality care to those with intellectual disabilities. Much of the available research captures the experiences of staff in acute services. There is a paucity of research available exploring experiences of disability service providers.
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Gilliand M, Bernier Emch A, Perrenoud B. Adults with intellectual disabilities' satisfaction regarding their hospitalization: A correlational descriptive study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231193461. [PMID: 37565271 DOI: 10.1177/17446295231193461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
When hospitalized, adults with intellectual disabilities are more anxious and have more unmet needs than the general population. Despite these problems, studies report contradictory results about their satisfaction with hospitalization. The aim of this study was to determine the level of satisfaction of adults with intellectual disabilities regarding their hospital care and the factors associated with satisfaction. An analysis of the Patient Satisfaction Scale (PSS) and Cognitive Appraisal of Health Scale (CAHS) instruments completed by adults with intellectual disabilities, or their caregivers, after hospitalization was done. The 32 participants' mean PSS score was 3.6/5, with means of 13.3/25 and 8.7/25 on the CAHS' 'harm/loss' dimension and 'challenge' dimension, respectively. None of the factors studied was associated with the total PSS score. Adults with intellectual disabilities were not fully satisfied with their hospital care, experiencing challenges and losses. These findings call for a rethink of the care provided to this population.
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Affiliation(s)
- Morgane Gilliand
- HESAV School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland; Institute of Higher Education and Research in Healthcare-IUFRS, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | - Béatrice Perrenoud
- Lausanne University Hospital (CHUV), Lausanne, Switzerland; La Source School of Nursing Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
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Ní Riain M, Wickham S. "She just makes it easier…" The impact of having a dedicated nursing role in supporting people with intellectual disability when accessing acute hospitals, from the perspective of their support staff, the Irish context. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231190252. [PMID: 37499117 DOI: 10.1177/17446295231190252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Learning Disability Liaison Nurses have been shown to improve hospital experiences and this is an emerging role in Ireland. This research qualitatively explored the impact of a Clinical Nurse Specialist Acute Hospital Liaison from the perspective of staff in an intellectual disability community organisation. Participants identified significant challenges with supporting people attending hospitals including accessing and understanding information, anxieties and not being prepared for transitions through the hospital. The findings demonstrate the introduction of this role is a supportive, positive step with reports of improved information sharing, feeling better prepared and alleviating anxieties related to supporting someone in hospital. The findings clearly identify that this role has considerable benefits when set in a community organisation. This role has had a positive impact on service users and staff when interacting with hospitals, providing evidence of the value of this role in Ireland and also of they having a specialist qualification in the role.
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Affiliation(s)
- Muireann Ní Riain
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Sheelagh Wickham
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
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13
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Kersten M, Wilson NJ, Pracilio A, Howie V, Trollor J, Buckley T, Morphet J, Bryce J, Griffin K, Cashin A. A scoping review to inform an auditing framework evaluating healthcare environments for inclusion of people with intellectual disability and/or autism. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231174282. [PMID: 37217215 DOI: 10.1177/17446295231174282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
People with intellectual disability and/or autism are likely to be in hospital more often, for longer, and have poorer health outcomes. Few audit tools exist to identify their barriers in mainstream healthcare environments. This study aimed to identify evidence of audit characteristics of healthcare contexts specifically for people with intellectual disability and/or autism, for conceptual development of an auditing framework. A scoping review of evaluations of healthcare environments was completed in January 2023. Findings were presented using the PAGER framework. Of the sixteen studies identified, most originated in the UK, nine focused on intellectual disability, four on autism, and three were concerned with mixed diagnosis. Six domains for auditing healthcare environments were identified: care imperatives, communication to individuals, understanding communication from individuals, providing supportive environments of care, supporting positive behaviour, and actions to make things go well. Further research is recommended to refine an audit framework.
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Affiliation(s)
- Michelle Kersten
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Nathan John Wilson
- School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
| | - Amy Pracilio
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Virginia Howie
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Thomas Buckley
- Susan Wakil Building, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Julia Morphet
- Nursing & Midwifery, Monash University, Peninsula Campus, Frankston, VIC, 3199, Australia
| | - Julianne Bryce
- Australian Nursing and Midwifery Federation, Federal Office, Melbourne, VIC, 3000, Australia
| | - Ken Griffin
- Australian Primary Health Care Nurses Association, Melbourne, VIC, 3000, Australia
| | - Andrew Cashin
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
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Morris AC, Ibrahim Z, Moghraby OS, Stringaris A, Grant IM, Zalewski L, McClellan S, Moriarty G, Simonoff E, Dobson RJB, Downs J. Moving from development to implementation of digital innovations within the NHS: myHealthE, a remote monitoring system for tracking patient outcomes in child and adolescent mental health services. Digit Health 2023; 9:20552076231211551. [PMID: 37954687 PMCID: PMC10638880 DOI: 10.1177/20552076231211551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023] Open
Abstract
Objective This paper aims to report our experience of developing, implementing, and evaluating myHealthE (MHE), a digital innovation for Child and Adolescents Mental Health Services (CAMHS), which automates the remote collection and reporting of Patient-Reported Outcome Measures (PROMs) into National Health Services (NHS) electronic healthcare records. Methods We describe the logistical and governance issues encountered in developing the MHE interface with patient-identifiable information, and the steps taken to overcome these development barriers. We describe the application's architecture and hosting environment to enable its operability within the NHS, as well as the capabilities needed within the technical team to bridge the gap between academic development and NHS operational teams. Results We present evidence on the feasibility and acceptability of this system within clinical services and the process of iterative development, highlighting additional functions that were incorporated to increase system utility. Conclusion This article provides a framework with which to plan, develop, and implement automated PROM collection from remote devices back to NHS infrastructure. The challenges and solutions described in this paper will be pertinent to other digital health innovation researchers aspiring to deploy interoperable systems within NHS clinical systems.
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Affiliation(s)
- Anna C Morris
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Zina Ibrahim
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Omer S Moghraby
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Argyris Stringaris
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Emotion & Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Ian M Grant
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
| | - Lukasz Zalewski
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
| | | | - Garry Moriarty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emily Simonoff
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
| | - Richard JB Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
- Health Data Research UK London, University College London, London, UK
- Institute of Health Informatics, University College London, London, UK
- NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Johnny Downs
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR South London and Maudsley Biomedical Research Centre, London, UK
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15
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Ong N, Mimmo L, Barnett D, Long J, Weise J, Walton M. Reported clinical incidents of children with intellectual disability: A qualitative analysis. Dev Med Child Neurol 2022; 64:1359-1365. [PMID: 35578400 PMCID: PMC9790611 DOI: 10.1111/dmcn.15262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/26/2022] [Accepted: 04/14/2022] [Indexed: 12/30/2022]
Abstract
AIM To qualitatively explore reported clinical incidents of children with intellectual disability aged 0 to 18 years. METHOD A secondary qualitative evaluation using latent content analysis was used on retrospective hospital incident management reporting data (1st January-31st December 2017) on 1367 admissions for 1018 randomly selected patients admitted to two tertiary children's hospitals in New South Wales, Australia. Sex and age at admission in children with and without intellectual disability: 83 (43.7%) versus 507 (43.1%) females and 107 (56.3%) versus 670 (56.9%) males, p=0.875; median age 3 years (0-18y) versus 4 years (0-18y), p=0.122. Of these, 44 patient safety incident reports for children with intellectual disability (sex, SD, and range) and 167 incident reports for children without intellectual disability (sex, SD, and range) were found and analysed. RESULTS Ten themes were synthesized from the data and represented the groups with and without intellectual disability. Children with intellectual disability had a significantly higher proportion of care issues identified by their parents. They also had higher rates of multiple reported clinical incidents per admission compared to children without intellectual disability. INTERPRETATION Mechanisms to advocate and raise patient safety issues for children with intellectual disability are needed. Partnerships with parents and training of staff in reporting clinical incidents for this population would enhance the embedding of reasonable adaptations into incident management systems for ongoing monitoring and improvement. WHAT THIS PAPER ADDS Children with intellectual disability experienced multiple patient safety incidents per admission compared to children without intellectual disability. Children with intellectual disability had significantly increased rates of parent-identified incidents. Issues with medication, communication, delays in diagnosis and treatment, and identification of deterioration were noted.
