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Patients with intellectual disabilities less likely to have longer consultations

Patients with intellectual disabilities are less likely to have longer consultations with the GP or continuity of care, but they are more likely to have higher levels of chronic disease and use primary care than the general population, according to a study.

Practices should offer patients with intellectual disabilities (ID) double appointments and enhanced continuity of care.

The study, published in the British Journal of General Practice, looked at continuity of care and length of consultations for 14,751 patients with ID registered with 408 practices in England and compared them with 86,221 other patients.

One-in-ten of the patients had Down's syndrome and one-in-ten had a diagnosis of autistic spectrum disorder.

Compared with the general population controls people with ID had “a markedly higher prevalence” of epilepsy, severe mental illness and dementia.

This was higher in communal settings where a fifth of the patients live.

They also had “moderately increased” rates of hypothyroidism and heart failure.

Patients with ID also had a “significantly higher rate of stroke, diabetes, chronic kidney disease and osteoporosis.

However the rates of ischaemic heart disease and cancer was lower than the general population.

Patients with ID were also had higher rates of mobility, vision or hearing problems than the control population.

They also had higher rates of bowel and urinary continence problems and constipation and were more likely to have a recorded behavioural problem in the last five years.

They saw that patients with ID found they were consistently less likely to see the same doctor.

The authors suggested that practices could find ways to give patients with ID similar levels of longer appointments and continuity of care as the general population.

Simple flags on computerised primary care records could prompt receptionists to offer double appointments if possible and by-pass on-call arrangements for specific patients, they said.

The authors led by Iain Carey from the Population Health Research Institute at St George's University of London, said findings on prevalence of chronic disease raise concern over inadequate identification of some conditions.

“Specifically, the low prevalence of ischaemic heart disease is surprising” as there were high rates of risk factors including diabetes, obesity, hypothyroidism, chronic kidney disease and stroke.

The lower prevalence of cancer also needs further exploration, they said, as it may indicate late diagnosis or poorer survival.

However a potential alternative explanation could be the lower rates of smoking and alcohol use by adults with ID, but further evidence is needed, they said.

The authors said the higher consultation rates for people with ID were contrary to existing UK data and are not explained by the higher rate of conditions included in the quality and outcomes framework (QOF).

This meant that the costs are unlikely to be met through remuneration or systems developed for the QOF, the study found.

The report can be found here