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Ailey SH, Molly B, Tichá R, Abery B, Khuu BK, Angel L. Health professionals' education related to people with intellectual and developmental disabilities: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13208. [PMID: 38382496 DOI: 10.1111/jar.13208] [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: 08/09/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND People with intellectual and developmental disabilities are among the most underserved in an inequitable healthcare system. METHODS Using Arksey and O'Malley's methodology and a social determinants of health framework, we conducted a scoping review of literature on the state of practice in education of healthcare professionals in the health and healthcare needs of this population. RESULTS Searches found 4948 articles, with 182 included in the final review. Themes identified included gaps of not being informed by workforce needs, continued use of the medical model of care, not addressing intersectionality with racial/ethnic and other discriminations, and lack of involvement of the population in developing/evaluating programs and promising trends of development of competency-based interprofessional programs with experiential learning. CONCLUSION We provide recommendations for best practices in a concerted effort to educate a healthcare workforce equipped with the knowledge and skills to address the health needs of this population.
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Affiliation(s)
- Sarah H Ailey
- Department of Community, Systems, and Mental Health Nursing, Rush University College of Nursing, Chicago, Illinois, USA
| | - Bathje Molly
- Occupational Therapy Program, DePaul University, College of Science and Health, Chicago, Illinois, USA
| | - Renáta Tichá
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota, USA
| | - Brian Abery
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota, USA
| | - Belle K Khuu
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lisa Angel
- Department of Community, Systems, and Mental Health Nursing, Rush University College of Nursing, Chicago, Illinois, USA
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Molnar C, Strnadová I, Dunn M, Loblinzk J, Sarfaraz S, Cathcart-King Y, Tso M, Danker J, Hayes S, Willow SA, Hansen J, Lim TQ, Boyle J, Terrill B, Scully JL, Palmer EE. The need for co-educators to drive a new model of inclusive, person-centred and respectful co-healthcare with people with intellectual disability. Front Psychiatry 2024; 15:1346423. [PMID: 38414506 PMCID: PMC10896908 DOI: 10.3389/fpsyt.2024.1346423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Affiliation(s)
- Chloe Molnar
- Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Iva Strnadová
- School of Education, University of New South Wales, Sydney, NSW, Australia
- Disability Innovation Institute, University of New South Wales, Sydney, NSW, Australia
- Self-Advocacy Sydney Inc., Sydney, NSW, Australia
| | - Manjekah Dunn
- Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Julie Loblinzk
- School of Education, University of New South Wales, Sydney, NSW, Australia
- Self-Advocacy Sydney Inc., Sydney, NSW, Australia
| | | | | | - Michelle Tso
- School of Education, University of New South Wales, Sydney, NSW, Australia
| | - Joanne Danker
- School of Education, University of New South Wales, Sydney, NSW, Australia
| | - Sarah Hayes
- School of Education, University of New South Wales, Sydney, NSW, Australia
| | | | - Jennifer Hansen
- School of Education, University of New South Wales, Sydney, NSW, Australia
| | - Tiffany Qing Lim
- School of Education, University of New South Wales, Sydney, NSW, Australia
| | - Jackie Boyle
- The New South Wales Genetics of Learning Disability (GOLD) Service, Waratah, NSW, Australia
| | - Bronwyn Terrill
- Australian Genomics, Melbourne, VIC, Australia
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Jackie Leach Scully
- Disability Innovation Institute, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Emma Palmer
- Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, NSW, Australia
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Guthrie E, Charon R. Disability and narrative medicine: Challenges and opportunities. Dev Med Child Neurol 2024; 66:149-154. [PMID: 37390126 DOI: 10.1111/dmcn.15685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 07/02/2023]
Abstract
Despite decades of international entreaties for improvement, education about and provision of healthcare for people with disabilities remains harmfully inferior to that of the non-disabled population. Many obstacles confound efforts to ameliorate this inequity, perhaps the most pernicious of which is negative bias on the part of providers. Narrative medicine offers a means to address healthcare attitudes towards people with disabilities, in particular negative attitudes based on 'ableism'. Through absorbing, writing, and sharing of diverse perspectives, narrative medicine kindles imagination and empathy, promoting self-reflection. This approach enriches the students' capacity to absorb what their patients are trying to say, and to appreciate, respect, and hopefully meet the healthcare needs of people with disability. WHAT THIS PAPER ADDS: Narrative medicine is a pedagogical tool to help providers listen and reflect on patients with disabilities.