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Affiliation(s)
- Natalie Ong
- School of Public Health, Faculty of Medicine and HealthUniversity of SydneyCamperdownNSWAustralia,Child Development Unit; Children's Hospital at WestmeadSydney Children's Hospitals NetworkWestmeadNSWAustralia
| | - Laurel Mimmo
- School of Population HealthUniversity of New South Wales Medicine, University of New South WalesKensingtonNSWAustralia,Clinical Governance UnitSydney Children's Hospitals NetworkSydneyNSWAustralia
| | - Diana Barnett
- Child Development Unit; Children's Hospital at WestmeadSydney Children's Hospitals NetworkWestmeadNSWAustralia
| | - Janet Long
- Australian Institute of Health Innovation, Faculty of Medicine and Health SciencesMacquarie UniversityMacquarie ParkNSWAustralia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry (3DN)University of New South Wales Medicine, University of New South WalesRandwickNSWAustralia
| | - Merrilyn Walton
- School of Public Health, Faculty of Medicine and HealthUniversity of SydneyCamperdownNSWAustralia
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16
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Song M, Ware RS, Doan TN, Harley D. Characteristics associated with frequent health system use by Australian adults with intellectual disability: A cohort study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1403-1417. [DOI: 10.1111/jar.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/23/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Menghuan Song
- Queensland Centre for Intellectual and Developmental Disability (QCIDD) Mater Research Institute‐University of Queensland (MRI‐UQ) South Brisbane Queensland Australia
| | - Robert S. Ware
- Queensland Centre for Intellectual and Developmental Disability (QCIDD) Mater Research Institute‐University of Queensland (MRI‐UQ) South Brisbane Queensland Australia
- Menzies Health Institute Queensland Griffith University Nathan Queensland Australia
| | - Tan N. Doan
- Department of Medicine at The Royal Melbourne Hospital University of Melbourne Melbourne Victoria Australia
| | - David Harley
- Centre for Clinical Research University of Queensland South Brisbane Queensland Australia
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17
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Walker AR, Trollor JN, Florio T, Srasuebkul P. Predictors and outcomes of recognition of intellectual disability for adults during hospital admissions: A retrospective data linkage study in NSW, Australia. PLoS One 2022; 17:e0266051. [PMID: 35333913 PMCID: PMC8956190 DOI: 10.1371/journal.pone.0266051] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/11/2022] [Indexed: 11/18/2022] Open
Abstract
Adults with intellectual disability have high health care needs. Despite frequent contact with health services, they often receive inadequate health care. One method to improve health care delivery is reasonable adjustments, that is, the adaptation of health care delivery such that barriers to participation are removed for the person with disability. A starting point for the provision of reasonable adjustments is recognition of intellectual disability during the health care contact. To determine rates and predictors of the recognition of intellectual disability during hospital admissions, and its impact on admission metrics, we examined a population of adults with intellectual disability identified from disability services datasets from New South Wales, Australia between 2005 and 2014. Recognition of intellectual disability was determined by the recording of an International Classification of Diseases 10th revision (ICD-10) diagnostic code for intellectual disability during a given hospital admission. We examined how recognition of intellectual disability related to length of hospital episodes. We found an overall low rate of recognition of intellectual disability (23.79%) across all hospital episodes, with the proportion of hospital episodes recognising intellectual disability decreasing from 2005–2015. Admissions for adults with complex health profiles (e.g., those with many comorbidities, those with Autism Spectrum Disorder, and those admitted for urgent treatment) were more likely to recognise intellectual disability, but admissions for adults with complexity in other domains (i.e., for those in custody, or those with drug and alcohol disorders) were less likely to recognise intellectual disability. Recognition of intellectual disability was associated with longer episodes of care, possibly indicating the greater provision of reasonable adjustments. To improve the recognition of intellectual disability for adults during health service contacts, we advocate for the implementation of targeted initiatives (such as a nationwide disability flag to be included in health service records) to improve the provision of reasonable adjustments.
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Affiliation(s)
- Adrian Raymond Walker
- The Department of Developmental Disability Neuropsychiatry, The University of New South Wales Sydney, New South Wales, Australia
| | - Julian Norman Trollor
- The Department of Developmental Disability Neuropsychiatry, The University of New South Wales Sydney, New South Wales, Australia
- * E-mail:
| | - Tony Florio
- Australian Catholic University, New South Wales, Australia
| | - Preeyaporn Srasuebkul
- The Department of Developmental Disability Neuropsychiatry, The University of New South Wales Sydney, New South Wales, Australia
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18
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Wilson NJ, Pracilio A, Kersten M, Morphet J, Buckely T, Trollor JN, Griffin K, Bryce J, Cashin A. Registered nurses' awareness and implementation of reasonable adjustments for people with intellectual disability and/or autism. J Adv Nurs 2022; 78:2426-2435. [PMID: 35128714 DOI: 10.1111/jan.15171] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
Abstract
AIM To describe Australian registered nurses' awareness, and implementation of reasonable adjustments within their practice when caring for people with intellectual disability and/or autism. Additionally, the association between key demographic, workforce, and respondent variables and familiarity of the term and regularity of use was explored. DESIGN Cross-sectional survey. METHODS Survey data were collected between August and October 2020 using an online survey tool. Data were analysed using descriptive and inferential statistics. RESULTS Familiarity of the concept of reasonable adjustments was relatively low, compared to respondents who report applying adjustments when caring for people with intellectual disability and/or autism. Higher levels of confidence, comfort, and knowledge when caring for this cohort were associated with greater awareness and application of reasonable adjustments. CONCLUSION A higher volume, and diversity in type of, nursing education related to care for people with intellectual disability and/or autism is indicated.
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Affiliation(s)
- Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Richmond, New South Wales, Australia
| | - Amy Pracilio
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Michelle Kersten
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Julia Morphet
- School of Nursing & Midwifery, Monash University, Frankston, Victoria, Australia
| | - Thomas Buckely
- Acute/Critical Care Nursing, Susan Walki Building, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ken Griffin
- Australian Primary Health Care Nurses Association, Melbourne, Victoria, Australia
| | - Julianne Bryce
- Australian Nursing and Midwifery Federation, Melbourne, Victoria, Australia
| | - Andrew Cashin
- Faculty of Health and Human Sciences and Health Clinic, Southern Cross University, Lismore, New South Wales, Australia
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19
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Hope J, Schoonhoven L, Griffiths P, Gould L, Bridges J. 'I'll put up with things for a long time before I need to call anybody': Face work, the Total Institution and the perpetuation of care inequalities. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:469-487. [PMID: 35076086 PMCID: PMC9306934 DOI: 10.1111/1467-9566.13435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/01/2022] [Accepted: 01/05/2022] [Indexed: 06/01/2023]
Abstract
Failures in fundamental care (e.g. nutrition or pain-relief) for hospitalised patients can have serious consequences, including avoidable deaths. Policy rhetoric of 'shared decision-making' fails to consider how structural constraints and power dynamics limit patient agency in nursing staff-patient interactions. Goffman's concepts of face work, the presentation of self and the Total Institution shaped our analysis of interview and focus group data from hospital patients. Patients avoided threatening 'good' patient and staff face by only requesting missed care when staff face was convincing as 'caring' and 'available' ('engaged'). Patients did not request care from 'distracted' staff ('caring' but not 'available'), whilst patient requests were ignored in Total Institution-like 'dismissive' interactions. This meant patients experienced missed care with both 'distracted' and 'dismissive' staff. Patients with higher support needs were less able to carry out their own missed care to protect staff face, so experienced more serious care omissions. These findings show that many elements of the Total Institution survive in modern healthcare settings despite attempts to support individualised care. Unless nursing staff can maintain face as 'engaged' (despite organisational constraints that can reduce their capacity to do so) patient participation in care decisions will remain at the level of rhetoric.
