comprehensive health assessments for adults with intellectual disability in manitoba
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Comprehensive Health Assessments for adults with Intellectual Disability in Manitoba. CCDDA, 2014. Research Team. Dr. Shahin Shooshtari , Faculty of Human Ecology Dr . Beverley Temple , College of Nursing Celeste Waldman, RA, MN Student, Nursing - PowerPoint PPT PresentationTRANSCRIPT
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Comprehensive Health Assessments for adults with
Intellectual Disability in Manitoba
CCDDA, 2014
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Research TeamDr. Shahin Shooshtari, Faculty of Human
Ecology Dr. Beverley Temple, College of Nursing
Celeste Waldman, RA, MN Student, Nursing
Sneha Abraham, Trainee, Community Health Sciences
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BackgroundOResearch from Canada and abroad
shows that:O Significant health disparities exist between
persons with and without ID (see Ouellette-Kuntz et al., 2005, for a comprehensive review).
O Despite poorer health and higher health-care needs, persons with ID experience more difficulty accessing proper health care than the general population [e.g., Janicki et al., 2002; Krahn, et al., 2006; Bigby, 1998; Robertson et al., 2011).
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Your ExpectationsO How many of you have had an annual health
check/physical?
O Why do you have those ?
O What do you expect to accomplish by having a physical?
O What kinds of screening have you had? O Cancer checks – such as stool, colonoscopy, pap
tests, prostate checks, mammography?O Eye, hearing, dental?
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BackgroundO Different strategies have been
suggested to reduce health disparities for persons with ID. For example: Comprehensive health assessments
O The CHAP, an Australian-developed tool, was designed to help minimize the barriers to access primary health care for persons with ID by prompting comprehensive health reviews.
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BackgroundO The effectiveness of the CHAP was
established through well-designed studies [RCT; 450+ participants] (Lennox et al., 2007). O increased health promotion, disease prevention,
and case-finding activity in the intervention group, who received comprehensive health assessment based on the CHAP.
O 30-fold increase in hearing testing; 9-fold increase in rates of immunization; 8-fold increase in women’s health screening, and increased detection of new disease (e.g., diabetes, heart disease) by 1.6 times.
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BackgroundO The CHAP is a two-part booklet O The caregiver will complete the first partO The GP will complete the second partO A list of conditions which are usually
unrecognized or poorly managed in populations with ID (Page 15).
O A chart of syndrome-specific comorbidity, which has proven useful for GPs (Page s 22-23).
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Study AimO To determine the feasibility of
implementing the Comprehensive Health Assessment Program (CHAP) for adults with ID in the Province of Manitoba.
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Study MethodOInterviews with
O General Practitioners (GPs)O Nurse Practitioners (NPs)O Frontline Support Workers O Family Members
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Providers or FamiliesO Question areas include:
O Breathing system – e.g does the person cough?O Heart system – do they have chest pain? Ankles
swell?O Muscles and joints – do they have joint/back
pain?O Stomach and bowel – Lost weight, trouble
swallowing?O Urinary system – Pain when passing urine? Any
blood in urine?O Nervous system – are they unsteady on their
feet when walking?
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Providers or FamiliesO Epilepsy?
O Types of seizuresO Drs. Seen for epilepsy
O AllergiesO Cause of Intellectual DisabilityO Human Relations – sexual activity?O Medications
O PrescriptionO Over the counter
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Providers or FamiliesO Women’s health – menstrual cycles,
contraception, etcO Pap smear, mammograms?O Men’s health – discharge from penis,
undescended testes?O Problem BehavioursO Mental HealthO VisionO Hearing
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Providers or FamiliesO DentalO Blood PressureO CigarettesO AlcoholO Thyroid, Vit D test, Bowel cancer testsO Activity and lifestyle – mobility changes, ?
exercise, diet?O Immunizations O Personal Medical history – e.g. surgeriesO Family History
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Barriers and Facilitators
O Ideas of barriers to completing the CHAP
OWays to facilitate useO What would you need to assist
you to complete the 1st part?
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Barriers and BenefitsFrom GPs and NPs, some initial ideas that have arisen include:Barriers• Time • PaymentBenefits• Assist practitioners to anticipate more
diseases to provide better care• Potential difficulty in completing the
action plan – or follow-ups.
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Next StepsO We are organizing the ideas from all of the
interviews from Nurse Practitioners, and GPs O We will be recruiting family members and
direct support workers to discuss their ideas of using the CHAP
O Plan to meet with government to discuss reimbursement of GPs who would be willing to do the assessments
O Need to develop ways to measure success – improved health of people with ID if we have CHAP done.
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Do you have questions?
Are you ready to help improve the health of people you support?
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ReferencesO Bigby, C. (1998). Shifting responsibilities: The patterns of formal service use by
older people with intellectual disability in Victoria. Journal of Intellectual and Developmental Disability, 23(3), 97-109.
O Janicki, M., McCallions, P., & Dalton, A. (2002). Dementia-related care decision-making in group homes for persons with intellectual disabilities. Journal of Gerontological Social Work, 38(1/2), 179-195.
O Krahn, G., Hammond, L., & Turner, A. (2006). A cascade of disparities: health and health care access for people with intellectual disabilities. Mental Retardation and Developmental Disabilities Research Reviews,
O Lennox, N., Bain, C., Rey-Conde, T., Purdie, D., Bush, R., Pandeya, N. (2007). Effects of a comprehensive health assessment programme for Australian adults with intellectual disability: a cluster randomized trial. International Journal of Epidemiology, 36(1), 139-140.
O Ouellette-Kuntz, H., Garcin, N., Lewis, M., Minnes, P., Martin, C., Holden, J. (2005). Addressing health disparities through promoting equity for individuals with intellectual disability. Canadian Journal of Public Health, 96 (S2), S8-S22.
O Robertson, J., Roberts, H,. Emerson, E., Turner, S., Greig, R. (2011). The impact of health checks for people with intellectual disabilities: a systematic review of evidence. Journal of Intellectual Disability Research, 55(11), 1009-1019.