After-hours primary care for people with intellectual disabilities in The Netherlands-Current arrangements and challenges.
After-hours care for Dutch adults with ID is a mixed patchwork — map your local chain and plug the gaps before crisis night.
01Research in Context
What this study did
Heutmekers et al. (2016) sent a survey to Dutch doctors, nurses, and disability service managers. They asked how people with intellectual disabilities get medical help at night, on weekends, and during holidays. The team wanted to see who answers the phone, who visits the home, and how records move between services.
What they found
The survey showed a patchwork system. Some towns use disability nurses on call, others send regular GPs, and a few have no clear plan. Staff said they often lack training in ID and do not know who holds the latest behavior or medication plan. Hand-offs between daytime and night teams are weak.
How this fits with other research
Holingue et al. (2020) asked US caregivers the same question and heard the same pain: after-hours mental-health help is scarce. The two studies echo each other across the ocean — the problem is global.
Lunsky et al. (2008) interviewed ER staff and found that people with ID land in the emergency room when night support fails. Marloes et al. map the front end of that pipeline; Yona shows where it ends.
Cannella et al. (2006) give hope. Their UK team built one service that blends ID and mental-health staff. Clients got better and ER visits dropped. The Dutch survey shows the need; the UK study shows the fix.
Why it matters
If you write crisis plans, ask where your client goes at 2 a.m. Build a one-page sheet with meds, triggers, and a phone tree. Fax it to the local GP coop and the night nurse. One shared sheet can spare an ER trip.
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02At a glance
03Original abstract
BACKGROUND: Little is known about the organisation of after-hours primary care for people with intellectual disabilities (ID), and mainstream care is not self-evidently accessible or fit for this group. A first step towards improvement is a greater understanding of current after-hours primary ID care. AIMS: This study explores the organisation of and experiences with after-hours primary care provided for people with ID in The Netherlands. METHODS AND PROCEDURES: A telephone survey amongst 68 care provider services including questions on organisational characteristics, problem areas, facilitators, and inhibitors. OUTCOMES AND RESULTS: A multitude of different after-hours primary care arrangements were found. Primary care physicians (PCPs) were involved in almost all care provider services, often in alliance with PCP cooperatives. Specialised ID physicians had differing roles as gatekeeper, primary caregiver, or consultant. Most problems during the after-hours arose regarding daily care professionals' competences. Facilitators and inhibitors of after-hours primary care were themed around complexity of, and need for, specialised care, multidisciplinary team of professionals, communication and information, and prerequisites at organisational level. CONCLUSIONS AND IMPLICATIONS: Evidence on specific after-hours health needs of people with ID is needed to strengthen collaboration between specialist ID care services and mainstream healthcare services to adequately provide care.
Research in developmental disabilities, 2016 · doi:10.1016/j.ridd.2016.07.007