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Affiliation(s)
- Jo Hope
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Lisette Schoonhoven
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Peter Griffiths
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Lisa Gould
- Department of Surgery and CancerFaculty of MedicineInstitute of Global Health InnovationImperial College LondonLondonUK
| | - Jackie Bridges
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
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20
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Ong N, Long JC, Weise J, Walton M. Responding to safe care: Healthcare staff experiences caring for a child with intellectual disability in hospital. Implications for practice and training. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:675-690. [DOI: 10.1111/jar.12978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 11/07/2021] [Accepted: 01/09/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Natalie Ong
- Child Development Unit, Children's Hospital Westmead Clinical School University of Sydney Sydney New South Wales Australia
| | - Janet C. Long
- Australian Institute of Health Innovation Macquarie University Sydney New South Wales Australia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry University of New South Wales Sydney New South Wales Australia
| | - Merrilyn Walton
- Department of Public Health, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
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21
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Ramsey L, Albutt A, Perfetto K, Quinton N, Baker J, Louch G, O’Hara J. Systemic safety inequities for people with learning disabilities: a qualitative integrative analysis of the experiences of English health and social care for people with learning disabilities, their families and carers. Int J Equity Health 2022; 21:13. [PMID: 35090463 PMCID: PMC8795982 DOI: 10.1186/s12939-021-01612-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/18/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Failures in care for people with learning disabilities have been repeatedly highlighted and remain an international issue, exemplified by a disparity in premature death due to poor quality and unsafe care. This needs urgent attention. Therefore, the aim of the study was to understand the care experiences of people with learning disabilities, and explore the potential patient safety issues they, their carers and families raised. METHODS Two data sources exploring the lived experience of care for people with learning disabilities were synthesised using an integrative approach, and explored using reflexive thematic analysis. This comprised two focus groups with a total of 13 people with learning disabilities and supportive staff, and 377 narratives posted publicly via the feedback platform Care Opinion. RESULTS The qualitative exploration highlighted three key themes. Firstly, health and social care systems operated with varying levels of rigidity. This contributed to an inability to effectively cater to; complex and individualised care needs, written and verbal communication needs and needs for adequate time and space. Secondly, there were various gaps and traps within systems for this population. This highlighted the importance of care continuity, interoperability and attending to the variation in support provision from professionals. Finally, essential 'dependency work' was reliant upon social capital and fulfilled by paid and unpaid caring roles to divergent extents, however, advocacy provided an additional supportive safety net. CONCLUSIONS A series of safety inequities have been identified for people with learning disabilities, alongside potential protective buffers. These include; access to social support and advocacy, a malleable system able to accommodate for individualised care and communication needs, adequate staffing levels, sufficient learning disabilities expertise within and between care settings, and the interoperability of safety initiatives. In order to attend to the safety inequities for this population, these factors need to be considered at a policy and organisational level, spanning across health and social care systems. Findings have wide ranging implications for those with learning disabilities, their carers and families and health and social care providers, with the potential for international learning more widely.
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Affiliation(s)
- Lauren Ramsey
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- Bradford Institute for Health Research and NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Abigail Albutt
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- Bradford Institute for Health Research and NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Kayley Perfetto
- Queen’s University, 9 University Avenue, Kingston, Ontario Canada
| | - Naomi Quinton
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Gemma Louch
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- Bradford Institute for Health Research and NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Jane O’Hara
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- School of Healthcare, University of Leeds, Leeds, UK
- School of Healthcare University of Leeds UK and Theme Lead of Patient Involvement in Patient Safety NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Leeds, UK
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22
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Rose J, Willner P, Cooper V, Langdon PE, Murphy GH, Stenfert Kroese B. The effect on and experience of families with a member who has Intellectual and Developmental Disabilities of the COVID-19 pandemic in the UK: developing an investigation. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 68:234-236. [PMID: 35309704 PMCID: PMC8928853 DOI: 10.1080/20473869.2020.1764257] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- John Rose
- Centre for Applied Psychology, School of Psychology, The University of Birmingham, Birmingham, UK
- Correspondence to: John Rose, Centre for Applied Psychology, School of Psychology, The University of Birmingham, Birmingham, UK.
| | - Paul Willner
- Department of Psychology, Swansea University, Swansea, UK
| | | | - Peter E. Langdon
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, U K and Coventry and Warwickshire NHS Partnership Trust, United Kingdom and Worcestershire Health and Care NHS Trust, Coventry, UK
| | | | - Biza Stenfert Kroese
- Centre for Applied Psychology, School of Psychology, The University of Birmingham, Birmingham, UK
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23
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Walsh C, Lydon S, Geoghegan R, Carey C, Creed M, O'Loughlin L, Walsh E, Byrne D, O'Connor P. Development and preliminary evaluation of a novel physician-report tool for assessing barriers to providing care to autistic patients. BMC Health Serv Res 2021; 21:873. [PMID: 34445991 PMCID: PMC8390217 DOI: 10.1186/s12913-021-06842-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/30/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Individuals on the autism spectrum face significant disparities in health and physicians often report difficulties in providing care to autistic patients. In order to improve the quality of care autistic individuals receive, it is important to identify the barriers that physicians experience in providing care so that these may be addressed. This paper reports the initial development and preliminary evaluation of a physician-report 'Barriers to Providing Healthcare' measurement tool. METHOD An established taxonomy of healthcare barriers for autistic individuals informed the initial draft of a 22-item measurement tool. This measurement tool was distributed to physicians working in various healthcare specialties and settings. Exploratory factor analysis (EFA) was conducted to determine the construct validity of the tool; discriminant validity between, and internal consistency of, the resultant factors were assessed. Multiple regressions were used to explore variables potentially associated with barriers endorsed by physicians. RESULTS A total of 203 physicians were included in the analyses. The EFA resulted in a 17-item tool with three distinct factors which explained 37.6% of the variance: 1) Patient-related barriers (Cronbach's α = 0.83; e.g., the patient's reactivity to the healthcare environment); 2) Healthcare provider (HCP)/family-related barriers (Cronbach's α = 0.81; e.g., a lack of providers willing to work with autistic patients); and 3) System-related barriers (Cronbach's α = 0.84; e.g., there is a lack of support for patients and families). Discriminant validity between the factors was adequate (r < .8). The barriers that were most frequently endorsed as occurring 'often' or 'very often' included a lack of support for patients and families (endorsed by 79.9% of physicians); communication difficulties (73.4%); and a lack of coordination between services (69.9%). The regression analyses identified no significant associated variables. CONCLUSION A preliminary version of a novel physician-report tool to assess barriers to providing care to autistic patients has been developed although further validation work is required. The use of this tool will help physicians to identify issues specific to different medical specialities and healthcare settings. This information may help identify the supports physicians require to recognise and implement the required accommodations. Future research which elucidates barriers to healthcare provision for autistic patients is required to support systemic change in healthcare so as to improve care experiences and health outcomes for people on the autism spectrum.
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Affiliation(s)
- Chloe Walsh
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland.
- School of Medicine, National University of Ireland Galway, Galway, Ireland.
| | - Rosemary Geoghegan
- Discipline of Paediatrics, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Cornelia Carey
- Department of Liaison Psychiatry, Beaumont Hospital, Dublin 9, Ireland
| | - Michael Creed
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
- Galway University Hospital, Galway, Ireland
| | | | - Ellen Walsh
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
- Galway University Hospital, Galway, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
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24
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Louch G, Albutt A, Harlow-Trigg J, Moore S, Smyth K, Ramsey L, O'Hara JK. Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review. BMJ Open 2021; 11:e047102. [PMID: 34011599 PMCID: PMC8137174 DOI: 10.1136/bmjopen-2020-047102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To produce a narrative synthesis of published academic and grey literature focusing on patient safety outcomes for people with learning disabilities in an acute hospital setting. DESIGN Scoping review with narrative synthesis. METHODS The review followed the six stages of the Arksey and O'Malley framework. We searched four research databases from January 2000 to March 2021, in addition to handsearching and backwards searching using terms relating to our eligibility criteria-patient safety and adverse events, learning disability and hospital setting. Following stakeholder input, we searched grey literature databases and specific websites of known organisations until March 2020. Potentially relevant articles and grey literature materials were screened against the eligibility criteria. Findings were extracted and collated in data charting forms. RESULTS 45 academic articles and 33 grey literature materials were included, and we organised the findings around six concepts: (1) adverse events, patient safety and quality of care; (2) maternal and infant outcomes; (3) postoperative outcomes; (4) role of family and carers; (5) understanding needs in hospital and (6) supporting initiatives, recommendations and good practice examples. The findings suggest inequalities and inequities for a range of specific patient safety outcomes including adverse events, quality of care, maternal and infant outcomes and postoperative outcomes, in addition to potential protective factors, such as the roles of family and carers and the extent to which health professionals are able to understand the needs of people with learning disabilities. CONCLUSION People with learning disabilities appear to experience poorer patient safety outcomes in hospital. The involvement of family and carers, and understanding and effectively meeting the needs of people with learning disabilities may play a protective role. Promising interventions and examples of good practice exist, however many of these have not been implemented consistently and warrant further robust evaluation.
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Affiliation(s)
- Gemma Louch
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Abigail Albutt
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | | | - Sally Moore
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kate Smyth
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Lauren Ramsey
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
| | - Jane K O'Hara
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, UK
- School of Healthcare, University of Leeds, Leeds, UK
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Drozd M, Chadwick D, Jester R. A cross-case comparison of the trauma and orthopaedic hospital experiences of adults with intellectual disabilities using interpretative phenomenological analysis. Nurs Open 2021; 8:858-869. [PMID: 33570307 PMCID: PMC7877147 DOI: 10.1002/nop2.693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/25/2020] [Accepted: 10/28/2020] [Indexed: 11/12/2022] Open
Abstract
AIM To present the cross-case comparison component of a qualitative study exploring and describing the experiences of adults with an intellectual disability who have received trauma and orthopaedic hospital care for musculoskeletal conditions or injuries in the United Kingdom. DESIGN A qualitative, exploratory study was conducted using 1:1 semi-structured interviews to describe the lived experiences of trauma and orthopaedic hospital care from the perspectives of people with intellectual disabilities and a carer of a person with profound and multiple intellectual disabilities. The data were analysed using interpretative phenomenological analysis. The Standards for Reporting Qualitative Research guidelines were applied. RESULTS There were common and interconnected experiences across the five participants: communication challenges; lack of person-centred care; issues related to pain management; lack of confidence in hospital care; the valuable support and expertise of carers; and incompetence of hospital staff and isolation and loneliness.
