Research Scientist for the Provincial System Support Program of the Centre for Addiction and Mental Health in Toronto, Ont, and Associate Professor in the Department of Psychiatry at the University of Toronto.
Research Coordinator for the Provincial System Support Program of the Centre for Addiction and Mental Health.
Can Fam Physician. 2019 Apr;65(Suppl 1):S66-S72.
To implement a Health Check protocol for patients with intellectual and developmental disabilities (IDD) and assess outcomes.
Retrospective chart review and staff survey.
Two Ontario family health teams.
Of 276 patients with IDD identified, 139 received the Health Check (Health Check group). A convenience sample (N = 147) of clinical staff participated in the survey.
The protocol included patient identification, invitation, and modified health examination. Chart review assessed completion of 8 preventive maneuvers, and clinical staff were surveyed on their comfort, knowledge, and skills in care of patients with IDD. Logistic regression analyses were used to compare outcomes for the Health Check and non-Health Check groups, adjusted for practice site.
Documentation of blood pressure, weight, body mass index, and influenza vaccination was significantly higher ( < .001) in the Health Check group, exceeding 70% of patients. Screening rates were higher for mammograms (63% vs 54%), fecal occult blood testing (39% vs 23%), and diabetes testing (80% vs 61%), but not significantly so, and they were similar to general population rates. Papanicolaou test rates were low for both groups (34% vs 32%). Staff comfort and skills were rated significantly higher ( < .05) for those who performed the Health Check. Still, fewer than half thought they had the necessary skills and resources to care for patients with IDD.
Performing the Health Check was associated with improved preventive care and staff experience. Wider implementation and evaluation is needed, along with protocol adjustments to provide more support to staff for this work.
为智力和发育障碍（IDD）患者实施健康检查方案并评估结果。
回顾性病历审查和员工调查。
安大略省的两个家庭健康团队。
在确定的 276 名 IDD 患者中，有 139 名接受了健康检查（健康检查组）。临床工作人员参与了一项便利抽样调查（N=147）。
该方案包括患者识别、邀请和改良健康检查。病历审查评估了 8 项预防措施的完成情况，临床工作人员就其照顾 IDD 患者的舒适度、知识和技能进行了调查。采用逻辑回归分析比较健康检查组和非健康检查组的结果，并根据实践地点进行调整。
健康检查组的血压、体重、体重指数和流感疫苗接种记录明显更高（<0.001），超过 70%的患者都有记录。乳房 X 光检查（63%对 54%）、粪便潜血检查（39%对 23%）和糖尿病检查（80%对 61%）的筛查率更高，但差异无统计学意义，且与一般人群的筛查率相似。两组巴氏涂片检查率都较低（34%对 32%）。进行健康检查的员工舒适度和技能评分明显更高（<0.05）。尽管如此，仍有不到一半的人认为他们有必要的技能和资源来照顾 IDD 患者。
进行健康检查与改善预防保健和员工体验相关。需要更广泛地实施和评估，并对方案进行调整，为员工提供更多支持，以开展这项工作。
