title: Assessment of an incentivised scheme to provide annual health checks in primary care for adults with intellectual disability: a longitudinal cohort study.
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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Targeted annual health checks for people with ID in primary care could reduce health inequities.
  
  
  BACKGROUND
  National Institute for Health Research.
authors.affiliation: 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.
authors.forename: Marta
authors.initials: M
authors.lastname: Buszewicz
authors.affiliation: Research Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Welch
authors.affiliation: Research Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, London, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Horsfall
authors.affiliation: Research Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, London, UK.
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Osborn
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Hassiotis
authors.affiliation: Learning Disabilities team, Public Health England, IPH, University Forvie Site, Cambridge, UK.
authors.forename: Gyles
authors.initials: G
authors.lastname: Glover
authors.affiliation: NHS East Lancashire Clinical Commissioning Group, Nelson, UK.
authors.forename: Umesh
authors.initials: U
authors.lastname: Chauhan
authors.affiliation: Clevedon Riverside Group, Clevedon, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hoghton
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors.forename: Sally-Ann
authors.initials: SA
authors.lastname: Cooper
authors.affiliation: South Staffordshire and Shropshire NHS Foundation Trust, St Georges Hospital, Stafford, UK.
authors.forename: Gwen
authors.initials: G
authors.lastname: Moulster
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: Rosalyn
authors.initials: R
authors.lastname: Hithersay
authors.affiliation: Research Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, London, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Hunter
authors.affiliation: Norah Fry Research Centre, University of Bristol, Bristol, UK.
authors.forename: Pauline
authors.initials: P
authors.lastname: Heslop
authors.affiliation: Barnet, Enfield and Haringey Mental Health Trust, Haringey Learning Disabilities Partnership, London, UK.
authors.forename: Ken
authors.initials: K
authors.lastname: Courtenay
authors.affiliation: Division of Psychiatry, University College London, London, UK.
authors.forename: André
authors.initials: A
authors.lastname: Strydom