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Affiliation(s)
- Mary Drozd
- University of WolverhamptonWolverhamptonUK
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Moloney M, Hennessy T, Doody O. Reasonable adjustments for people with intellectual disability in acute care: a scoping review of the evidence. BMJ Open 2021; 11:e039647. [PMID: 33619184 PMCID: PMC7903074 DOI: 10.1136/bmjopen-2020-039647] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES People with intellectual disability are vulnerable in terms of health service provision due to increased comorbidity, higher dependency and cognitive impairment. This review explored the literature to ascertain what reasonable adjustments are evident in acute care to support people with intellectual disability, ensuring they have fair access and utilisation of health services. DESIGN Scoping review. SETTING Acute care settings. METHODS Five databases were systematically searched to identify studies that reported on the implementation of reasonable adjustments. Authors worked in pairs to screen studies for inclusion, data were extracted and charted and findings were synthesised according to content and themes. RESULTS Of the 7770 records identified, six studies were included in the review. The volume of evidence was influenced by specific inclusion criteria, and only papers that reported on the actual implementation of a reasonable adjustment within an acute care setting were included. Many papers reported on the concept of reasonable adjustment; however, few identified its applications in practice. CONCLUSIONS The scoping review highlights a lack of research on the practice and implementation of reasonable adjustments within acute care settings. There is a need for increased support, education and the provision of intellectual disability specialists across acute care settings.
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Affiliation(s)
- Mairead Moloney
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Therese Hennessy
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, Health Implementation Science and Technology, University of Limerick, Limerick, Ireland
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Drozd M, Chadwick D, Jester R. An integrative review of the hospital experiences of people with an intellectual disability: Lack of orthopaedic and trauma perspectives. Int J Orthop Trauma Nurs 2020; 39:100795. [DOI: 10.1016/j.ijotn.2020.100795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/16/2020] [Accepted: 06/29/2020] [Indexed: 01/13/2023]
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Walsh C, Lydon S, O'Dowd E, O'Connor P. Barriers to Healthcare for Persons with Autism: A Systematic Review of the Literature and Development of A Taxonomy. Dev Neurorehabil 2020; 23:413-430. [PMID: 36112897 DOI: 10.1080/17518423.2020.1716868] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: This review aimed to 1) synthesize extant research on barriers to healthcare access experienced by persons with autism, their caregivers, and health-care providers; and 2) present a taxonomy of barriers to physical healthcare for individuals with autism.Method: Systematic searches were conducted in five electronic databases. Methodological rigor was assessed using the Quality Assessment Tool for Studies with Diverse Designs. Thematic analysis was used to classify barriers and to develop a taxonomy.Results: In total, 31 articles were included in the review. The resulting taxonomy consisted of four themes: 1) Challenges Associated with Autism-related Characteristics; 2) Health-care Provider-based Issues; 3) Healthcare System Issues; and 4) Patient-related factors.Conclusions: Barriers to healthcare access for persons with autism are prevalent and occur at the patient, provider, and system levels. The taxonomy developed may facilitate measurement of barriers within health-care facilities and prompt identification of areas where interventions are warranted to improve care.
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Affiliation(s)
- Chloe Walsh
- National University of Ireland Galway, Galway, Ireland
| | - Sinéad Lydon
- National University of Ireland Galway, Galway, Ireland
| | - Emily O'Dowd
- National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- National University of Ireland Galway, Galway, Ireland
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Heslop P, Turner S, Read S, Tucker J, Seaton S, Evans B. Implementing reasonable adjustments for -disabled people in healthcare services. Nurs Stand 2020; 34:29-34. [PMID: 31468776 DOI: 10.7748/ns.2019.e11172] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 11/09/2022]
Abstract
Disabled people are one of the groups in society with the greatest health needs, yet they experience some of the most significant barriers to accessing healthcare services. This article describes examples of how three healthcare services have met the Equality Act 2010 duty to make reasonable adjustments for disabled people, so that they are not disadvantaged in accessing these services. Each of these services identified disabled patients, and considered and recorded the specific reasonable adjustments that were required. In doing so, they took time to fully understand the needs of the individual from their perspective. The services collaborated and coordinated the provision of reasonably adjusted care by communicating effectively with other health and social care providers, working together as a team, and treating disabled people as individuals.
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Affiliation(s)
- Pauline Heslop
- School for Policy Studies, Norah Fry Centre for Disability Studies, University of Bristol, Bristol, England
| | - Sue Turner
- National Development Team for Inclusion, Bath, England
| | - Stuart Read
- School for Policy Studies, University of Bristol, Bristol, England
| | | | - Steve Seaton
- Bristol, Bath and Weston AAA screening programme, North Bristol NHS Trust, Bristol, England
| | - Brian Evans
- University Hospitals of Morecambe Bay NHS Trust, Kendal, England
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Iacono T, Bigby C, Douglas J, Spong J. A prospective study of hospital episodes of adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:357-367. [PMID: 32173949 PMCID: PMC7216832 DOI: 10.1111/jir.12725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Previous research has shown poor hospital experiences and dire outcomes for people with intellectual disability. The main objective of this study was to prospectively track episodes for adults with intellectual disability (ID) in Australian hospitals, with a focus on indications of the quality of care provided. METHODS A prospective audit of hospital records over 35 months yielded quantitative data about patient characteristics, frequency and length of hospital episodes, diagnostic assessments and outcomes, post-emergency department (ED) destinations and post-discharge recommendations. Fifty participants were recruited largely by identification on hospital ED entry. An audit of patients' hospital records was conducted towards the end of hospital episodes, using a tool developed for the study. RESULTS Participants were mostly men (70%), aged 42.9 years on average, living mostly with family (46%) or in supported accommodation (44%). Of 157 recorded episodes, 96% started in ED, 85% required urgent or semi-urgent care and 62% were in the first 3 months of study participation. Average time in ED exceeded the 4-h national benchmark, met in 40% of episodes. One or more diagnostic assessments were conducted in 91% episodes and others in short stay units. Almost half (49%) resulted in a ward stay. With an extreme data point removed, <1-35 days were spent in wards. The most frequent diagnosis in 75% of episodes was for digestive problems, followed by nervous system problems then injuries. Median length of bed stays reflected data available for Australian refined diagnosis-related groups. High hospital re-presentations were found: for 67% of episodes in total, 26% (n = 12) of which were within 72 h and 59% (n = 23) within 30 days. CONCLUSIONS Adults with ID presented frequently to ED and often had lengthy stays. We found no indication of poor care practices in terms of hospital staff willingness to keep patients in ED and conduct of diagnostic assessments. Frequent re-presentations, however, indicated failed hospital care at some level.
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Affiliation(s)
- T. Iacono
- Living with Disability Research CentreLa Trobe UniversityBendigoVic.Australia
| | - C. Bigby
- Living with Disability Research CentreLa Trobe UniversityMelbourneVic.Australia
| | - J. Douglas
- Living with Disability Research CentreLa Trobe UniversityMelbourneVic.Australia
| | - J. Spong
- Living with Disability Research CentreLa Trobe UniversityBendigoVic.Australia
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Olsson S, Gustafsson C. Employees' experiences of education and knowledge in intellectual disability practice. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2020. [DOI: 10.1111/jppi.12338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sylvia Olsson
- Department of School of Health Care and Social WelfareMälardalen University Eskilstuna Sweden
| | - Christine Gustafsson
- Department of School of Health Care and Social WelfareMälardalen University Eskilstuna Sweden
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Oulton K, Wray J, Hassiotis A, Kenten C, Russell J, Tuffrey-Wijne I, Whiting M, Gibson F. Learning disability nurse provision in children's hospitals: hospital staff perceptions of whether it makes a difference. BMC Pediatr 2019; 19:192. [PMID: 31182066 PMCID: PMC6558867 DOI: 10.1186/s12887-019-1547-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 05/20/2019] [Indexed: 12/16/2022] Open
Abstract
Background In response to multiple United Kingdom investigations and inquiries into the care of adults with learning disabilities, Mencap produced the Getting it Right Charter which campaigned for the appointment of a Learning Disability Liaison Nurse in every hospital. More recent best practice guidelines from the Care Quality Commission included the need for all children’s units to have access to a senior learning disability nurse who can support staff and help them manage difficult situations. However, little evidence exists of the extent of learning disability nurse provision in children’s hospitals or the nature and impact of this role. Here we report selected findings from a national mixed methods study of hospital care for children and young people with and without learning disabilities in England. The extent of learning disability nurse provision in children’s hospitals is described and perceptions of staff working in hospitals with and without such provision is compared. Methods Semi-structured interviews were conducted with senior staff across 15 children’s hospitals and an anonymous survey was sent to clinical and non-clinical staff with patient (children and young people) contact within these hospitals. The survey focused on six different elements of care for those with and without learning disability, with additional questions concerning identifying and tracking those with learning disabilities and two open-ended questions. Results Forty-eight senior staff took part in interviews, which included a subset of nine nurses and one allied health professional employed in a dedicted learning disability nurse role, or similar. Surveys were completed by 1681, of whom 752 worked in a hospital with dedicated learning disability nurse provision. We found evidence of limited and varied learning disability nurse provision which was valued by hospital staff and shown to positively impact their perceptions of being capable to care for children and young people with learning disabilities, but not shown to increase staff perceptions of capacity or confidence, or how children and young people are valued within the hospital, their safety or access to appointments. Conclusion Further consideration must be given to how learning disability nurse roles within children’s hospitals are best operationalised in practice to have the greatest impact on staff and families, as well as how we monitor and evaluate them to ensure they are being utilised effectively and efficiently. Trial registration The study has been registered on the NIHR CRN portfolio 20,461 (Phase 1), 31,336 (Phases 2–4).
