Changes over time in the management of long-term conditions in primary health care for adults with intellectual disabilities, and the healthcare inequality gap

Laura Hughes-McCormack; Nicola Greenlaw; Paula McSkimming; Colin McCowan; Kevin Ross; Linda Allan; Angela Henderson; Craig Melville; Jill Morrison; Sally-Ann Cooper

doi:10.1111/jar.12833

Changes over time in the management of long-term conditions in primary health care for adults with intellectual disabilities, and the healthcare inequality gap

J Appl Res Intellect Disabil. 2021 Mar;34(2):634-647. doi: 10.1111/jar.12833. Epub 2020 Nov 30.

Authors

Affiliations

¹ Mental Health and Wellbeing Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
² Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
³ School of Medicine, University of St Andrews, St Andrews, UK.
⁴ Infection, Immunity and Inflammation, Institute of Health and Wellbeing University of Glasgow, Glasgow, UK.
⁵ General Practice and Primary Care Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.

PMID: 33283349
DOI: 10.1111/jar.12833

Abstract

Background: Quality of primary healthcare impacts on health outcomes. This study aimed to quantify trends in good practice and the healthcare inequalities gap.

Method: Indicators of best-practice management of long-term conditions and health promotion were extracted from primary healthcare records on 721 adults with intellectual disabilities in 2007-2010, and 3638 in 2014. They were compared over time, and with the general population in 2014, using Fisher's Exact test and ordinal regression.

Results: Management improved for adults with intellectual disabilities over time (OR = 5.32; CI = 2.69-10.55), but not for the general population (OR = 0.74; CI = 0.34-1.64). However, it remained poorer, but to a lesser extent, compared with the general population (OR = 0.38; CI = 0.20-0.73 in 2014, and OR = 0.05; CI = 0.02-0.12 in 2007-2010). In 2014, health care was comparable to the general population on 49/78 (62.8%) indicators.

Conclusions: The extent of the healthcare inequality gap reduced over this period, but remaining inequalities highlight that further action is still necessary.

Keywords: chronic disease management; general practice; health; intellectual disabilities; long term conditions; primary care.

MeSH terms

Adult
Healthcare Disparities*
Humans
Intellectual Disability* / therapy
Primary Health Care

Grants and funding

Scottish Government