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Affiliation(s)
- Elisabeth Guthrie
- New York State Psychiatric Institute, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Rita Charon
- Columbia University Irving Medical Center, New York, NY, USA
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Rinaldi R, Batselé E. "Is it my job?" An exploratory qualitative analysis of medical specialists' adaptation strategies when addressing the health needs of people with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:388-403. [PMID: 35503871 DOI: 10.1177/17446295221095706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Access to equal healthcare is a priority for people with intellectual disabilities. Most studies have focused on primary care providers; however, the administration of inclusive healthcare also relies on medical specialists, who should be considered a specific group because their practice varies significantly in this regard. Semi-directive interviews were conducted with 12 medical specialists to explore their representations regarding the care of people with intellectual disabilities. An inductive thematic analysis was applied to the data. The results highlighted a significant heterogeneity between practitioners' representations of people with intellectual disabilities in healthcare, current practices, and their perceptions and expectations in the process of ensuring quality care. This study highlights the importance of considering medical specialists' awareness raising and training to handle consultations with people with intellectual disabilities. From a broader perspective, a clear political framework to guide healthcare practices at the national level should be developed.
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Affiliation(s)
- Romina Rinaldi
- Université de Mons, Service d'Orthopédagogie Clinique, Mons, Belgium
| | - Elise Batselé
- Université de Mons, Service d'Orthopédagogie Clinique, Mons, Belgium
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Vi L, Jiwa MI, Lunsky Y, Thakur A. A systematic review of intellectual and developmental disability curriculum in international pre-graduate health professional education. BMC MEDICAL EDUCATION 2023; 23:329. [PMID: 37170246 PMCID: PMC10176941 DOI: 10.1186/s12909-023-04259-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/13/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Despite the increasing global population of individuals with intellectual and developmental disabilities (IDD), this population remains especially vulnerable to health disparities through several factors such as a lack of access to sufficient medical care and poor determinants of health. To add, numerous studies have shown that healthcare professionals are still insufficiently prepared to support this population of patients. This review synthesizes the literature on current pre-graduate IDD training programs across healthcare professions with the goal of informing the creation of evidence-based curricula. METHODS Four major databases were searched for current pre-graduate IDD training interventions for healthcare professionals. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram and the Best Evidence Medical Educations systematic review guide were used to frame our collection and analysis. RESULTS Of the 8601 studies screened, 32 studies were identified, with most studies involving medical students (50%). Of note, 35% of studies were interprofessional. Most interventions utilized multiple pedagogical methods with a majority including clinical experiences (63%) followed by theoretical teaching (59%). Kirkpatrick levels showed 9% were level 0, 6% were level 1, 31% were level 2A, 31% were level 2B, 19% were level 3, 3% were level 4A, and none were level 4B. CONCLUSIONS There is a paucity of formally evaluated studies in pre-graduate health professional IDD education. As well, there are a lack of longitudinal learning opportunities and integration into formal curriculum. Strengths identified were the use of multimodal approaches to teaching, including interprofessional approaches to optimize team competencies.
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Affiliation(s)
- Lisa Vi
- University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada.
| | - Muhammad Irfan Jiwa
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Yona Lunsky
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anupam Thakur
- University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Selick A, Durbin J, Hamdani Y, Rayner J, Lunsky Y. "Can you hear me now?": a qualitative exploration of communication quality in virtual primary care encounters for patients with intellectual and developmental disabilities. BMC PRIMARY CARE 2023; 24:105. [PMID: 37081380 PMCID: PMC10117251 DOI: 10.1186/s12875-023-02055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND High quality communication is central to effective primary care. The COVID-19 pandemic led to a dramatic increase in virtual care but little is known about how this may affect communication quality. Adults with intellectual and developmental disabilities (IDD) can experience challenges communicating or communicate in non-traditional ways. This study explored how the use of virtual modalities, including telephone and video, affects communication in primary care interactions for patients with IDD. METHODS This qualitative descriptive study included semi-structured interviews with a multi-stakeholder sample of 38 participants, including 11 adults with IDD, 13 family caregivers, 5 IDD support staff and 9 primary care physicians. Interviews were conducted in Ontario, Canada between March and November 2021 by video-conference or telephone. A mixed inductive and deductive thematic analysis approach was used to code the data and identify themes. Themes were reviewed and refined with members of each stakeholder group. RESULTS Four elements of communication were identified that were affected by virtual care: (1) patient engagement in the virtual appointment; (2) the ability to hear other participants and have the time and space to be heard; (3) the ability to use nonverbal communication strategies; and (4) the ability to form trusting relationships. In some cases, the virtual platform hindered these elements of communication. Video offered some advantages over telephone to support nonverbal communication, and stimulate engagement; though this could be limited by technical challenges. For adults with IDD who find it difficult to attend in-person appointments, virtual care improved communication quality by allowing them to participate from a space where they were comfortable. CONCLUSION Though there are circumstances in which virtual delivery can improve communication for patients with IDD, there are also challenges to achieving high quality patient-provider communication over telephone and video. Improved infrastructure and training for providers, patients and caregivers can help improve communication quality, though in some cases it may never be appropriate. A flexible patient-centred approach is needed that includes in-person, telephone and video options for care.