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Affiliation(s)
- Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, Level 4, Barclay House, 37 Queen Square, London, WC1N 3BH, England.
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, Level 4, Barclay House, 37 Queen Square, London, WC1N 3BH, England
| | - Angela Hassiotis
- UCL Division of Psychiatry, London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, England
| | - Charlotte Kenten
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, Level 4, Barclay House, 37 Queen Square, London, WC1N 3BH, England
| | - Jessica Russell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, Level 4, Barclay House, 37 Queen Square, London, WC1N 3BH, England
| | - Irene Tuffrey-Wijne
- Faculty of Health, Social Care & Education, Cranmer Terrace, Kingston University & St George's, University of London, 6th floor Hunter Wing, London, SW17 0RE, UK
| | - Mark Whiting
- Health Research Building, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, England
| | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, Level 4, Barclay House, 37 Queen Square, London, WC1N 3BH, England.,School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, England
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Bauer A, Taggart L, Rasmussen J, Hatton C, Owen L, Knapp M. Access to health care for older people with intellectual disability: a modelling study to explore the cost-effectiveness of health checks. BMC Public Health 2019; 19:706. [PMID: 31174506 PMCID: PMC6556058 DOI: 10.1186/s12889-019-6912-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/29/2019] [Indexed: 01/09/2023] Open
Abstract
Background Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England. Methods Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters. Results Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective. Conclusion Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions. Electronic supplementary material The online version of this article (10.1186/s12889-019-6912-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annette Bauer
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK.
| | - Laurence Taggart
- Institute of Nursing & Health Research, Ulster University, N Ireland, Newtownabbey, BT37 0QB, UK
| | - Jill Rasmussen
- Royal College of General Practitioners (RCGP), 30 Euston Square, London, England, NW1 2FB, UK
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Lancaster University, Lancaster, England, LA1 4YG, UK
| | - Lesley Owen
- National Institute for Health and Care Excellence, 10 Spring Gardens, London, England, SW1A 2BU, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK
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Glover G, Williams R, Tompkins G, Oyinlola J. An observational study of the use of acute hospital care by people with intellectual disabilities in England. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:85-99. [PMID: 30221429 DOI: 10.1111/jir.12544] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 10/01/2017] [Accepted: 07/16/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Providing safe, high-quality admitted-patient care for people with intellectual disabilities (IDs) requires consideration for their special needs particularly in relation to communication and consent. To make allowance for these special requirements, it would be helpful for hospitals to know how often they are likely to arise. This study set out to identify the amount and patterns of use of acute, non-psychiatric hospital admitted-patient care in England by people with ID. Patterns are considered in relation to clinical specialties, modes of admission (emergency or planned) and life stages (children and young people, working age and older adults). In each case, patterns for people with ID are compared with patterns for those without. METHODS Descriptive observational study using a major general practitioner (GP) research database (Clinical Practice Research Datalink GOLD) linked to routine national statistical records of admitted-patient care. RESULTS Overall people identified by their GP as having ID had higher rates of admitted-patient care episodes and longer durations of stay than those without. Differences varied considerably between clinical specialties with rates more elevated in medical and paediatric than surgical specialties. Admitted-patient care rates for women with ID in obstetrics and gynaecology were lower than for other women, while rates for admitted-patient dental care were much higher for both men and women with ID. In an average English health administrative area with a local population of 250 000 people, at any time, there are likely to be approximately 670 people receiving acute admitted-patient care. Approximately six of these are likely to have been identified by their GP as having ID. At 0.9% of hospital in-patients, this is just under twice the proportion in the population. CONCLUSION AND IMPLICATIONS Our figures are likely to be an underestimate as GP identification of people with ID is known to be far from complete. However, they indicate that the number of people with ID in acute hospital settings is likely to be substantially more than a recent survey of English health services indicated they were aware of. The study is intended to help guide expectations for acute hospitals seeking to audit the completeness of their identification of people with ID and to indicate their likely distribution between clinical specialties.
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Affiliation(s)
- G Glover
- Public Health England Learning Disabilities Observatory, West Wing, Victoria House, Capital Park, Fulbourn, Cambridge, UK
| | - R Williams
- Clinical Practice Research Datalink Group, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - G Tompkins
- Public Health in Gateshead, Gateshead Council, Gateshead, UK
| | - J Oyinlola
- Clinical Practice Research Datalink Group, Medicines and Healthcare Products Regulatory Agency, London, UK
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Selick A, Durbin J, Casson I, Lee J, Lunsky Y. Barriers and facilitators to improving health care for adults with intellectual and developmental disabilities: what do staff tell us? HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2019; 38:349-357. [PMID: 30303655 DOI: 10.24095/hpcdp.38.10.01] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Adults with intellectual and developmental disabilities (IDD) have high rates of morbidity and are less likely to receive preventive care. Emergency departments and primary care clinics are important entry points into the health care system. Improving care in these settings can lead to increased prevention activities, early disease identification, and ongoing management. We studied barriers and facilitators to improving the care of patients with IDD in three primary and three emergency care sites in Ontario. METHODS Data sources included structured implementation logs at each site, focus groups (n = 5) and interviews (n = 8). Barriers and facilitators were coded deductively based on the Consolidated Framework for Implementation Research (CFIR). Synthesis to higher level themes was achieved through review and discussion by the research team. Focus was given to differences between higher and lower implementing sites. RESULTS All sites were challenged to prioritize care improvement for a small, complex population and varied levels of implementation were achieved. Having national guidelines, using local data to demonstrate need and sharing evidence on value were important engagement strategies. Factors present at higher implementing sites included strong champions, alignment with site mandate, and use of electronic prompts/reminders. Lower implementing sites showed more passive endorsement of the innovation and had lower capacity to implement. CONCLUSION Providing effective care for small, complex groups, such as adults with IDD, is critical to improving long-term health outcomes but is challenging to achieve. At a systemic level, funding incentives, access to expertise and improved electronic record systems may enhance capacity.
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Affiliation(s)
- Avra Selick
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Janet Durbin
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ian Casson
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jacques Lee
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Yona Lunsky
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Read S, Heslop P, Turner S, Mason-Angelow V, Tilbury N, Miles C, Hatton C. Disabled people's experiences of accessing reasonable adjustments in hospitals: a qualitative study. BMC Health Serv Res 2018; 18:931. [PMID: 30509323 PMCID: PMC6278140 DOI: 10.1186/s12913-018-3757-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/22/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The UK Equality Act 2010 requires providers of health services to make changes or 'reasonable adjustments' to their practices in order to protect disabled people from discrimination or disadvantage when accessing care. Existing evidence suggests that despite this legislation, health services are not always providing reasonably adjusted care for disabled people. This paper presents the perspectives of disabled people themselves in relation to their experiences of accessing reasonable adjustments in hospitals in England. METHODS Twenty-one semi-structured interviews were held with disabled people who had a recent experience of hospital care in England. Participants were asked about the extent to which the hospital provided reasonably adjusted care, and if necessary, how they thought the provision of reasonable adjustments could be improved. Each interview was anonymised and transcribed, and the data analysed using thematic analysis. RESULTS Participants reported mixed experiences about whether and how reasonable adjustments were provided: some shared positive examples of good practice; others spoke about difficult encounters and limited provision. Recommendations made include a need for culture change in how reasonable adjustments are perceived and enacted; improvements in identifying the needs of disabled people; improvements to the hospital environment and the provision of information; and the need to involve disabled people themselves in the process of change. CONCLUSIONS Gaps remain in how reasonable adjustments are provided for disabled people accessing hospital care. It is important for hospital staff to listen to the perspectives of disabled people about the provision of reasonable adjustments, and make improvements as necessary. Hospital staff could also do more to share good practice in relation to the provision of reasonable adjustments to effectively inspire and embed positive change.
