Health checks in primary care for adults with intellectual disabilities: how extensive should they be?
UK doctors paid by standard targets skip ID-specific health issues, so bring a short checklist to annual visits.
01Research in Context
What this study did
Chauhan et al. (2010) compared two kinds of health checks for adults with intellectual disabilities. One group of doctors used the UK pay-for-performance rules. The other group added extra checks that matter for ID clients.
The team then counted what each doctor wrote down. They looked for ID-specific items like epilepsy review, behavior meds, and hearing tests.
What they found
Doctors paid by the standard scheme recorded far more general items. They hit the rewarded targets like blood pressure and smoking status.
They rarely noted ID-only issues. The extra-check group wrote down more epilepsy, mental health, and swallowing data, but still less than the general items.
How this fits with other research
Ferreri et al. (2011) backs the need. Their review of 38 papers shows health checks keep finding hidden illness in people with ID. Yet Chauhan et al. (2010) shows money rewards push doctors away from those very checks.
Eisenhower et al. (2006) tried a fix earlier. They gave UK primary-care staff a short workshop plus a handout. Knowledge and confidence rose. The 2010 study proves the fix is still needed, because recording gaps remain.
Dagnan et al. (2025) offers a tool. They show PHQ-9 and GAD-7 work for adults with ID. You can add those short scales to the annual visit and still fit the time doctors already use.
Why it matters
If you serve adults with ID, ask the GP for a one-page add-on list. Include epilepsy review, psych med check, and a quick PHQ-9. It takes five extra minutes and lines up with pay rules. You help the doctor hit targets and catch the issues rewards miss.
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02At a glance
03Original abstract
BACKGROUND: Routine health checks have gained prominence as a way of detecting unmet need in primary care for adults with intellectual disabilities (ID) and general practitioners are being incentivised in the UK to carry out health checks for many conditions through an incentivisation scheme known as the Quality and Outcomes Framework (QOF). However, little is known about the data being routinely recorded in such health checks in relation to people with ID as practices are currently only incentivised to keep a register of people with ID. The aim of this study was to explore the additional value of a health check for people with ID compared with standard care provided through the current QOF structure. METHODS: Representative practices were recruited using a stratified sampling approach in four primary care trusts to carry out health checks over a 6-month period. The extracted data were divided into two aggregated informational domains for the purpose of multilevel regression analysis: 'ID-specific' (containing data on visual assessment, hearing assessment, behaviour assessment, bladder function, bowel function and feeding assessment) and financially incentivised QOF targets (blood pressure, smoking status, ethnicity, body mass index, urine analysis and carer details) which are incentivised processes. RESULTS: A total of 651 patients with ID were identified in 27 practices. Only nine practices undertook a health check on 92 of their patients with ID. Significant differences were found in the recorded information, between those who underwent a health check and those who did not (P < 0.001, chi(2) = 56.3). In the group that had health check, recorded information was on average higher for the 'QOF targets' domain, compared with the 'ID-specific' domain, by 58.7% (95% CI: 54.1, 63.3, P < 0.001). CONCLUSIONS: If incentives are to be used as a method for improving care for people with ID through health checks a more targeted approach focused on ID-specific health issues might be more appropriate than an extensive health check.
Journal of intellectual disability research : JIDR, 2010 · doi:10.1111/j.1365-2788.2010.01263.x