Effects of a comprehensive health assessment programme for Australian adults with intellectual disability: a cluster randomized trial.
BACKGROUND
People with intellectual disability constitute approximately 2% of the population. They die prematurely, and often have a number of unrecognized or poorly managed medical conditions as well as inadequate health promotion and disease prevention.


METHODS
A cluster randomized controlled trial with matched pairs was carried out. The participants were adults with intellectual disability (n = 453 in 34 clusters). The intervention was a health assessment programme to enhance interactions between the adult with intellectual disability, their carer and their general practitioner (GP). It prompted the systematic gathering of a health history and, subsequently, access to a GP for a guided health review and development of a health action plan. It also provided information about the health of adults with intellectual disability. Follow-up was for 1 year post intervention, with outcomes extracted from GPs' clinical records.


RESULTS
Increased health promotion, disease prevention and case-finding activity was found in the intervention group. Compared with the control group there was a 6.6-fold increase in detection of vision impairment (95% confidence interval 1.9-40); a 30-fold increase in hearing testing (4.0-230); an increase in immunization updates [tetanus/diphtheria a 9-fold increase (4.2-19)], and improvements in women's health screening [Papanicolau smears were eight times more common (1.8-35)]. The intervention increased detection of new disease by 1.6 times (0.9-2.8).


CONCLUSIONS
The Comprehensive Health Assessment Program (CHAP) produced a substantial increase in GPs' attention to the health needs of adults with intellectual disability with concomitantly more disease detection. The presumption that these will yield longer-term health benefits, while suggestive, remains unexamined.
Lennox
Nicholas
N
Queensland Centre for Intellectual & Developmental Disability (QCIDD), School of Medicine, University of Queensland, Mater Hospitals, Raymond Terrace, South Brisbane 4101, Australia. n.lennox@uq.edu.au
Bain
Christopher
C
Rey-Conde
Therese
T
Purdie
David
D
Bush
Robert
R
Pandeya
Nirmala
N
D000328:Adult; D000368:Aged; D015982:Bias; D003191:Comprehensive Health Care / Q000379:methods; D003695:Delivery of Health Care / Q000379:methods; D003933:Diagnosis; D004185:Disability Evaluation; D005194:Family Practice / Q000379:methods; D005260:Female; D006293:Health Promotion / Q000379:methods; D006304:Health Status; D006801:Humans; D007114:Immunization / Q000379:methods; D007360:Intelligence; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology*; D008875:Middle Aged; D011314:Preventive Health Services / Q000379:methods; D011793:Queensland / Q000453:epidemiology; D017678:Sex Distribution