UPTAKE OF THE PERIODIC HEALTH EXAM AMONG ADULTS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES FROM 2003 TO 2015

Background: Over the past decade, annual heath exams have been de-emphasized for the general population but emphasized for adults with intellectual and developmental disabilities (IDD). The purpose of this project was to determine if there has been an increase in the uptake of the health exam among adults with IDD in Ontario, to what extent, and the effect on the quality of preventive care provided. Methods: Using administrative health data, the proportion of adults (18-64 years old) with IDD who received a health exam (long appointment, general assessment, and “true” health exam), a high value on the primary care quality composite score (PCQS), and a health exam or high PCQS each year was compared to the proportion in a propensity score matched sample of the general population. Negative binomial and segmented negative binomial regression controlling for age and sex were used to determine the relative risk of having a health exam/high PCQS/health exam or PCQS over time. Results: Pre joinpoint, the long appointment and general assessment health exam definitions saw a decrease and the “true” health exam saw an increase in the likelihood of adults having a health exam. Post joinpoint, all health exam definitions saw a decrease in the likelihood of adults having a health exam. Pre joinpoint, all PCQS measures (high PCQS, long appointment or high PCQS, “true” health exam or high PCQS) saw an increase in the likelihood for adults to achieve a high PCQS or high PCQS/have a health exam. Post joinpoint, all PCQS measures saw a decrease in the likelihood for adults to achieve a high PCQS or high PCQS/have a health exam. Achieving a high PCQS was strongly associated with having a health exam regardless of health exam definition or IDD status. Conclusions: Despite the publication of guidelines, only a small proportion of adults with IDD are receiving health exams. This indicates that the publication of guidelines alone was not sufficient to change practice. More targeted measures, such as the implementation of an IDD-specific health exam fee code, should be considered to increase the uptake of the health exam among adults with IDD.

A Developmental Approach to Sport Expertise

This chapter examines the personal and contextual factors of youth sport that affect sport expertise and developmental outcomes. The developmental model of sport participation (DMSP) is used as a comprehensive framework that outlines different pathways of involvement in sport. Activities and contexts that promote continued sport participation and expert performance are discussed as the building blocks of all effective youth sport programs. This chapter provides evidence that performance in sport, participation, and psychological development should be considered as a whole instead of as separate entities by youth sport programmers. Adults in youth sports (i.e. coaches, parents, sport psychologists, administrators) must consider the differing implications of concepts such as deliberate play, deliberate practice, sampling, specialization, and program structure at different stages of an athlete's talent development. Seven postulates are presented regarding important transitions in youth sport and the role that sampling and deliberate play, as opposed to specialization and deliberate practice, can have during the childhood in promoting continued participation and elite performance in sport