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Affiliation(s)
- Stuart Read
- Norah Fry Centre for Disability Studies, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Pauline Heslop
- Norah Fry Centre for Disability Studies, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Sue Turner
- National Development Team for Inclusion, First Floor, 30-32 Westgate Buildings, Bath, BA1 1EF UK
| | - Victoria Mason-Angelow
- Norah Fry Centre for Disability Studies, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Nadine Tilbury
- Norah Fry Centre for Disability Studies, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Caroline Miles
- Norah Fry Centre for Disability Studies, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Chris Hatton
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, LA1 4YG UK
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Oulton K, Gibson F, Carr L, Hassiotis A, Jewitt C, Kenten C, Russell J, Whiting M, Tuffrey-Wijne I, Wray J. Mapping staff perspectives towards the delivery of hospital care for children and young people with and without learning disabilities in England: a mixed methods national study. BMC Health Serv Res 2018; 18:203. [PMID: 29566681 PMCID: PMC5865304 DOI: 10.1186/s12913-018-2970-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/27/2018] [Indexed: 11/16/2022] Open
Abstract
Background Children and young people (CYP) with learning disabilities (LD) are a vulnerable population with increased risk of abuse and accidental injury and whose parents have reported concerns about the quality, safety and accessibility of their hospital care. The Care Quality Commission’s (CQC) view of best practice for this group of patients includes: access to senior LD nurse provision; a clearly visible flagging system for identifying them; the use of hospital passports; and defined communication strategies (Glasper, Comp Child Adolesc Nurs 40:63-67, 2017). What remains unclear is whether these recommendations are being applied and if so, what difference they are making. Furthermore, what we do not know is whether parental concerns of CYP with LD differ from parents of other children with long-term conditions. The aims of this study were to 1) describe the organisational context for healthcare delivery to CYP with LD and their families and 2) compare staff perceptions of their ability to identify the needs of CYP with and without LD and their families and provide high quality care to effectively meet these needs. Methods Individual interviews (n = 65) and anonymised online survey (n = 2261) were conducted with hospital staff working with CYP in 15 children’s and 9 non-children’s hospitals in England. The majority of interviews were conducted over the telephone and recorded and transcribed verbatim. Health Research Authority was obtained and verbal or written consent for data collection was obtained from all interview participants. Results The nature and extent of organisational policies, systems and practices in place within hospitals to support the care of CYP with LD differs across England and some uncertainty exists within and across hospitals as to what is currently available and accessed. Staff perceived that those with LD were included less, valued less, and less safe than CYP without LD. They also reported having less confidence, capability and capacity to meet the needs of this population compared to those without LD. Conclusion Findings indicate inequality with regards the provision of high quality hospital care to children and young people with LD that meets their needs. There is a pressing need to understand the impact this has on them and their families. Trial registration The study has been registered on the NIHR CRN portfolio 20461 (Phase 1), 31336 (Phases 2-4). Electronic supplementary material The online version of this article (10.1186/s12913-018-2970-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, Level 4, Barclay House, 37 Queen Square, London, WC1N 3BH, UK.
| | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, Level 4, Barclay House, 37 Queen Square, London, WC1N 3BH, UK.,School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Lucinda Carr
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Angela Hassiotis
- UCL Division of Psychiatry, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Carey Jewitt
- UCL Knowledge Lab, Institute of Education, 23-29 Emerald Street, London, WC1N 3QS, UK
| | - Charlotte Kenten
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, Level 4, Barclay House, 37 Queen Square, London, WC1N 3BH, UK
| | - Jessica Russell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, Level 4, Barclay House, 37 Queen Square, London, WC1N 3BH, UK
| | - Mark Whiting
- Health Research Building, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Irene Tuffrey-Wijne
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, 6th floor Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, Level 4, Barclay House, 37 Queen Square, London, WC1N 3BH, UK
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Heutmekers M, Naaldenberg J, Verheggen SA, Assendelft WJJ, Lantman - de Valk HMJVS, Tobi H, Leusink GL. Does risk and urgency of requested out-of-hours general practitioners care differ for people with intellectual disabilities in residential settings compared with the general population in the Netherlands? A cross-sectional routine data-based study. BMJ Open 2017; 7:e019222. [PMID: 29101152 PMCID: PMC5695369 DOI: 10.1136/bmjopen-2017-019222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/23/2017] [Accepted: 10/05/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To investigate whether people with intellectual disabilities (ID) in residential setting were more likely than people from the general population to request out-of-hours general practitioner (GP) care and whether these requests had a similar level of urgency. DESIGN Cross-sectional routine data-based study. SETTING Two GP cooperatives providing out-of-hours primary care in an area in the Netherlands. POPULATION 432 582 persons living in the out-of-hours service areas, of which 1448 could be identified as having an ID. MAIN OUTCOME MEASURES GP cooperative records of all contacts in 2014 for people with and without ID were used to calculate the relative risk of requesting care and the associated level of urgency. RESULTS Of the people with ID (448/1448), 30.9% requested out-of-hours GP care, whereas for the general population this was 18.4% (79 206/431 134), resulting in a relative risk of 1.7 (95% CI 1.6 to 1.8). We found a different distribution of urgency level for people with and without ID. Generally, requests for people with ID were rated as less urgent. CONCLUSION People with ID in residential setting were more likely to request out-of-hours GP care than the general population. The distribution of the urgency level of requests differed between the two groups. The high percentage of demands relating to people with ID requesting counselling and advice suggests that some out-of-hours GP care may be avoidable. However, more insight is needed into the nature of out-of-hours primary care requests of people with ID to direct structural and reasonable adjustments towards the improvement of health information exchange in and around-the-clock access to primary care for people with ID.
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Affiliation(s)
- Marloes Heutmekers
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jenneken Naaldenberg
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sabine A Verheggen
- General Practitioner Cooperative Nijmegen and Boxmeer, Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Hilde Tobi
- Wageningen University and Research, Biometris, Wageningen, The Netherlands
| | - Geraline L Leusink
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Chester V, Simmons H, Henriksen M, Alexander RT. Vitamin D deficiency in an inpatient forensic intellectual disability service. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2017; 21:134-143. [PMID: 27193572 DOI: 10.1177/1744629516649124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
No research has examined vitamin D deficiency among inpatients within forensic intellectual disability services, despite their potentially increased risk. Tests of serum 25(OHD) concentration in blood are routinely offered to patients within the service as part of the admission and annual physical health check. Results were classified as deficient <25, insufficient <50, sufficient 50-75 or optimal >75. Deficient or insufficient patients were offered supplement treatment and retested within 6 months. Levels were compared between groups: level of security and gender. At baseline, 87% of patients were deficient or insufficient, whilst 13% were sufficient or optimal. At follow-up, 53% had sufficient or optimal levels. However, some patients remained deficient (13%) or insufficient (34%) due to non-compliance with treatment. Women appeared more likely to be deficient. High levels of vitamin D deficiency were found among this population. Vitamin D screening and treatment is a simple and effective way of improving the physical health of this population.
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Pelleboer-Gunnink HA, Van Oorsouw WMWJ, Van Weeghel J, Embregts PJCM. Mainstream health professionals' stigmatising attitudes towards people with intellectual disabilities: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:411-434. [PMID: 28198094 DOI: 10.1111/jir.12353] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/08/2016] [Accepted: 11/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Equal access to mainstream healthcare services for people with intellectual disabilities (ID) still requires attention. Although recent studies suggest that health professionals hold positive attitudes towards people with ID, stigmatising attitudes may influence their efforts to serve people with ID in community healthcare practice. To stimulate inclusion in mainstream healthcare services, this systematic review focussed on barriers in attitudes of mainstream health professionals towards people with ID. METHOD Five electronic databases were systematically searched and references in full text articles were checked for studies published in the English language between January 1994 and January 2016. A social-psychological triad of cognitive, affective and behavioural dimensions of stigmatising attitudes is used to structure and discuss the results. RESULTS The literature search generated 2190 records with 30 studies that passed our exclusion criteria. Studies were mostly cross-sectional and of moderate quality. With respect to stigma, a lack of familiarity with and knowledge about people with ID was found. ID was considered as a stable condition not under personal control. Moreover, mainstream health professionals had either low or high expectations of the capabilities of people with ID. Professionals reported stress, lack of confidence, fear and anxiety, a tendency to treat people with ID differently and a lack of supporting autonomy. CONCLUSIONS Stigmatising attitudes towards people with ID appeared to be present among mainstream health professionals. This might affect the ongoing challenges regarding inclusion in mainstream healthcare services. To facilitate inclusion in mainstream healthcare services, it is recommended to include contact and collaboration with experts-by-experience in education programs of health professionals. Future research should progress beyond descriptive accounts of stigma towards exploring relationships between cognitive, affective and behavioural dimensions as pointers for intervention. Finally, inclusion would benefit from an understanding of 'equal' treatment that means reasonable adjustments instead of undifferentiated treatment.
