Management of long term health conditions amongst adults with learning disabilities in primary care settings


People with learning disabilities face barriers in accessing health services, compounded by communication difficulties, and organisational and social support limitations. As a result, this may contribute to the poorer health and higher levels of multi-morbidity experienced by people with learning disabilities in comparison to the general population. In order to reduce inequities, primary health care providers need to effectively manage long-term conditions in keeping with best practice. However, current evidence suggests this may not always occur. This project measured the management of long-term conditions within primary health care for adults with learning disabilities, and compared this with the general population. Additionally we investigated the number of recognised health conditions experienced by adults with learning disabilities compared with the general population, and the potential influence of a range of individual, social and environmental factors upon these health problems.

What we did

In the UK, general practitioners/family physicians receive pay for performance on management of long-term conditions, according to best-practice indicators. These indicators are specified in the general practitioners’ contract (the “Quality and Outcomes Framework”). The primary health care records of a population based cohort of adults with learning disabilities were scrutinised to determine performance on management of long-term conditions according to Quality and Outcomes Framework indicators. Management of long‐term conditions was compared between 721 adults with intellectual disabilities and the general population (n = 764,672). Prevalence of long‐term conditions was determined, and associated factors were investigated via logistic regression analyses.

What we found

Adults with intellectual disabilities received significantly poorer management of all long‐term conditions on 38/57 (66.7%) indicators. Achievement was high (75.1%–100%) for only 19.6% of adults with intellectual disabilities, compared with 76.8% of the general population. Adults with intellectual disabilities had higher rates of epilepsy, psychosis, hypothyroidism, asthma, diabetes and heart failure. There were no clear associations with neighbourhood deprivation.

What these findings mean

Adults with intellectual disabilities receive poorer care, despite conditions being more prevalent. The imperative now is to find practical, implementable means of supporting the challenges that general practices face in delivering equitable care.

For more information about this research, contact Laura Hughes-McCormack

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Page updated 25 August 2020