Organising health care services for persons with an intellectual disability

 

Abstract

Background

When compared to the general population, persons with an intellectual disability have lower life expectancy, higher morbidity, higher rates of unmet health needs, and more difficulty finding and getting health care. Organisational interventions are used to reconfigure the structure or delivery of health care services and may prove useful to decrease the noted disparities.

Objectives

To assess the effects of organisational interventions for the mental and physical health problems of persons with an intellectual disability.

Search methods

We searched the Cochrane Effective Practice and Organisation of Care Group specialised register (no year restriction), MEDLINE, EMBASE, CINAHL, other databases from January 1990 to April 2006 reference lists of included studies, and we consulted experts in the field.

Selection criteria

Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of organisational interventions aimed at improving care of mental and physical health problems of adult persons with an intellectual disability.

Data collection and analysis

Two review authors independently extracted data and assessed study quality. Missing data were requested from authors of included studies.

Main results

Eight studies met the selection criteria: six were randomised controlled trials, one was a controlled before and after study, and one was an interrupted time series. In general the studies were of acceptable methodological quality. The included studies investigated interventions dealing with the mental health problems of persons with an intellectual disability, none focused on physical health problems. Three of the studies identified effective organisational interventions and five showed no evidence of effect. Only two studies were similar enough to analyse using a meta-analysis. In the pooled analyses 25 participants received assertive community treatment and 25 received standard community treatment. Results from measures of function, caregiver burden and quality of life were non-significant.

Authors' conclusions

There are currently no well designed studies focusing on organising the health services of persons with an intellectual disability and concurrent physical problems. There are very few studies of organisational interventions targeting mental health needs and the results of those that were found need corroboration. There is an urgent need for high quality health services research to identify optimal health services for persons with an intellectual disability and concurrent physical problem.

 

Plain language summary

Health care services for adults with an intellectual disability

Adults with an intellectual disability often have difficulty meeting their health care needs.  Compared to the general population, they have poorer health and have more difficulty finding, getting to, and paying for health care.  This difficulty is true for both physical and mental health care needs.

Efforts in the community have been made to reduce these problems for people with intellectually disabilities.  In the past, people with intellectually disabilities were taken care of in special institutions.  Now there is a shift towards moving people out of institutions and into the community.  But with this shift, it is necessary to ensure that there are appropriate community services available.  Many ways to organise the community health care services have been developed.    

To determine what are the effects of different ways to organise services, a review of the literature was conducted.  After searching for all relevant studies, eight studies were found.  These studies were done in a variety of countries which have different health care systems overall.  Therefore it is difficult to say whether a specific service works the same way in a different country. 

In England, community services which provide more contact to people with intellectual disabilities and mental health problems, may provide the same benefits as a standard service. 

In the United States, community services which provide more intense services to people with intellectually disabilities and mental health problems, may provide more benefits than standard services.  This may be true in England for people with mild or borderline intellectual disabilities. 

Overall, more research is needed to determine the effects of different ways to organise services for people with intellectual disabilities.  Most studies focused on people who had intellectual disabilities and mental health problems.  But there were no studies on people who had intellectual disabilities and physical problems.

 

摘要

背景

籌組對智力障礙人士的健康保健服務

與一般的大眾相比較，智力障礙的人，有較短的壽命，較高的發病率，較高比例的未滿足的健康需求，較困難發現健康問題，及較不易得到健康保健服務。機構化的介入可用來重新配置保健服務的結構或提供，並且可能證明其對減少被注意到的不對等是有用的。

目標

評估機構化介入，對於智力障礙人士的心智及身體健康問題的解決成效

搜尋策略

搜索Cochrane Effective Practice and Organisation of Care Group specialised register (年份不限)、MEDLINE、 EMBASE、 CINAHL及其他資料庫，從1990年1月至2006年4月的相關研究的參考文獻清單，也和領域中的專家討論。

選擇標準

隨機對照試驗組的實驗設計、對照臨床試驗設計、前後測的對照研究設計、及打斷時間序列等的機構化介入研究，這些機構化介入研究的目的在改善智力障礙成年人士的心智照護及身體健康問題。

資料收集與分析

兩位評論作者獨立的拮取數據及評估研究品質。若納入的研究有遺漏的數據向原作者索取。

主要結論

8個研究符合篩選的標準：其中6個是隨機對照試驗，一個是前後測的對照研究，一個是打斷時間序列的研究。大致而言，方法學的品質是可以接受的。包括在內的研究，調查干預對智力障礙人士心智問題的成效，沒有一個專注在身體健康的成效。3個研究確認機構化的介入的成效，5個顯示沒有實證的效果。只有2個研究是類似的足以進行統合分析(metaanalysis)。在匯總的數據中，分析25個參與者接受堅定信心的團體治療，另25個接受標準的團體治療。在功能評估、照顧者的負荷、及生活品質等方面的結果並沒有顯著的差異。

作者結論

在探討機構化的健康保健服務對於合併有身體健康問題的智力障礙人士的成效上，目前沒有良好設計的研究。僅有少數幾個研究探討針對心理健康的需求的機構化干預，且結果發現仍需要證實。急迫的需要高品質的健康服務的研究，以確認對合併有身體健康問題的智力障礙人士，最理想的健康服務。

翻譯人

本摘要由高雄榮民總醫院陳淑梅翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對智力障礙人士之機構化健康保健服務：與一般大眾比較起來，智力障礙的人士經常有健康的問題，但很困難發現以及得到健康服務。這篇評論包括8個研究結果並檢驗機構化介入的效果。機構化的介入可用來改變保健服務的架構或傳送，並且可能證明其可改善智力障礙人士的健康。這篇評論發現，可提供密集服務給有身體健康問題的智力障礙人士之多專業團隊，可以改善心理健康結果。但是由一個國家得到的結果不一定適合應用到其他國家的機構。