Lewis Mary Ann, Lewis Charles E, Leake Barbara, King Bryan H, Lindemann Robert
School of Nursing, University of California, Los Angeles 90095, USA.
Public Health Rep. 2002 Mar-Apr;117(2):174-84. doi: 10.1093/phr/117.2.174.
The purpose of this study was to determine the health status of adults with developmental disabilities residing in community settings and the quality of the preventive, medical, dental, and psychiatric services they receive.
Data were collected on a sample of 353 adults residing in Los Angeles, California, in 1997. Historical data were obtained from study subjects or caregivers, physical and dental examinations were performed, blood was drawn for analysis, and a psychiatrist reviewed medical records for reports of psychiatric diagnoses and consultations.
Health markers, such as rates of obesity, and laboratory test results of routine screening panels including blood cell counts, hemoglobin, and hematocrits; blood concentrations of liver enzymes and other enzymes, cholesterol, and tryglycerides; and urinalyses were within normal limits for an adult population. However, preventive services were notably lacking, especially for individuals living at home. Fewer than half of the study subjects had received influenza vaccine; only a third of those living alone or with family or friends had received this vaccination. Chart audits revealed that about a third received psychotropic medications, but only 24% of these individuals had psychiatric consultations noted in their record. Further, 36% of this medicated group received psychotropic drugs without any identifiable diagnosis, and simultaneous receipt of two or more antipsychotics was not uncommon.
Given that the U.S. health care system fails to ensure the provision of preventive services for all people, including the developmentally disabled, a systematic overhaul is necessary to establish an effective quality assurance program that will provide preventive medical, dental, and psychiatric services for people with developmental disabilities.
本研究旨在确定居住在社区环境中的发育障碍成年人的健康状况，以及他们所接受的预防、医疗、牙科和精神科服务的质量。
1997年，对居住在加利福尼亚州洛杉矶的353名成年人样本进行了数据收集。从研究对象或照料者处获取历史数据，进行身体和牙科检查，采集血液进行分析，并且由一名精神科医生查阅病历以获取精神科诊断和会诊报告。
肥胖率等健康指标以及包括血细胞计数、血红蛋白和血细胞比容在内的常规筛查项目的实验室检查结果；肝酶和其他酶、胆固醇和甘油三酯的血液浓度；以及尿液分析结果在成年人群中均处于正常范围内。然而，预防服务明显不足，尤其是对于居家生活的个体。不到一半的研究对象接种了流感疫苗；独自生活或与家人或朋友一起生活的人中只有三分之一接种了这种疫苗。病历审核显示，约三分之一的人接受了精神药物治疗，但这些人中只有24%的病历中有精神科会诊记录。此外，该用药组中有36%的人在没有任何明确诊断的情况下接受了精神药物治疗，同时服用两种或更多抗精神病药物的情况并不罕见。
鉴于美国医疗保健系统未能确保为所有人，包括发育障碍者，提供预防服务，有必要进行系统改革，以建立一个有效的质量保证项目，为发育障碍者提供预防性医疗、牙科和精神科服务。
