Queensland Centre for Intellectual and Developmental Disability, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
J Intellect Disabil Res. 2013 Oct;57(10):913-22. doi: 10.1111/j.1365-2788.2012.01586.x. Epub 2012 Jul 10.
Health assessments for people with intellectual disability have been implemented in the UK, New Zealand and Australia, and have led to improved health outcomes. The Comprehensive Health Assessment Program (CHAP) has been shown to improve the health of people with intellectual disability. Similar to other health assessments, it is designed to address healthcare needs, many of which are often overlooked in this population, through better communication between the general practitioner (GP), support worker and the person with intellectual disability. This study investigates GP views of the perceived and actual benefits, gains and barriers associated with its uptake and use in practice.
As part of a larger randomised controlled trial of the CHAP, 46 GPs in Queensland, Australia, completed two telephone interviews that included open-ended questions about their perceptions of the health assessment. The GPs were enrolled in the intervention arm of the trial. Interviews took place at commencement and conclusion of the trial to gain the views of GPs as they experienced using the CHAP. Thematic analysis was used to identify key themes and patterns from the GP responses.
Four themes were identified: better healthcare and uncertain benefits captured GP perceptions of the potential gains associated with use of the CHAP, while two further themes, organisational barriers in the general practice setting and engagement across the healthcare triad highlighted strengths and barriers related to implementation. Anticipated concerns about time raised by GPs at commencement of the trial were borne out in practice, but concerns about communication and cooperation of people with disabilities were not. Matters associated with support worker engagement emerged as an area of concern.
GPs perceive the CHAP as a structured and comprehensive approach to the detection of medical problems as well as an aid in overcoming communication barriers between the doctor and the person with disability. Our findings suggest that some GPs may find it difficult to predict the benefits of using health assessments such as the CHAP. Achieving optimal uptake is likely to require attention at policy and systems levels to address: GP time constraints in providing healthcare to this population; enhancement of support worker training and organisational structures to encourage comprehensive health assessment and follow-up activities; and GP awareness of the improved health outcomes shown to derive from the use of comprehensive health assessments.
英国、新西兰和澳大利亚已经实施了针对智力残疾人士的健康评估，这些评估已经改善了他们的健康状况。综合健康评估计划（CHAP）已被证明可以改善智力残疾人士的健康状况。与其他健康评估一样，它旨在通过改善全科医生（GP）、支持人员和智力残疾人士之间的沟通，来满足他们的医疗需求，这些需求在这一人群中往往被忽视。本研究调查了全科医生对采用和使用该评估计划的感知和实际收益、收获和障碍的看法。
作为 CHAP 更大规模随机对照试验的一部分，澳大利亚昆士兰州的 46 名全科医生完成了两次电话访谈，其中包括关于他们对健康评估看法的开放性问题。这些全科医生参加了试验的干预组。访谈在试验开始和结束时进行，以了解全科医生在使用 CHAP 时的看法。使用主题分析来确定来自全科医生回答的关键主题和模式。
确定了四个主题：更好的医疗保健和不确定的收益，这反映了全科医生对使用 CHAP 相关潜在收益的看法，而另外两个主题，即全科医疗实践中的组织障碍和医疗三角中的协作，突出了实施过程中的优势和障碍。全科医生在试验开始时提出的对时间的预期担忧在实践中得到了证实，但对残疾人士的沟通和合作的担忧并未得到证实。与支持人员参与相关的事项成为关注的一个领域。
全科医生认为 CHAP 是一种结构化和全面的方法，可以发现医疗问题，也是克服医生与残疾人士之间沟通障碍的一种手段。我们的研究结果表明，一些全科医生可能会发现很难预测使用 CHAP 等健康评估的收益。要实现最佳采用率，可能需要在政策和系统层面上关注：全科医生在为这一人群提供医疗保健方面的时间限制；增强支持人员的培训和组织结构，以鼓励全面的健康评估和后续活动；以及全科医生对使用全面健康评估所带来的改善健康结果的认识。
