People with an intellectual disability (ID) have more complex and different patterns of health care needs than the general population. They experience a greater burden of multi-morbidity, high levels of undetected and unmanaged health issues, and premature mortality than the general population. Primary care has a key role in the health care of people with an ID. Currently, very little is known about the consultation type and length, problems managed, and how general practitioners (GPs) manage these problems for people with an ID compared with the general population. This information would provide valuable insights into how GPs are achieving the health guidelines and facilitating people with an ID to achieve the highest attainable standard of health.
A secondary analysis of data was collected from January 2003 to December 2012 from the Bettering the Evaluation and Care of Health (BEACH) programme. Consultation type, consultation length in minutes, problem(s) managed during the consultation, medications, treatments provided, and referrals made, pre and post age–sex standardisation, at all GP encounters with people identified in the encounter record as having an ID (‘ID’ encounters, n = 690) were compared with those at ‘non-ID’ encounters (n = 970 641). Statistical significance was tested with 95% confidence intervals.
This study identified significant differences in consultation types, consultation length, problem(s) managed during the consultation, medications, treatments provided, and referrals made at ‘ID’ encounters compared with ‘non-ID’ encounters. ‘ID’ encounters had more indirect encounters, longer consultations, more problems managed, but an under management of common health conditions in people with an ID. Administrative rather than medically related actions dominated clinical treatments for people at ‘ID’ encounters, and they received fewer procedural treatments, referrals to specialists, and medications compared with those at ‘non-ID’ encounters.
The significant differences in consultations, problems identified and managed suggest that GPs may require additional support to (1) identify and manage common medical conditions experienced by people with an ID; (2) manage the increased time required for consultations; and (3) directly consult with people with an ID. Further research is required to determine why GPs managed problems in a significantly different way for people with an ID.
On a Friday afternoon in July 2009, President Obama gave remarks in the East Room of the White House about the signing of an international human rights treaty to protect the rights of people with disabilities.
“Disability rights aren’t just civil rights to be enforced here at home; they’re universal rights to be recognized and promoted around the world,” Obama said. “And that’s why I’m proud to announce that next week, the United States of America will join 140 other nations in signing the United Nations Convention on the Rights of Persons with Disabilities, the first new human rights convention of the 21st century.”
The treaty, known as CRPD, was inspired by U.S. leadership on disability rights and is modeled after the Americans with Disabilities Act (ADA) of 1990, which protects individuals with disabilities against discrimination in areas such as employment, public accommodations, and transportation.
“This extraordinary treaty calls on all nations to guarantee rights like those afforded under the ADA. It urges equal protection and equal benefits before the law for all citizens; reaffirms the inherent dignity and worth and independence of all persons with disabilities worldwide,” Obama said.
CRPD opened for signature 10 years ago today — and as the committee that monitors CRPD implementation meets in Geneva right now to consider reports from eight countries, it’s a good reminder that the United States isn’t one of them. Despite Obama’s signature nearly eight years ago, the treaty — ratified by 172 countries — still awaits U.S. Senate ratification.
In December 2012, a Senate vote (61–38) fell five votes short of the two-thirds majority required to adopt an international treaty. In July 2014, the Senate Foreign Relations Committee advanced the treaty (12–6) — but the full Senate never took a vote.
At a time when the United States has a president who mocked (while campaigning) a reporter with a disability, when the U.S. Secretary of Education is a threat to children with disabilities, and when the current U.S. Supreme Court nominee has repeatedly ruled against students with disabilities and who’s demonstrated a troubling approach to the rights of people with disabilities, it’s easy to feel discouraged about the state (and future) of disability rights.
But ratifying CRPD represents an opportunity to take bipartisan action and stand with the rest of the world in advancing the civil and human rights of people with disabilities everywhere. And it’s an opportunity to continue our nation’s tradition of advancing important human rights protections, as we did with the Rehabilitation Act, the Individuals with Disabilities Education Act, the ADA, and the ADA Amendments Act of 2008 — all signed by Republican presidents.
Disability rights are civil and human rights. Now, a decade after the treaty opened for signature, it’s time to finally make a global commitment to protecting disability rights by ratifying it.