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Affiliation(s)
- H A Pelleboer-Gunnink
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
- Dichterbij Innovation and Science, Gennep, The Netherlands
| | - W M W J Van Oorsouw
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
| | - J Van Weeghel
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
- Phrenos Centre of Expertise, Utrecht, The Netherlands
- Parnassia Group, Dijk en Duin Mental Health Centre, Castricum, The Netherlands
| | - P J C M Embregts
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
- Dichterbij Innovation and Science, Gennep, The Netherlands
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Lewis P, Gaffney RJ, Wilson NJ. A narrative review of acute care nurses’ experiences nursing patients with intellectual disability: underprepared, communication barriers and ambiguity about the role of caregivers. J Clin Nurs 2017; 26:1473-1484. [DOI: 10.1111/jocn.13512] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Peter Lewis
- School of Nursing and Midwifery; Western Sydney University; Richmond NSW Australia
| | - Ryan J Gaffney
- School of Nursing and Midwifery; Western Sydney University; Richmond NSW Australia
| | - Nathan J Wilson
- School of Nursing and Midwifery; Ingham Institute for Applied Medical Research; Western Sydney University; Richmond NSW Australia
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Oulton K, Wray J, Carr L, Hassiotis A, Jewitt C, Kerry S, Tuffrey-Wijne I, Gibson F. Pay More Attention: a national mixed methods study to identify the barriers and facilitators to ensuring equal access to high-quality hospital care and services for children and young people with and without learning disabilities and their families. BMJ Open 2016; 6:e012333. [PMID: 27940626 PMCID: PMC5168702 DOI: 10.1136/bmjopen-2016-012333] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Despite evidence of health inequalities for adults with intellectual disability (ID) there has yet to be a comprehensive review of how well hospital services are meeting the needs of children and young people (CYP) with ID and their families. We do not know how relevant existing recommendations and guidelines are to CYP, whether these are being applied in the paediatric setting or what difference they are making. Evidence of parental dissatisfaction with the quality, safety and accessibility of hospital care for CYP with ID exists. However, the extent to which their experience differs from parents of CYP without ID is not known and the views and experiences of CYP with ID have not been investigated. We will compare how services are delivered to, and experienced by CYP aged 5-15 years with and without ID and their families to see what inequalities exist, for whom, why and under what circumstances. METHODS AND ANALYSIS We will use a transformative, mixed methods case study design to collect data over four consecutive phases. We will involve CYP, parents and hospital staff using a range of methods; interviews, parental electronic diary, hospital and community staff questionnaire, patient and parent satisfaction questionnaire, content analysis of hospital documents and a retrospective mapping of patient hospital activity. Qualitative data will be managed and analysed using NVivo and quantitative data will be analysed using parametric and non-parametric descriptive statistics. ETHICS AND DISSEMINATION The study will run from December 2015 to November 2018. We have Health Authority Approval (IRAS project ID: 193932) for phase 1 involving staff only and ethical and Health Authority Approval for phases 2-4 (IRAS project ID: 178525). We will disseminate widely to relevant stakeholders, using a range of accessible formats, including social media. We will publish in international peer-reviewed journals and present to professional, academic and lay audiences through national and international conferences.
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Affiliation(s)
- Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK
- JM Barrie Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Lucinda Carr
- JM Barrie Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | | | - Carey Jewitt
- UCL Knowledge Lab, UCL Institute of Education, London, UK
| | - Sam Kerry
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | | | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK
- School of Health Science, University of Surrey, Surrey, UK
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Trollor JN, Eagleson C, Turner B, Salomon C, Cashin A, Iacono T, Goddard L, Lennox N. Intellectual disability health content within nursing curriculum: An audit of what our future nurses are taught. NURSE EDUCATION TODAY 2016; 45:72-79. [PMID: 27429409 DOI: 10.1016/j.nedt.2016.06.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/01/2016] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Individuals with intellectual disability experience chronic and complex health issues, but face considerable barriers to healthcare. One such barrier is inadequate education of healthcare professionals. OBJECTIVE To establish the quantity and nature of intellectual disability content offered within Australian nursing degree curricula. DESIGN A two-phase national audit of nursing curriculum content was conducted using an interview and online survey. SETTING Australian nursing schools offering pre-registration courses. PARTICIPANTS Pre-registration course coordinators from 31 universities completed the Phase 1 interview on course structure. Unit coordinators and teaching staff from 15 universities in which intellectual disability content was identified completed the Phase 2 online survey. METHODS Quantity of compulsory and elective intellectual disability content offered (units and teaching time) and the nature of the content (broad categories, specific topics, and inclusive teaching) were audited using an online survey. RESULTS Over half (52%) of the schools offered no intellectual disability content. For units of study that contained some auditable intellectual disability content, the area was taught on average for 3.6h per unit of study. Units were evenly distributed across the three years of study. Just three participating schools offered 50% of all units audited. Clinical assessment skills, and ethics and legal issues were most frequently taught, while human rights issues and preventative health were poorly represented. Only one nursing school involved a person with intellectual disability in content development or delivery. CONCLUSION Despite significant unmet health needs of people with intellectual disability, there is considerable variability in the teaching of key intellectual disability content, with many gaps evident. Equipping nursing students with skills in this area is vital to building workforce capacity.
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Affiliation(s)
- Julian N Trollor
- Department of Developmental Disability Neuropsychiatry (3DN), School of Psychiatry, UNSW Australia, 34 Botany Street, Randwick, NSW 2052, Australia.
| | - Claire Eagleson
- Department of Developmental Disability Neuropsychiatry (3DN), School of Psychiatry, UNSW Australia, 34 Botany Street, Randwick, NSW 2052, Australia.
| | - Beth Turner
- Department of Developmental Disability Neuropsychiatry (3DN), School of Psychiatry, UNSW Australia, 34 Botany Street, Randwick, NSW 2052, Australia.
| | - Carmela Salomon
- Department of Developmental Disability Neuropsychiatry (3DN), School of Psychiatry, UNSW Australia, 34 Botany Street, Randwick, NSW 2052, Australia.
| | - Andrew Cashin
- School of Health and Human Sciences, Southern Cross University, PO Box 157, Lismore, NSW 2480, Australia.
| | - Teresa Iacono
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, VIC 3552, Australia.
| | - Linda Goddard
- Department of Mental Health and Learning Disabilities, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom.
| | - Nicholas Lennox
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute/The University of Queensland, Mater Hospitals, Raymond Terrace, South Brisbane, QLD 4101, Australia.
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Sheehan R, Gandesha A, Hassiotis A, Gallagher P, Burnell M, Jones G, Kerr M, Hall I, Chaplin R, Crawford MJ. An audit of the quality of inpatient care for adults with learning disability in the UK. BMJ Open 2016; 6:e010480. [PMID: 27091821 PMCID: PMC4838729 DOI: 10.1136/bmjopen-2015-010480] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To audit patient hospital records to evaluate the performance of acute general and mental health services in delivering inpatient care to people with learning disability and explore the influence of organisational factors on the quality of care they deliver. SETTING Nine acute general hospital Trusts and six mental health services. PARTICIPANTS Adults with learning disability who received inpatient hospital care between May 2013 and April 2014. PRIMARY AND SECONDARY OUTCOME MEASURES Data on seven key indicators of high-quality care were collected from 176 patients. These covered physical health/monitoring, communication and meeting needs, capacity and decision-making, discharge planning and carer involvement. The impact of services having an electronic system for flagging patients with learning disability and employing a learning disability liaison nurse was assessed. RESULTS Indicators of physical healthcare (body mass index, swallowing assessment, epilepsy risk assessment) were poorly recorded in acute general and mental health inpatient settings. Overall, only 34 (19.3%) patients received any assessment of swallowing and 12 of the 57 with epilepsy (21.1%) had an epilepsy risk assessment. For most quality indicators, there was a non-statistically significant trend for improved performance in services with a learning disability liaison nurse. The presence of an electronic flagging system showed less evidence of benefit. CONCLUSIONS Inpatient care for people with learning disability needs to be improved. The work gives tentative support to the role of a learning disability liaison nurse in acute general and mental health services, but further work is needed to confirm these benefits and to trial other interventions that might improve the quality and safety of care for this high-need group.
