title: Organising healthcare services for persons with an intellectual disability.
abstract: BACKGROUND
  When compared to the general population, persons with an intellectual disability have lower life expectancy, higher morbidity, and more difficulty finding and obtaining healthcare. Organisational interventions are used to reconfigure the structure or delivery of healthcare services. This is the first update of the original review.
  
  
  OBJECTIVE
  To assess the effects of organisational interventions of healthcare services for the mental and physical health problems of persons with an intellectual disability.
  
  
  METHODS
  For this update we searched CENTRAL, MEDLINE, EMBASE, CINAHL and other databases, from April 2006 to 4 September 2015. We checked reference lists of included studies and consulted experts in the field.
  
  
  METHODS
  Randomised controlled trials of organisational interventions of healthcare services aimed at improving care of mental and physical health problems of adult persons with an intellectual disability.
  
  
  METHODS
  We employed standard methodological procedures as outlined in the Cochrane Handbook of Systematic Reviews of Interventions, in addition to specific guidance from the Cochrane Effective Practice and Organisation of Care (EPOC) Group.
  
  
  RESULTS
  We identified one new trial from the updated searches.Seven trials (347 participants) met the selection criteria. The interventions varied but had common components: interventions that increased the intensity and frequency of service delivery (4 trials, 200 participants), community-based specialist behaviour therapy (1 trial, 63 participants), and outreach treatment (1 trial, 50 participants). Another trial compared two active arms (traditional counselling and integrated intervention for bereavement, 34 participants).The included studies investigated interventions dealing with the mental health problems of persons with an intellectual disability; none focused on physical health problems. Four studies assessed the effect of organisational interventions on behavioural problems for persons with an intellectual disability, three assessed care giver burden, and three assessed the costs associated with the interventions. None of the included studies reported data on the effect of organisational interventions on adverse events. Most studies were assessed as having low risk of bias.It is uncertain whether interventions that increase the frequency and intensity of delivery or outreach treatment decrease behavioural problems for persons with an intellectual disability (two and one trials respectively, very low certainty evidence). Behavioural problems were slightly decreased by community-based specialist behavioural therapy (one trial, low certainty evidence). Increasing the frequency and intensity of service delivery probably makes little or no difference to care giver burden (MD 0.03, 95% CI -3.48 to 3.54, two trials, moderate certainty evidence). It is uncertain whether outreach treatment makes any difference for care giver burden (one trial, very low certainty evidence). There was very limited evidence regarding costs, with low to very low certainty evidence for the different interventions.
  
  
  CONCLUSIONS
  There is very limited evidence on the organisation of healthcare services for persons with an intellectual disability. There are currently no well-designed studies focusing on organising the health services of persons with an intellectual disability and concurrent physical problems. There are very few studies of organisational interventions targeting mental health needs and the results of those that were found need corroboration. There is an urgent need for high-quality health services research to identify optimal health services for persons with an intellectual disability and concurrent physical problem.
authors.affiliation: Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street North, Oshawa, ON, Canada, L1H 7K4.
authors.forename: Robert
authors.initials: R
authors.lastname: Balogh
authors.forename: Carly A
authors.initials: CA
authors.lastname: McMorris
authors.forename: Yona
authors.initials: Y
authors.lastname: Lunsky
authors.forename: Helene
authors.initials: H
authors.lastname: Ouellette-Kuntz
authors.forename: Laurie
authors.initials: L
authors.lastname: Bourne
authors.forename: Angela
authors.initials: A
authors.lastname: Colantonio
authors.forename: Daniela C
authors.initials: DC
authors.lastname: Gonçalves-Bradley
mesh_terms: D066086:Health Services for Persons with Disabilities / Q000458:organization & administration*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D019989:Persons with Intellectual Disabilities; D016032:Randomized Controlled Trials as Topic