Health inequities in unscheduled healthcare for children with intellectual disabilities in Ireland: a study protocol

Background: Health inequities for children with intellectual disabilities (ID) are prevalent within different health systems, and children with ID have shorter life expectancies than the general population, higher mortality rates before the age of 17 and have a greater risk of potentially preventable hospitalisations. A health systems approach to research in this area provides a useful means through which research can inform policy and practice to ensure people with ID receive equitable healthcare; however, there is a paucity of evidence regarding how to address differences that have been described in the literature to date. The overall aim of this research is to establish the extent of health inequities for children with ID in Ireland compared to children without ID with respect to their utilisation of primary care and rates of hospitalisation, and to gain a better understanding of what influences utilisation of primary care and ED services in this population. Methods and analysis: The design of this research adopts a mixed-methods approach: statistical analysis of health data to determine the extent of health inequities in relation to healthcare utilisation; discrete choice experiments to explore General Practitioners’ decision making and parental preferences for optimal care; and concept mapping to develop consensus between stakeholders on how to address current healthcare inequities. Discussion: By applying a systems lens to the issue of health inequities for children with ID, the research hopes to gain a thorough understanding of the varying components that can contribute to the maintenance of such healthcare inequities. A key output from the research will be a set of feasible solutions and interventions that can address health inequities for this population.

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Health inequities in unscheduled healthcare for children with intellectual disabilities in Ireland: a study protocol

HRB Open Research ◽

10.12688/hrbopenres.12973.2 ◽

2020 ◽

Vol 3 ◽

pp. 3

Author(s):

Emma Nicholson ◽

Edel Doherty ◽

Suja Somanadhan ◽

Suzanne Guerin ◽

James Schreiber ◽

...

Keyword(s):

Primary Care ◽

Intellectual Disabilities ◽

Health Systems ◽

Systems Approach ◽

Healthcare Utilisation ◽

Health Inequities ◽

Discrete Choice Experiments ◽

Policy And Practice ◽

Optimal Care ◽

Feasible Solutions

Background: Health inequities for children with intellectual disabilities are prevalent within different health systems, and children with intellectual disabilites have shorter life expectancies than the general population, higher mortality rates before the age of 17 and have a greater risk of potentially preventable hospitalisations. A health systems approach to research in this area provides a useful means through which research can inform policy and practice to ensure people with intellectual disabilities receive equitable healthcare; however, there is a paucity of evidence regarding how to address differences that have been described in the literature to date. The overall aim of this research is to establish the extent of health inequities for children with intellectual disabilities in Ireland compared to children without intellectual disabilities with respect to their utilisation of primary care and rates of hospitalisation, and to gain a better understanding of what influences utilisation of primary care and emergency department services in this population. Methods and analysis: The design of this research adopts a multi-methods approach: statistical analysis of health data to determine the extent of health inequities in relation to healthcare utilisation; discrete choice experiments to explore General Practitioners’ decision making and parental preferences for optimal care; and concept mapping to develop consensus between stakeholders on how to address current healthcare inequities. Discussion: By applying a systems lens to the issue of health inequities for children with intellectual disabilities, the research hopes to gain a thorough understanding of the varying components that can contribute to the maintenance of such healthcare inequities. A key output from the research will be a set of feasible solutions and interventions that can address health inequities for this population.

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Developing measures to capture the true value of primary care

BJGP Open ◽

10.3399/bjgpo.2020.0152 ◽

2021 ◽

pp. BJGPO.2020.0152

Author(s):

Tim C olde Hartman ◽

Andrew Bazemore ◽

Rebecca Etz ◽

Ryuki Kassai ◽

Michael Kidd ◽

...

Keyword(s):

Primary Care ◽

Health Systems ◽

Positive Impact ◽

Health Coverage ◽

Policy And Practice ◽

Actual Performance ◽

Quality Healthcare ◽

True Value ◽

Practice Performance ◽

Overall Performance

Primary care (PC) is an essential building block for any high quality healthcare system, and has a particularly positive impact on vulnerable patients. It contributes to the overall performance of health systems, and countries that reorient their health system towards PC are better prepared to achieve universal health coverage. Monitoring the actual performance of PC in health systems is essential health policy to support PC. However, current indicators are often too narrowly defined to account for quality of care in the complex populations with which PC deals. This article reviews a number of conceptual frameworks developed to capture PC values in robust measures and indicators that can inform policy and practice performance. Each have benefits and limitations. Further work is needed to develop meaningful primary health care (PHC) and PC measures to inform strategic action by policymakers and governments for improved overall performance of health systems.

