Sally-Ann Cooper, Laura Hughes-McCormack, Nicola Greenlaw, Alex McConnachie, Linda Allan, Marion Baltzer, Laura McArthur, Angela Henderson, Craig Melville, Paula McSkimming, Jill Morrison First published: 20 July 2017
Background In the UK, general practitioners/family physicians receive pay for performance on management of long-term conditions, according to best-practice indicators.
Method Management of long-term conditions was compared between 721 adults with intellectual disabilities and the general population (n = 764,672). Prevalence of long-term conditions was determined, and associated factors were investigated via logistic regression analyses.
Results Adults with intellectual disabilities received significantly poorer management of all long-term conditions on 38/57 (66.7%) indicators. Achievement was high (75.1%–100%) for only 19.6% of adults with intellectual disabilities, compared with 76.8% of the general population. Adults with intellectual disabilities had higher rates of epilepsy, psychosis, hypothyroidism, asthma, diabetes and heart failure. There were no clear associations with neighbourhood deprivation.
Conclusions Adults with intellectual disabilities receive poorer care, despite conditions being more prevalent. The imperative now is to find practical, implementable means of supporting the challenges that general practices face in delivering equitable care.
Background Transition to adulthood might be a risk period for poor health in people with intellectual disabilities. However, the present authors could find no synthesis of evidence on health and well-being outcomes during transition in this population. This review aimed to answer this question. MethodPRISMA/MOOSE guidelines were followed. Search terms were defined, electronic searches of six databases were conducted, reference lists and key journals were reviewed, and grey literature was searched. Papers were selected based on clear inclusion criteria. Data were extracted from the selected papers, and their quality was systematically reviewed. The review was prospectively registered on PROSPERO: CRD42015016905. Results A total of 15 985 articles were extracted; of these, 17 met the inclusion criteria. The results of these articles were mixed but suggested the presence of some health and well-being issues in this population during transition to adulthood, including obesity and sexual health issues. Conclusion This review reveals a gap in the literature on transition and health and points to the need for future work in this area.
I was born profoundly deaf in both ears, which means I could only hear sound above 95 decibels. Without hearing aids, I could hear extremely loud sounds, such as a plane taking off or a train going by, only if I was near them. With hearing aids, I could hear sound at 40 decibels and up, so I could understand one-on-one conversations as long as there was no background noise, the person didn’t mumble and I could see his or her mouth clearly.
Before starting medical school, I got a cochlear implant, which helps me hear so much more than I could before. When I listen to music now, I can hear all the different sounds rather than one static sound, and it’s much easier to differentiate between the instruments. Understanding speech has also become much easier. I now communicate orally with hearing people and via sign language with deaf people. However, I am still deaf, and there are still times when I am unable to understand what people are saying, such as group settings where there’s a lot of ambient noise.
I chose osteopathic medicine because I heard from many patients who spoke highly of DOs, and the osteopathic philosophy resonated with me as well. I strongly believe in treating the person as a whole and that lifestyle factors can dramatically affect a person’s health. Ultimately, I hope to become an obstetrician-gynecologist. I’d like my practice to include caring for deaf patients—some deaf people have very little health literacy due to communication barriers growing up, which is something I hope to combat.
Culture and communication
Growing up as a deaf person has given me insights I hope to incorporate in my future practice as a physician. The first is the importance of maintaining eye contact during conversations. That’s not only because it helps me lip-read and understand what’s being said; eye contact shows that you are truly listening to the other person. It shows respect.
Secondly, because of growing up in the deaf culture, I’m very aware that all cultures are different. Physicians may not encounter deaf patients frequently, but they will definitely care for patients who have special needs when receiving medical care, such as a disability or an interpreter if English isn’t their primary language. As a patient, I’ve learned that I need to speak up about my needs, because sometimes people just are not aware. As a physician, I’ll know to ask patients what they need.
Tips for physicians
Physicians should keep in mind that American Sign Language is its own language, so written English doesn’t automatically translate to ASL. A deaf person who uses exclusively ASL and is not fluent in English might have trouble understanding written text, which is why some patients prefer to use an interpreter.
