Hospitalisation rates for ambulatory care sensitive conditions for persons with and without an intellectual disability--a population perspective.
Preventable hospital stays are six times higher for people with ID—fix primary-care access and you cut the risk.
01Research in Context
What this study did
McConkey et al. (2010) compared hospital records across an entire Canadian province. They counted how often people with intellectual disability were admitted for conditions that good primary care should prevent.
The team matched these records to the general population to see the size of the gap.
What they found
People with ID were hospitalized for preventable problems at six times the rate of everyone else.
These stays were for things like asthma, diabetes crises, and simple infections—care a family doctor should handle.
How this fits with other research
C-Pitetti et al. (2007) saw the same pattern earlier in Taiwan. Their data showed 10–15 % of institutionalized adults with ID went to hospital each year, mostly for pneumonia and epilepsy. The new study proves the problem is not just in institutions—it hits the whole ID population.
Durbin et al. (2018) offers a bright spot. They found that when adults with ID have one regular primary-care doctor, emergency visits drop sharply. The six-fold gap R et al. found can shrink if we lock in continuity.
Faso et al. (2016) explains part of the cause. In Australia, people with ID book fewer preventive visits and check-ups. Less routine care leads straight to the higher hospital use R et al. measured.
Why it matters
You can act today. Add a health-access goal to every adult ISP. Schedule the annual physical, flu shot, and dental check during the same month you write the plan. Track if the visit happened and bring the results to team meetings. Six-fold risk drops when we treat primary care as part of behavior planning.
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02At a glance
03Original abstract
BACKGROUND: There is evidence that persons with an intellectual disability (ID) face barriers to primary care; however, this has not been extensively studied at the population level. Rates of hospitalisation for ambulatory care sensitive conditions are used as an indicator of access to, and quality of, primary care. The objective of the study was to compare hospitalisation rates for ambulatory care sensitive conditions between persons with and without an ID in a publicly insured population. METHODS: Persons with an ID were identified among the general population of a Canadian province between 1999 and 2003. Using a list of conditions applicable to persons with an ID, rates of hospitalisations for ambulatory care sensitive conditions for persons with and without an ID were calculated and compared. Regression models were used to adjust for age, sex and place of residence. Hospitalisation rates for specific conditions were also compared, controlling for differences in disease prevalence where possible. RESULTS: Persons with an ID were consistently hospitalised for ambulatory care sensitive conditions at a higher rate than persons without an ID. Between 1999 and 2003 the adjusted rate ratio (RR) was 6.1 [95% confidence interval (CI) = 5.6, 6.7]. Rate ratios were highest when comparing persons with, to persons without, an ID between the ages of 30-39 (RR = 13.1; 95% CI = 10.6, 16.2) and among urban area dwellers (RR = 7.0; 95% CI = 6.2, 7.9). Hospitalisation rates for epilepsy and schizophrenic disorders were, respectively, 54 and 15 times higher for persons with compared with persons without an ID. Rate ratios for diabetes and asthma remained significant after controlling for the population prevalence of these diseases. CONCLUSIONS: The large discrepancy in rates of hospitalisation between persons with and without an ID is an indicator of inadequate primary care for this vulnerable population. Decreasing the number of ambulatory care sensitive condition hospitalisations through specialised outpatient programmes for persons with an ID would potentially lead to better health, improved quality of life and cost savings. Future research should include potentially important factors such as disease severity, socio-economic variables and measures of health service organisation in the analysis. International comparisons of ambulatory care sensitive condition hospitalisation rates could point to the benefits and limitations of the health service policy directions adopted by different countries.
Journal of intellectual disability research : JIDR, 2010 · doi:10.1111/j.1365-2788.2010.01311.x