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Sexuality and People With Intellectual Disabilities: Policy and Practice

PsycEXTRA Dataset ◽

10.1037/e680462007-001 ◽

2007 ◽

Author(s):

Joel M. Levy

Keyword(s):

Intellectual Disabilities ◽

Policy And Practice ◽

People With Intellectual Disabilities

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The Evolution of Physical Activity on Prescription (FaR) in Sweden

Swiss Sports & Exercise Medicine ◽

10.34045/ssem/2014/10 ◽

2014 ◽

Vol 62 (2) ◽

Keyword(s):

Physical Activity ◽

Primary Care ◽

Healthcare Professionals ◽

Systems Approach ◽

Ecological Model ◽

Controlled Trial ◽

Professional Associations ◽

Successful Implementation ◽

Surgeon General ◽

Positive Effects

In 1996, the first Report of the US Surgeon General on Physical Activity and Health provided an extensive knowledge overview about the positive effects of physical activity (PA) on several health outcomes and PA recommendations. This contributed to an enhanced interest for PA in Sweden. The Swedish Professional Associations for Physical Activity (YFA) were appointed to form a Scientific Expert Group in the project “Sweden on the Move” and YFA created the idea of Physical Activity on Prescription (FaR) and the production of a handbook (FYSS) for healthcare professionals. In Swedish primary care, licensed healthcare professionals, i.e. physicians, physiotherapists and nurses, can prescribe PA if they have sufficient knowledge about the patient’s current state of health, how PA can be used for promotion, prevention and treatment and are trained in patient-centred counselling and the FaR method. The prescription is followed individually or by visiting local FaR providers. These include sport associations, patient organisations, municipal facilities, commercial providers such as gyms, sports clubs and walking clubs or other organisations with FaR educated staff such as health promoters or personal trainers. In clinical practice, the FaR method increases the level of PA in primary care patients, at 6 and at 12 months. Self-reported adherence to the prescription was 65% at 6 months, similar to the known compliance for medications. In a randomised controlled trial, FaR significantly improved body composition and reduced metabolic risk factors. It is suggested that a successful implementation of PA in healthcare depends on a combination of a systems approach (socio-ecological model) and the strengthening of individual motivation and capability. General support from policymakers, healthcare leadership and professional associations is important. To lower barriers, tools for implementation and structures for delivery must be readily available. Examples include handbooks such as FYSS, the FaR system and the use of pedometers.

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Learning health systems in primary care: a systematic scoping review

BMC Family Practice ◽

10.1186/s12875-021-01483-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Danielle M. Nash ◽

Zohra Bhimani ◽

Jennifer Rayner ◽

Merrick Zwarenstein

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Health Systems ◽

Scoping Review ◽

Early Stage ◽

Point Of Care ◽

The United States ◽

Stage Of Development ◽

Integrated Health ◽

Google Search

Abstract Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

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The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

BMC Health Services Research ◽

10.1186/s12913-021-06140-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dimuthu Rathnayake ◽

Mike Clarke

Keyword(s):

Primary Care ◽

Health Systems ◽

Elective Surgery ◽

Waiting Times ◽

Surgical Care ◽

High Income ◽

Surgical Patients ◽

Timely Access ◽

Referral Systems

Abstract Background Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. Results The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. Conclusions The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.

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Working alongside people with intellectual disabilities who have had difficult experiences: Reflections on trauma-informed care within a service context

Journal of Intellectual Disabilities ◽

10.1177/1744629520987717 ◽

2021 ◽

pp. 174462952098771

Author(s):

Elisabeth Goad

Keyword(s):

Intellectual Disabilities ◽

Systems Approach ◽

Traumatic Experiences ◽

Childhood Experiences ◽

Trauma Informed Care ◽

Adverse Childhood ◽

Conference Presentations ◽

Trauma Informed ◽

People With Intellectual Disabilities ◽

Whole Systems

People with intellectual disabilities are more likely to experience adverse childhood experiences than those in the general population. Additionally, the conceptualization of ‘trauma’ is far broader than traditionally understood in order to encompass the far reaching relational nature of people with intellectual disabilities traumatic experiences. This reflective account details the first steps one service took to embrace trauma-informed care as a whole systems approach. The paper is a response to calls following conference presentations about our work, to share the process of the beginning of this journey, it also aims to provide key learning points, practical considerations and questions for reflection in order to support other services to begin their own relationships with trauma-informed care.

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