At the end of the visit, I appreciate being asked to repeat back my treatment plan so my physician can be sure I fully understand what was said. Receiving a written copy of my doctor’s recommendations is also very helpful—that’s probably true for any patient, not only those who are deaf.
If you’re unsure how to communicate with a patient who is deaf, or anyone with a disability, just ask! I suggest language such as, “I believe in offering top-notch accessible care. Do you need any special accommodations?” Then let the patients explain to you what they need, because they are the experts on themselves.
Ying Tsao, Hui-Chen Kuo, Hsui-Chuan Lee and Shuenn-Jiun Yiin
Version of Record online: 20 JUL 2017 | DOI: 10.1111/ijn.12569
Distress associated with needle-related procedures is a major concern in preschool-aged children nursing. This study developed a medical picture book for supporting preschool-aged children facing a venipuncture and determined the effectiveness of such a book intervention in decreasing behavioural distress.
The picture book was designed in 3 stages: developing stories on medical situations, penning the text, and drafting the book. We conducted a quasiexperimental study to examine the effectiveness of the book. The behavioural distress of the control and picture book groups were assessed before, during, and after the intervention by using the Observational Scale of Behavioral Distress-Revised (OSBD-R).
We created a 12-page picture book, Sick Rui-Rui Bear, in which cartoon characters were depicted undergoing venipunctures, as a guide for vein injection and for facilitating positive venipuncture outcomes in preschool-aged children. Over time, the OSBD-R scores of the picture book group were significantly lower than those of the control group (P < .001).
We recommend the picture book be routinely read and used during venipunctures to decrease procedural distress in preschool-aged children.
SUMMARY STATEMENT What is already known about this topic?
Venipunctures may cause varying levels of distress in preschool-aged children. Pain is experienced during venipunctures, which often terrifies children and prolongs the intravenous procedures and the associated displeasure.
Although some picture books have been used to describe the medical procedures to children, to our knowledge, the process of venipunctures has not been explained for preschool-aged children.
What this paper adds: (research findings/key new information)
We created a picture book titled Sick Rui-Rui Bear, in which cartoon characters were depicted as receiving venipunctures. This 12-page book is a guide to vein injection and is aimed at facilitating excellent venipuncture outcomes for preschool-aged children.
We adopted analytical statistics to compare the behavioural distress scores of the control and venipuncture picture book groups. Results showed that the picture book group had significantly lower scores of OSBD-R over time than that of the control group.
The implications of this paper: (how findings influence or can be used to change policy/practice/research/education)
When administering a venipuncture, nurses should be concerned about the distress in preschool-aged children. Interaction among nurses, parents, and preschool-aged children can be stimulated by providing them with a venipuncture picture book, thereby enabling preschool-aged children to face such a medical treatment experience.
Nurses can use a venipuncture picture book to reduce distress in preschool-aged children during vein injection.
Crisis Trends aims to empower journalists, researchers, school administrators, parents and all citizens to understand the crises Americans face so we can work together to prevent future crises from happening.
…for each age group measured except persons age 65 or older, the rate of violent victimization against persons with disabilities was at least 2.5 times the unadjusted rate for those without disabilities.
…persons with cognitive disabilities had the highest victimization rate among the disability types measured for total violent crime…
Presents 2009-2015 National Crime Victimization Survey (NCVS) estimates of nonfatal violent crime (rape or sexual assault, robbery, aggravated assault, and simple assault) against persons age 12 or older with disabilities. Disabilities are classified according to six limitations: hearing, vision, cognitive, ambulatory, self-care, and independent living. The report compares the victimization of persons with and without disabilities living in noninstitutionalized households, including distributions by sex, race, Hispanic origin, age, disability type, and other victim characteristics. It also includes crime characteristics, such as victim-offender relationship, time of crime, reporting to police, and use of victim services agencies. NCVS data were combined with data from the U.S. Census Bureau’s American Community Survey to generate victimization rates.
