Organising healthcare services for persons with an intellectual disability

Citation: Balogh R, McMorris CA, Lunsky Y, et al. Organising healthcare services for persons with an intellectual disability. Cochrane Database of Systematic Reviews. 2016;(4):CD007492.

Language: Abstract available in EN, ES, FA. Plain language summary available in EN, ES, FA, HR, TA. Full text available in EN.

Free to view: Yes.

Funding sources: The authors did not report any external sources of support for this review.

What is this? People with intellectual disabilities often experience disproportionate barriers to accessing the health care they need, both physically and financially, as well as poorer health outcomes, in comparison to those without intellectual disabilities. Improving this situation should help make health systems more resilient.

In this Cochrane systematic review, the authors searched for randomized trials of organizational interventions intended to help healthcare services to improve the mental and physical health of adults with intellectual disabilities. They did not restrict their searches by language or status of publication and did the search for this updated review in September 2015. They included 7 randomized trials, which were from the Netherlands (1 study), UK (5), and USA (1).

What works: Community-based behaviour therapy may slightly decrease behavioural problems in adults with intellectual disabilities.

What doesn’t work: Adjusting the frequency of health service provision probably has little to no effect on the burden experienced by caregivers of adults with intellectual disabilities.

What is uncertain: Whether the frequency of health service provision and outreach treatment reduces behavioural problems of adults with intellectual disabilities is uncertain.

There was uncertainty on whether any other interventions could reduce behavioural problems for adults with intellectual disabilities, and whether other interventions could minimize burden on caregivers and service costs.

Implications: The authors of the review concluded that their review found insufficient evidence to guide policy decisions about how to optimise healthcare services for people with intellectual disability. They stated that further research is needed to identify high-quality healthcare services for individuals with intellectual disabilities, particularly those with associated physical problems and to address the economic issues experienced when accessing health care for individuals with intellectual disabilities.

Other considerations: The authors of the review discussed their findings in the context of occupation, socioeconomic status, disability and time-dependent relationships (when accessing health services).

 

This summary was prepared by Yasmeen Saeed, checked by Cristián Mansilla and Ana Beatriz Pizarro, and finalized by Mike Clarke.

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Evidence Gaps: This review identified three main gaps:

Evidence gap	Classification	Population/setting identified	Study type
‘’Well-designed appropriately powered studies focusing on organizing the health services of persons with an intellectual disability and concurrent physical problems were conspicuously absent’’	More high-quality research is needed	Persons with an intellectual disability and concurrent physical problems	N/A
‘’Missing were studies on integration of care interventions which may prove useful to resolve ongoing healthcare service debates’’	More research is needed	Persons with an intellectual disability	N/A
‘The debate over the effectiveness of mainstream versus specialised health services for persons with an intellectual disability remains unanswered and requires rigorous study’’	More research is needed	Persons with an intellectual disability	Effectiveness studies

 

These gaps were identified up to September 2015, with no geographical restrictions.

An updated search was conducted on 5 October 2023 to check if new studies have filled these gaps, finding:

• 1 Systematic review appraising the effectiveness of both cognitive behavioral therapy and eye movement desensitization and reprocessing for PTSD and associated symptoms for both adults and children with mild, moderate, or severe intellectual delay might contribute to partially filling one of the gaps.

This evidence gap was identified, extracted, and classified by Ana Beatriz Pizarro and Jawaria Karim. Updated searches were carried out by Jane McHugh. Ana Beatriz Pizarro assessed the search results to address the gaps, and the findings were checked and finalized by Cristián Mansilla. The methodology we used to assess each gap can be found here.

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