Assessment of an incentivised scheme to provide annual health checks in primary care for adults with intellectual disability: a longitudinal cohort study

Marta Buszewicz; Catherine Welch; Laura Horsfall; Irwin Nazareth; David Osborn; Angela Hassiotis; Gyles Glover; Umesh Chauhan; Matthew Hoghton; Sally-Ann Cooper; Gwen Moulster; Rosalyn Hithersay; Rachael Hunter; Pauline Heslop; Ken Courtenay; André Strydom

doi:10.1016/S2215-0366(14)00079-0

Assessment of an incentivised scheme to provide annual health checks in primary care for adults with intellectual disability: a longitudinal cohort study

Lancet Psychiatry. 2014 Dec;1(7):522-30. doi: 10.1016/S2215-0366(14)00079-0. Epub 2014 Dec 3.

Authors

Marta Buszewicz¹, Catherine Welch², Laura Horsfall², Irwin Nazareth², David Osborn³, Angela Hassiotis³, Gyles Glover⁴, Umesh Chauhan⁵, Matthew Hoghton⁶, Sally-Ann Cooper⁷, Gwen Moulster⁸, Rosalyn Hithersay³, Rachael Hunter², Pauline Heslop⁹, Ken Courtenay¹⁰, André Strydom³

Affiliations

¹ Research Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, London, UK. Electronic address: m.buszewicz@ucl.ac.uk.
² Research Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, London, UK.
³ Division of Psychiatry, University College London, London, UK.
⁴ Learning Disabilities team, Public Health England, IPH, University Forvie Site, Cambridge, UK.
⁵ NHS East Lancashire Clinical Commissioning Group, Nelson, UK.
⁶ Clevedon Riverside Group, Clevedon, UK.
⁷ Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
⁸ South Staffordshire and Shropshire NHS Foundation Trust, St Georges Hospital, Stafford, UK.
⁹ Norah Fry Research Centre, University of Bristol, Bristol, UK.
¹⁰ Barnet, Enfield and Haringey Mental Health Trust, Haringey Learning Disabilities Partnership, London, UK.

PMID: 26361311
DOI: 10.1016/S2215-0366(14)00079-0

Abstract

Background: People with intellectual disabilities (ID) have many comorbidities but experience inequities in access to health care. National Health Service England uses an opt-in incentive scheme to encourage annual health checks of patients with ID in primary care. We investigated whether the first 3 years of the programme had improved health care of people with ID.

Methods: We did a longitudinal cohort study that used data from The Health Improvement Network primary care database. We did multivariate logistic regression to assess associations between various characteristics and whether or not practices had opted in to the incentivised scheme.

Findings: We assessed data for 8692 patients from 222 incentivised practices and those for 918 patients in 48 non-incentivised practices. More blood tests (eg, total cholesterol, odds ratio [OR] 1·88, 95% CI 1·47-2·41, p<0·0001) general health measurements (eg, smoking status, 6·0, 4·10-8·79, p<0·0001), specific health assessments (eg, hearing, 24·0, 11·5-49·9, p<0·0001), and medication reviews (2·23, 1·68-2·97, p<0·0001) were done in incentivised than in non-incentivised practices, and more health action plans (6·15, 1·41-26·9, p=0·0156) and secondary care referrals (1·47, 1·05-2·05, p=0·0256) were made. Identification rates were higher in incentivised practices for thyroid disorder (OR 2·72, 95% CI 1·09-6·81, p=0·0323), gastrointestinal disorders (1·94, 1·03-3·65, p=0·0390), and obesity (2·49, 1·76-3·53, p<0·0001).

Interpretation: Targeted annual health checks for people with ID in primary care could reduce health inequities.

Funding: National Institute for Health Research.