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Affiliation(s)
- Rory Sheehan
- Division of Psychiatry, University College London, London, UK
| | - Aarti Gandesha
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | | | - Pamela Gallagher
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Matthew Burnell
- Faculty of Population Health Sciences, University College London, London, UK
| | - Glyn Jones
- Abertawe Bro Morgannwg University Health Board, Cardiff, UK
| | - Michael Kerr
- Welsh Centre for Learning Disabilities, Cardiff University, Cardiff, UK
| | - Ian Hall
- Tower Hamlets Community Learning Disability Service, London, UK
| | - Robert Chaplin
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Michael J Crawford
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
- Centre for Mental Health, Imperial College London, London, UK
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Hemsley B, Georgiou A, Hill S, Rollo M, Steel J, Balandin S. An integrative review of patient safety in studies on the care and safety of patients with communication disabilities in hospital. PATIENT EDUCATION AND COUNSELING 2016; 99:501-511. [PMID: 26566195 DOI: 10.1016/j.pec.2015.10.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/29/2015] [Accepted: 10/28/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To review the research literature on the experiences of patients with communication disabilities in hospital according to the Generic Model of patient safety. METHODS In 2014 and 2015, we searched four scientific databases for studies with an aim or result relevant to safety of hospital patients with communication disabilities. The review included 27 studies. RESULTS A range of adverse event types were outlined in qualitative research. Little detail was provided about contributing or protective factors for safety incidents in hospital for these patients or the impact of the incidents on the patient or organisations involved. CONCLUSION Further research addressing the safety of patients with communication disabilities is needed. Sufficient detail is required to identify the nature, timing, and detection of incidents; factors that contribute to or prevent adverse events; and detail the impact of the adverse events. PRACTICE IMPLICATIONS In order to provide safe and effective care to people with communication disabilities in hospital, a priority for health and disability services must be the design and evaluation of ecologically appropriate and evidence-based interventions to improve patient care, communication, and reduce the risk of costly and harmful patient safety incidents.
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Affiliation(s)
- Bronwyn Hemsley
- Faculty of Education and Art, The University of Newcastle, Newcastle, Australia.
| | - Andrew Georgiou
- Australian Institute for Health Innovation, Macquarie University, Sydney, Australia
| | - Sophie Hill
- Department of Public Health, La Trobe University, Australia
| | - Megan Rollo
- Faculty of Education and Art, The University of Newcastle, Newcastle, Australia
| | - Joanne Steel
- Faculty of Education and Art, The University of Newcastle, Newcastle, Australia
| | - Susan Balandin
- Faculty of Health, Deakin University, Melbourne, Australia
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Affiliation(s)
- Julie Taylor
- University of Birmingham and Birmingham Children's Hospital NHS Foundation Trust, UK
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47
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Tint A, Lunsky Y. Individual, social and contextual factors associated with psychiatric care outcomes among patients with intellectual disabilities in the emergency department. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:999-1009. [PMID: 26041621 DOI: 10.1111/jir.12201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 02/25/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Individuals with intellectual disabilities (ID) are disproportionately high users of psychiatric emergency services. Despite the demand for psychiatric assessments in the emergency department (ED), no clear guidelines have been established as to what factors should guide clinical decision-making processes. The current study aimed to explore individual, social and contextual factors related to psychiatric care outcomes among patients with ID in the emergency department. METHOD Emergency department charts were reviewed for 66 individuals with ID who visited the emergency department during a psychiatric crisis. RESULTS Standardised crisis severity scores were significantly higher in patients seen by psychiatrists as compared with patients who did not receive psychiatric consultations in the emergency department. A significantly greater proportion of patients with moderate or severe levels of ID (vs. borderline/mild) received psychiatric consultations. Emergency department visits resulting in inpatient hospital admission did not differ from those that did not, with the exception of the level of ID: patients admitted to psychiatric inpatient care were more likely to have moderate or severe levels of ID. CONCLUSIONS The psychiatric care experiences of patients with ID in the emergency department appear highly variable. Further research focused on emergency department clinical decision-making practices concerning this population is warranted.
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Affiliation(s)
- A Tint
- Department of Psychology, York University, Toronto, ON, Canada
| | - Y Lunsky
- Underserved Populations Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Twomey CD, Baldwin DS, Hopfe M, Cieza A. A systematic review of the predictors of health service utilisation by adults with mental disorders in the UK. BMJ Open 2015; 5:e007575. [PMID: 26150142 PMCID: PMC4499684 DOI: 10.1136/bmjopen-2015-007575] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify variables that predict health service utilisation (HSU) by adults with mental disorders in the UK, and to determine the evidence level for these predictors. DESIGN A narrative synthesis of peer-reviewed studies published after the year 2000. The search was conducted using four databases (ie, PsycINFO, CINAHL Plus with full text, MEDLINE and EMBASE) and completed on 25 March 2014. SETTING The majority of included studies were set in health services across primary, secondary, specialist and inpatient care. Some studies used data from household and postal surveys. PARTICIPANTS Included were UK-based studies that predicted HSU by adults with mental disorders. Participants had a range of mental disorders including psychotic disorders, personality disorders, depression, anxiety disorders, eating disorders and dementia. PRIMARY OUTCOME A wide range of HSU outcomes were examined, including general practitioner (GP) contacts, medication usage, psychiatrist contacts, psychotherapy attendances, inpatient days, accident and emergency admissions and 'total HSU'. RESULTS Taking into account study quality, 28 studies identified a range of variables with good preliminary evidence supporting their ability to predict HSU. Of these variables, comorbidity, personality disorder, age (heterogeneous age ranges), neurotic symptoms, female gender, a marital status of divorced, separated or widowed, non-white ethnicity, high previous HSU and activities of daily living, were associated with increased HSU. Moreover, good preliminary evidence was found for associations of accessing a primary care psychological treatment service and medication use with decreased HSU. CONCLUSIONS The findings can inform decisions about which variables might be used to derive mental health clusters in 'payment by results' systems in the UK. The findings also support the need to investigate whether combining broad diagnoses with care pathways is an effective method for mental health clustering, and the need for research to further examine the association between mental health clusters and HSU.
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Affiliation(s)
- Conal D Twomey
- Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - David S Baldwin
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Maren Hopfe
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Alarcos Cieza
- Faculty of Social and Human Sciences, School of Psychology, University of Southampton, UK
- Department of Medical Informatics, Biometry and Epidemiology—IBE, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University (LMU), Munich, Germany
- Swiss Paraplegic Research, Nottwil, Switzerland
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Hafeez S, Singhera M, Huddart R. Exploration of the treatment challenges in men with intellectual difficulties and testicular cancer as seen in Down syndrome: single centre experience. BMC Med 2015; 13:152. [PMID: 26123546 PMCID: PMC4485877 DOI: 10.1186/s12916-015-0386-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/03/2015] [Indexed: 01/07/2023] Open
Abstract
Down syndrome is the most common chromosomal disorder in humans as well as the most common cause of inherited intellectual disability. A spectrum of physical and functional disability is associated with the syndrome as well as a predisposition to developing particular malignancies, including testicular cancers. These tumours ordinarily have a high cure rate even in widely disseminated disease. However, individuals with Down syndrome may have learning difficulties, behavioural problems, and multiple systemic complications that have the potential to make standard treatment more risky and necessitates individualized approach in order to avoid unacceptable harm. There is also suggestion that tumours may have a different natural history. Further, people with learning disabilities have often experienced poorer healthcare than the general population. In order to address these inequalities, legislation, professional bodies, and charities provide guidance; however, ultimately, consideration of the person in the context of their own psychosocial issues, comorbidities, and possible treatment strategies is vital in delivering optimal care. We aim to present a review of our own experience of delivering individualized care to this group of patients in order to close the existing health inequality gap.
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Affiliation(s)
- Shaista Hafeez
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK. .,The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Mausam Singhera
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.,Guy's and St Thomas' NHS Foundation Trust, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Robert Huddart
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.,The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
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50
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Affiliation(s)
- Pauline Heslop
- Pauline Heslop, Reader in Intellectual Disabilities Research, Matthew Hoghton, Anna Marriott, University of Bristol.
| | - Matthew Hoghton
- Pauline Heslop, Reader in Intellectual Disabilities Research, Matthew Hoghton, Anna Marriott, University of Bristol.
| | - Anna Marriott
- Pauline Heslop, Reader in Intellectual Disabilities Research, Matthew Hoghton, Anna Marriott, University of Bristol.
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