Marta Buszewicz1, Catherine Welch2, Laura Horsfall2, Irwin Nazareth2, David Osborn3, Angela Hassiotis3, Gyles Glover4, Umesh Chauhan5, Matthew Hoghton6, Sally-Ann Cooper7, Gwen Moulster8, Rosalyn Hithersay3, Rachael Hunter2, Pauline Heslop9, Ken Courtenay10, André Strydom3. 1. Research Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, London, UK. Electronic address: m.buszewicz@ucl.ac.uk. 2. Research Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, London, UK. 3. Division of Psychiatry, University College London, London, UK. 4. Learning Disabilities team, Public Health England, IPH, University Forvie Site, Cambridge, UK. 5. NHS East Lancashire Clinical Commissioning Group, Nelson, UK. 6. Clevedon Riverside Group, Clevedon, UK. 7. Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. 8. South Staffordshire and Shropshire NHS Foundation Trust, St Georges Hospital, Stafford, UK. 9. Norah Fry Research Centre, University of Bristol, Bristol, UK. 10. Barnet, Enfield and Haringey Mental Health Trust, Haringey Learning Disabilities Partnership, London, UK.
Abstract
BACKGROUND: People with intellectual disabilities (ID) have many comorbidities but experience inequities in access to health care. National Health Service England uses an opt-in incentive scheme to encourage annual health checks of patients with ID in primary care. We investigated whether the first 3 years of the programme had improved health care of people with ID. METHODS: We did a longitudinal cohort study that used data from The Health Improvement Network primary care database. We did multivariate logistic regression to assess associations between various characteristics and whether or not practices had opted in to the incentivised scheme. FINDINGS: We assessed data for 8692 patients from 222 incentivised practices and those for 918 patients in 48 non-incentivised practices. More blood tests (eg, total cholesterol, odds ratio [OR] 1·88, 95% CI 1·47-2·41, p<0·0001) general health measurements (eg, smoking status, 6·0, 4·10-8·79, p<0·0001), specific health assessments (eg, hearing, 24·0, 11·5-49·9, p<0·0001), and medication reviews (2·23, 1·68-2·97, p<0·0001) were done in incentivised than in non-incentivised practices, and more health action plans (6·15, 1·41-26·9, p=0·0156) and secondary care referrals (1·47, 1·05-2·05, p=0·0256) were made. Identification rates were higher in incentivised practices for thyroid disorder (OR 2·72, 95% CI 1·09-6·81, p=0·0323), gastrointestinal disorders (1·94, 1·03-3·65, p=0·0390), and obesity (2·49, 1·76-3·53, p<0·0001). INTERPRETATION: Targeted annual health checks for people with ID in primary care could reduce health inequities. FUNDING: National Institute for Health Research.
BACKGROUND:People with intellectual disabilities (ID) have many comorbidities but experience inequities in access to health care. National Health Service England uses an opt-in incentive scheme to encourage annual health checks of patients with ID in primary care. We investigated whether the first 3 years of the programme had improved health care of people with ID. METHODS: We did a longitudinal cohort study that used data from The Health Improvement Network primary care database. We did multivariate logistic regression to assess associations between various characteristics and whether or not practices had opted in to the incentivised scheme. FINDINGS: We assessed data for 8692 patients from 222 incentivised practices and those for 918 patients in 48 non-incentivised practices. More blood tests (eg, total cholesterol, odds ratio [OR] 1·88, 95% CI 1·47-2·41, p<0·0001) general health measurements (eg, smoking status, 6·0, 4·10-8·79, p<0·0001), specific health assessments (eg, hearing, 24·0, 11·5-49·9, p<0·0001), and medication reviews (2·23, 1·68-2·97, p<0·0001) were done in incentivised than in non-incentivised practices, and more health action plans (6·15, 1·41-26·9, p=0·0156) and secondary care referrals (1·47, 1·05-2·05, p=0·0256) were made. Identification rates were higher in incentivised practices for thyroid disorder (OR 2·72, 95% CI 1·09-6·81, p=0·0323), gastrointestinal disorders (1·94, 1·03-3·65, p=0·0390), and obesity (2·49, 1·76-3·53, p<0·0001). INTERPRETATION: Targeted annual health checks for people with ID in primary care could reduce health inequities. FUNDING: National Institute for Health Research.
Authors: Fay J Hosking; Iain M Carey; Stephen DeWilde; Tess Harris; Carole Beighton; Derek G Cook Journal: Ann Fam Med Date: 2017-09 Impact factor: 5.166
Authors: Iain M Carey; Fay J Hosking; Tess Harris; Stephen DeWilde; Carole Beighton; Sunil M Shah; Derek G Cook Journal: J Epidemiol Community Health Date: 2016-06-16 Impact factor: 3.710