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Affiliation(s)
- Avra Selick
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Janet Durbin
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yani Hamdani
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer Rayner
- Centre for Studies in Family Medicine, Western University, London, ON, Canada
- Department of Research and Evaluation, Alliance for Healthier Communities, Toronto, ON, Canada
| | - Yona Lunsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Campbell EG, Rao SR, Ressalam J, Bolcic-Jankovic D, Lawrence R, Moore JM, Iezzoni LI. Caring for Adults With Significant Levels of Intellectual Disability in Outpatient Settings: Results of a National Survey of Physicians. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 128:36-48. [PMID: 36548375 DOI: 10.1352/1944-7558-128.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/15/2022] [Indexed: 06/17/2023]
Abstract
Between 1% and 2% of the U.S. population has an intellectual disability (ID) and often experience disparities in health care. Communication patterns and sedation use for routine medical procedures are important aspects of care for this population. We explored physicians' communication patterns and sedation use in caring for patients with significant levels of ID through a mailed survey of 1,400 physicians among seven specialties in outpatient settings (response rate = 61.0%). Among physicians who saw at least one patient with significant levels of ID in an average month, 74.8% reported usually/always communicating primarily with someone other than the patient. Among specialists, 85.5% (95% CI: 80.5%-90.5%) reported doing so, compared to 69.9% (95% CI: 64.4%-75.4%) for primary care physicians (p < 0.001). Also, 11.4% reported sedating at least one patient with significant levels of ID for a routine procedure. Three quarters of physicians reported communicating primarily with persons other than the patient usually or always-an approach that, in some instances, may not align with best medical practice. The percentage of physicians who report sedating at least one individual is associated with significant ID and the physician's volume of patients with significant ID.
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Affiliation(s)
| | - Sowmya R Rao
- Sowmya R. Rao, Massachusetts General Hospital Biostatistics Center and Boston University School of Public Health
| | - Julie Ressalam
- Julie Ressalam, University of Colorado School of Medicine
| | | | - Rosa Lawrence
- Rosa Lawrence, University of Colorado School of Medicine
| | - Jaime M Moore
- Jaime M. Moore, University of Colorado School of Medicine
| | - Lisa I Iezzoni
- Lisa I. Iezzoni, Massachusetts General Hospital and Harvard Medical School
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Breuer MEJ, Bakker-van Gijssel EJ, Vlot-van Anrooij K, Tobi H, Leusink GL, Naaldenberg J. Exploring views on medical care for people with intellectual disabilities: an international concept mapping study. Int J Equity Health 2022; 21:99. [PMID: 35854317 PMCID: PMC9295354 DOI: 10.1186/s12939-022-01700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background Medical care for people with intellectual and developmental disabilities (IDD) is organized differently across the globe and interpretation of the concept of medical care for people with IDD may vary across countries. Existing models of medical care are not tailored to the specific medical care needs of people with IDD. This study aims to provide an improved understanding of which aspects constitute medical care for people with IDD by exploring how international researchers and practitioners describe this care, using concept mapping. Methods Twenty-five experts (researchers and practitioners) on medical care for people with IDD from 17 countries submitted statements on medical care in their country in a brainstorming session, using an online concept mapping tool. Next, they sorted all collected statements and rated them on importance. Results Participants generated statements that reflect current medical and health care practice, their ideas on good practice, and aspirations for future medical and health care for people with IDD. Based on the sorting of all statements, a concept map was formed, covering 13 aspects that characterize medical and health care for people with IDD across nations. The 13 aspects varied minimally in importance ratings and were grouped into five overarching conceptual themes: (i) active patient role, (ii) provider role, (iii) context of care, (iv) consequences of care for people with IDD, and (v) quality of care. Conclusions The themes, clusters and statements identified through this explorative study provide additional content and context for the specific patient group of people with IDD to the dimensions of previous models of medical care. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01700-w.
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Affiliation(s)
- Marian E J Breuer
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, The Netherlands.
| | - Esther J Bakker-van Gijssel
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, The Netherlands
| | - Kristel Vlot-van Anrooij
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, The Netherlands
| | - Hilde Tobi
- Biometrics, Wageningen University & Research, Wageningen, The Netherlands
| | - Geraline L Leusink
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, The Netherlands
| | - Jenneken Naaldenberg
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, The Netherlands
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Affiliation(s)
- Simone Reppermund
- The Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Adrian R Walker
- The Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia
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