The evidence for better health from health assessments: A large clustered randomised controlled trial

Aim: To test the efficacy of a comprehensive health assessment using the CHAP tool in adults with an intellectual disability (ID). Method: A cluster randomised control design was used. The intervention group received the CHAP, while the control group received usual care. This tool directed carers to gather a health history, which was reviewed by the person’s general practitioner (GP) who completed a medical examination and a healthcare plan. The tool acted as an advocacy tool, a ticket-of-entry to the GPs surgery and educated the GP and the caregiver about the deficits in the healthcare of adults with ID. The healthcare of the participants was followed for one-year after intervention by the collection of data from GP and service providers’ notes. Also interviews were performed with all those involved. Results: We obtained a representative sample of  adults with ID (RR%). We found the intervention group received a significant increase in many health promotion/disease prevention activities e.g. hearing screening was  times and a Pap smear was  times more likely to have occurred in the intervention groups.We also found a trend towards earlier detection of disease. Conclusions: The CHAP process improves the provision of health screening/promotion activities and should be implemented.

Are health assessments in the community acceptable to those involved? Yes, Yes and maybe

Aim: To test the acceptability of a comprehensive health assessment program (CHAP) in adults with an intellectual disability (ID). Method: We interviewed adults with ID, their general practitioners (GPs) and caregivers (healthcare triad), before and after the intervention period as part of a clustered randomised controlled trial to test the use of the CHAP tool in adults with ID. A content and thematic analysis of these interviews will be presented. Results: We found adults with ID were unable to recall the health assessment consultation or differentiate this consultation from the usual contact with their GP. GPs and residential staff where largely supportive of the process and considered it did improve the care they could provide to AWID. They also considered that the intervention helped other members of the healthcare triad. Conclusions: The CHAP was found to be acceptable to caregivers and GPs however further work is needed to ascertain the views of adults with ID.

Are a health advocacy diary and health assessment welcomed by those who use them?

Aim: To determine acceptability of a health advocacy intervention, the Ask Diary and the comprehensive health assessment program (CHAP). Method: We performed a two by two designed randomised controlled trial of the Ask Diary and the CHAP tool in  adults with intellectual disability. Results of interviews of self-advocates and caregiver advocates, both families and paid carers, will be presented. Results: The interviews found strong support for the Ask Diary and the CHAP tool among selfadvocates and family caregivers. There was clear indication that the Ask Diary improved advocacy, aided in the organisation of health matters and was easy to use. It was reported that the health assessment resulted in benefits for the person’s health and high acceptability by carers. There was less support for the interventions where the person was supported through government services. Conclusions: Self-advocates and family caregivers welcome and use a personalised health advocacy diary and also a health assessment. However paid carers used the diary less but were supportive of the health assessment.