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Rapid Responses: Rapid Responses published:
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Local innovation in tackling health inequalities in intellectual disability
- Meraj Tajuddin, Nicola Carley, ST4 trainee in psychiatry of intellectual disability (1 April 2008)
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Local innovation in tackling health inequalities in intellectual disability - correct postcode for author
- Trish Groves (2 April 2008)
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General Practice remains the key to improving the health of people with intellectual disabilities
- Nicholas G Lennox, Miriam Taylor (8 April 2008)
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Meraj Tajuddin, Consultant Psychiatrist in Intellectual Disability Earls House Hospital, Durham, DH1 4FH, Nicola Carley, ST4 trainee in psychiatry of intellectual disability
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We would like to respond to this very pertinent editorial by Ali and Hassiotis and their appeal for better communication and liaison between primary care, secondary care and intellectual disability services. Our innovative local practice has been helpful in raising awareness and, we hope, in tackling physical health inequalities in intellectual disability. Dr Tajuddin has already given interactive presentations on intellectual disability to several dentists, general practices and clinical pharmacists. Attendance at these lectures is now mandatory for all consultants (over 300) providing acute hospital care in the County Durham and Darlington NHS Foundation Trust, as part of the trust's training programme that includes education on the Mental Capacity Act. The main aim is to improve understanding about intellectual disability and the quality of physical healthcare to people with an intellectual disability, in keeping with Mencap's reports "Death by Indifference" (2007) and Valuing People Now (2007). These interactive presentations discuss evidence from the Disability Rights Commission and Mencap, with emphasis on the importance of respecting human rights and ensuring good communication with the NHS service user, parents, other relatives, and carers. This project has been delivered with a community nurse in intellectual disability and trainees in the psychiatry of intellectual disability, including Dr Carley. On one occasion a presentation was supported by a service user with complex psychiatric problems briefly describing his troublesome journey through NHS physical care services following a road traffic accident. The feedback continues to improve, and the future plan is to deliver workshops on physical health inequalities to all the ward staff who have service users with an intellectual disability. Although this a local project, Dr Tajuddin has also been invited to speak to all adult psychiatrists in the Leicestershire NHS Partnership Trust at their trust wide postgraduate meeting. The future plan is to present this very important topic to all the Royal Colleges, as all doctors come across human beings with intellectual disabilities and should be aware of respecting such patients' human rights. Competing interests: None declared |
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Trish Groves, Deputy editor BMJ
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Dr Tajuddin, author of the previous rapid response, has asked us to give his correct postcode. It is DH1 5RD. Competing interests: None declared |
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Nicholas G Lennox, Associate Professor, Doctor QCIDD, University of Queensland Australia, 4101, Miriam Taylor
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The authors are correct to draw our attention to the state of poor health of people with intellectual disabilities. This population die prematurely, has five or more unrecognized or poorly managed medical conditions and they receive inadequate, if at all any attention to disease prevention 1. The authors have demonstrated how service responses remain sorely deficient, with as shown, sometimes fatal consequences. However, we believe that general practitioners remain the key to improving the health of people with intellectual disabilities in parallel to securing improvements in medical training, policy and financial support, and in the use of effective health assessments. The QCIDD (Queensland Centre for Intellectual and Developmental Disability) randomized controlled trial (RCT) of the use of the Comprehensive Health Assessment Programme (CHAP) in general practice shows clear health benefits for adults with intellectual disabilities 2. The CHAP encourages general practice-driven activities, including increases in health promotion, disease prevention and case-finding activities, as well as the appropriate management of previously unmet health needs. General practitioners using the CHAP have shown significant increases in the identification of hearing and vision impairment, attention to immunization status, identification and management of obesity, implementation of women’s health screening and detection of new diseases in their patients with intellectual disabilities. The CHAP is only an intermediary step towards better health for people with intellectual disabilities. After many years of lobbying, the CHAP has been accompanied by the recent establishment of financial incentives via Medicare Australia for annual health assessments of people with intellectual disabilities. The new health assessment process via Medicare Australia promotes better diagnosis, treatment and health promotion for people with intellectual disabilities, and together with the Comprehensive Health Assessment Programme (CHAP) places the General Practitioner at the heart of health care for this needy population 2. References: 1. Krahn G, Hammond L, Turner A. A cascade of disparities: Health and health care access for people with intellectual disabilities. Mental Retardation and Developmental Disabilities Research Reviews 2006;12(1):70- 82. 2. Lennox N, Bain C, Rey-Conde T, Purdie D, Bush R, Pandeya N. Effects of a comprehensive health assessment programme for Australian adults with intellectual disability: a cluster randomized trial. International Journal of Epidemiology 2007;36(1):139-146. Competing interests: None declared |
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