Cooper, S.-A. et al. (2014) Practice nurse health checks for adults with intellectual disabilities: a cluster-design, randomised controlled trial. Lancet Psychiatry, 1(7), pp. 511-521. (doi: 10.1016/S2215-0366(14)00078-9)
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Publisher's URL: http://dx.doi.org/10.1016/S2215-0366(14)00078-9
Abstract
<b>Background</b> Adults with intellectual disabilities have substantial health inequalities and poor access to health care. We assessed whether practice nurse-delivered health checks could improve the health of adults with intellectual disabilities compared with standard care.<p></p> <b>Methods</b> In this cluster-design, single-blind, randomised controlled trial, we included general practices in Scotland, UK. From June to December, 2011, we randomly assigned (1:1) these general practices to either health checks plus standard care (health-checks group), or standard care only (control group), and we recruited the patients from these practices. Randomisation was done with stratification by number of GPs per practice and number of registered patients with intellectual disabilities (<20 or ≥20). Two research assistants were masked to allocation, and undertook the review of 9 month medical records and interviews. Participants and carers were not masked. The intervention was one health check designed especially for people with intellectual disabilities delivered by a practice nurse. The objective was improvement in health and health care 9 months after randomisation, and the primary outcome was the incidence of newly detected health needs being met by this timepoint. Whether needs were met was established by the investigators being masked to group allocation. The analysis was by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN43324841.<p></p> <b>Findings</b> Between June 26 and Dec 20, 2011, we recruited 38 practices. 85 participants (from 16 practices) were randomly assigned to intervention and 67 (from 17 practices) to standard care; five of the identified practices did not supply any participants. 83 intervention and 66 standard care participants completed the trial. More newly detected health needs were met in the intervention group than in the control standard care group (median 1 [range 0—8], 76•4% met [SD 36•5] vs 2 [0—11], 72•6% met [35•4]; odds ratio [OR] 1•73 [95% CI 0•93—3•22], p=0•085), although this difference was not significant. Significantly more health monitoring needs were met in the intervention group than standard care (median 2 [0—20], 69•9% [SD 34•2] vs 2 [0—22], 56•8% [29•4], OR 2•38 [95% CI 1•31—4•32, p=0•0053]). The probability that health checks are cost effective was between 0•6 and 0•8, irrespective of the cost-effectiveness threshold level. Costs per patient were —£71•48 for health checks and —£20•56 for standard care. The difference (−£50•92) was not significant [95% CI −434 to 362]. No adverse events were attributable to the intervention.<p></p> <b>Interpretation</b> Health checks given by practice nurses to adults with intellectual disabilities produced health-care improvements that were more conducive to longer-term health than standard care given to this population. The intervention dominated standard care, being both cheaper and more effective. Health-check programmes might therefore be indicated for adults with intellectual disabilities.<p></p>
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