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Organising health care services for persons with an intellectual disabilityBalogh R, Ouellette-Kuntz H, Bourne L, Lunsky Y, Colantonio A
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SummaryOrganising health care services for persons with an intellectual disabilityPersons with an intellectual disability experience frequent health problems but they have more difficulty finding and getting health services compared to the general population. This review included eight studies and examined the effects of organisational interventions. These are used to change the structure or delivery of health care services and may prove useful to improve the health outcomes of persons with an intellectual disability. The review found that multidisciplinary teams providing intensive services for persons with an intellectual disability and an mental health problem could lead to improved mental health outcomes; but, results from a study done in one country could not necessarily be applied to the situation in other countries.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 08. 2008 AbstractBackgroundWhen compared to the general population, persons with an intellectual disability have lower life expectancy, higher morbidity, higher rates of unmet health needs, and more difficulty finding and getting health care. Organisational interventions are used to reconfigure the structure or delivery of health care services and may prove useful to decrease the noted disparities.
ObjectivesTo assess the effects of organisational interventions for the mental and physical health problems of persons with an intellectual disability. Search strategyWe searched the Cochrane Effective Practice and Organisation of Care Group specialised register (no year restriction), MEDLINE, EMBASE, CINAHL, other databases from January 1990 to April 2006 reference lists of included studies, and we consulted experts in the field. Selection criteriaRandomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of organisational interventions aimed at improving care of mental and physical health problems of adult persons with an intellectual disability. Data collection and analysisTwo review authors independently extracted data and assessed study quality. Missing data were requested from authors of included studies. Main resultsEight studies met the selection criteria: six were randomised controlled trials, one was a controlled before and after study, and one was an interrupted time series. In general the studies were of acceptable methodological quality. The included studies investigated interventions dealing with the mental health problems of persons with an intellectual disability, none focused on physical health problems. Three of the studies identified effective organisational interventions and five showed no evidence of effect. Only two studies were similar enough to analyse using a meta-analysis. In the pooled analyses 25 participants received assertive community treatment and 25 received standard community treatment. Results from measures of function, caregiver burden and quality of life were non-significant. Authors' conclusionsThere 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. |