During the 5-year aggregate period from 2011 to 2015, for each age group measured except persons age 65 or older, the rate of violent victimization against persons with disabilities was at least 2.5 times the unadjusted rate for those without disabilities.
Among those with disabilities, persons ages 12 to 15 (144.1 per 1,000 age 12 or older) had the highest rate of violent victimization among all age groups measured.
The rate of violent victimization against males with disabilities was 31.8 per 1,000, compared to 14.1 per 1,000 males without disabilities.
For females with disabilities, the rate of violent victimization was 32.8 per 1,000, compared to 11.4 per 1,000 females without disabilities.
Males and females had similar rates of total violent victimization in every disability type measured, except independent living disabilities.
The United States spends far more on health care than other high-income countries, with spending levels that rose continuously over the past three decades (Exhibit 1). Yet the U.S. population has poorer health than other countries. 1Life expectancy, after improving for several decades, worsened in recent years for some populations, aggravated by the opioid crisis. 2In addition, as the baby boom population ages, more people in the U.S.—and all over the world—are living with age-related disabilities and chronic disease, placing pressure on health care systems to respond.
Timely and accessible health care could mitigate many of these challenges, but the U.S. health care system falls short, failing to deliver indicated services reliably to all who could benefit. 3In particular, poor access to primary care has contributed to inadequate prevention and management of chronic diseases, delayed diagnoses, incomplete adherence to treatments, wasteful overuse of drugs and technologies, and coordination and safety problems.
This report uses recent data to compare health care system performance in the U.S. with that of 10 other high-income countries and considers the different approaches to health care organization and delivery that can contribute to top performance. We based our analysis on 72 indicators that measure performance in five domains important to policymakers, providers, patients, and the public: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes.
Our data come from a variety of sources. One is comparative survey research. Since 1998, The Commonwealth Fund, in collaboration with international partners, has supported surveys of patients and primary care physicians in advanced countries, collecting information for a standardized set of metrics on health system performance. Other comparative data are drawn from the most recent reports of the Organization for Economic Cooperation and Development (OECD), the European Observatory on Health Systems and Policies, and the World Health Organization (WHO).
Healthcare access is important for all individuals, especially for people with disabilities. However, people with disabilities don’t always receive the healthcare they need. Several barriers can make it harder for them to access critical healthcare services or build optimal working relationships with their providers. Fortunately, by being aware of these barriers, we can overcome them with changes in design, training, and policy.
The Community Guide to Adult Oral Health Program Implementation (Oral Health Guide), along with the corresponding online database of community-based oral health programs, aims to help groups at the state and local levels start or enhance their own oral health programs for older adults. Here, community-based entities can find key tips, case studies, interactive tools, and other sources of support for creating cost-effective, sustainable programs. The Oral Health Guide can help you replicate or expand an existing program or take steps to design and implement a new program. In addition, recognizing the connection between oral health and overall health, the Oral Health Guide contains advice and links to resources concerning interprofessional collaboration to serve older adults’ oral health needs.
The Oral Health Guide begins with an introduction and includes the following eight key steps to implementation:
Conduct a Needs Assessment: Assessing the specific oral health needs of older adults in your community is a vital first step to implementation.
Establish Partnerships: Collaborating with a variety of organizations can help strengthen the planning process for a community-based oral health program for older adults and can expand the program’s impact.
Design the Program: As you define your program’s scope, you might choose to replicate, or copy, an existing program; adapt an existing program; or design an entirely new program.
Finance the Program: Obtaining funding is an important step to starting your program and sustaining it over the long term.
Implement the Program: You must consider several key steps as you proceed from planning and preparation to program operations and services delivery.
Evaluate the Program: During the early planning stages of your program, before you start serving older adults, developing an evaluation plan that reflects your program’s vision and mission is imperative.
Ensure Sustainability: Sharing your program results with partners, funders, and other community stakeholders is fundamental to maintain existing relationships, attract support and buy-in from your community, and thereby ensure your program’s long-term sustainability.
The Oral Health Guide also contains an appendix of funding sources for existing oral health programs and acknowledgments for individuals who helped develop the Oral Health Guide.