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Comprehensive Health Assessments for adults with Intellectual Disability in Manitoba CCDDA, 2014.

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Presentation on theme: "Comprehensive Health Assessments for adults with Intellectual Disability in Manitoba CCDDA, 2014."— Presentation transcript:

1 Comprehensive Health Assessments for adults with Intellectual Disability in Manitoba CCDDA, 2014

2 Research Team Dr. Shahin Shooshtari, Faculty of Human Ecology Dr. Beverley Temple, College of Nursing Celeste Waldman, RA, MN Student, Nursing Sneha Abraham, Trainee, Community Health Sciences

3 Background O Research 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).

4 Your Expectations O 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?

5 Background O 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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7 Background O 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.

8 Background O The CHAP is a two-part booklet O The caregiver will complete the first part O The GP will complete the second part O 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).

9 Study Aim O To determine the feasibility of implementing the Comprehensive Health Assessment Program (CHAP) for adults with ID in the Province of Manitoba.

10 Study Method O Interviews with O General Practitioners (GPs) O Nurse Practitioners (NPs) O Frontline Support Workers O Family Members

11 Providers or Families O 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?

12 Providers or Families O Epilepsy? O Types of seizures O Drs. Seen for epilepsy O Allergies O Cause of Intellectual Disability O Human Relations – sexual activity? O Medications O Prescription O Over the counter

13 Providers or Families O Women’s health – menstrual cycles, contraception, etc O Pap smear, mammograms? O Men’s health – discharge from penis, undescended testes? O Problem Behaviours O Mental Health O Vision O Hearing

14 Providers or Families O Dental O Blood Pressure O Cigarettes O Alcohol O Thyroid, Vit D test, Bowel cancer tests O Activity and lifestyle – mobility changes, ?exercise, diet? O Immunizations O Personal Medical history – e.g. surgeries O Family History

15 Barriers and Facilitators O Ideas of barriers to completing the CHAP O Ways to facilitate use O What would you need to assist you to complete the 1 st part?

16 Barriers and Benefits From GPs and NPs, some initial ideas that have arisen include: Barriers Time Payment Benefits Assist practitioners to anticipate more diseases to provide better care Potential difficulty in completing the action plan – or follow-ups.

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18 Next Steps O 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.

19 Do you have questions? Are you ready to help improve the health of people you support?

20 References O 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), 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), 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), 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),


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