Barriers and facilitators to improving health care for adults with intellectual and developmental disabilities: what do staff tell us?
Introduction: Adults with intellectual and developmental disabilities (IDD) have high rates of morbidity and are less likely to receive preventive care. Emergency departments and primary care clinics are important entry points into the health care system. Improving care in these settings can lead to...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Public Health Agency of Canada
2018-10-01
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| Series: | Health Promotion and Chronic Disease Prevention in Canada |
| Subjects: | |
| Online Access: | https://doi.org/10.24095/hpcdp.38.10.01 |
| _version_ | 1818858421658583040 |
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| author | Avra Selick Janet Durbin Ian Casson Jacques Lee Yona Lunsky |
| author_facet | Avra Selick Janet Durbin Ian Casson Jacques Lee Yona Lunsky |
| author_sort | Avra Selick |
| collection | DOAJ |
| description | Introduction: Adults with intellectual and developmental disabilities (IDD) have high rates of morbidity and are less likely to receive preventive care. Emergency departments and primary care clinics are important entry points into the health care system. Improving care in these settings can lead to increased prevention activities, early disease identification, and ongoing management. We studied barriers and facilitators to improving the care of patients with IDD in three primary and three emergency care sites in Ontario. Methods: Data sources included structured implementation logs at each site, focus groups (n = 5) and interviews (n = 8). Barriers and facilitators were coded deductively based on the Consolidated Framework for Implementation Research (CFIR). Synthesis to higher level themes was achieved through review and discussion by the research team. Focus was given to differences between higher and lower implementing sites. Results: All sites were challenged to prioritize care improvement for a small, complex population and varied levels of implementation were achieved. Having national guidelines, using local data to demonstrate need and sharing evidence on value were important engagement strategies. Factors present at higher implementing sites included strong champions, alignment with site mandate, and use of electronic prompts/reminders. Lower implementing sites showed more passive endorsement of the innovation and had lower capacity to implement. Conclusion: Providing effective care for small, complex groups, such as adults with IDD, is critical to improving long-term health outcomes but is challenging to achieve. At a systemic level, funding incentives, access to expertise and improved electronic record systems may enhance capacity. |
| first_indexed | 2024-12-19T08:56:01Z |
| format | Article |
| id | doaj.art-ba030861e14547e4a0ee6498a8f92f47 |
| institution | Directory Open Access Journal |
| issn | 2368-738X |
| language | English |
| last_indexed | 2024-12-19T08:56:01Z |
| publishDate | 2018-10-01 |
| publisher | Public Health Agency of Canada |
| record_format | Article |
| series | Health Promotion and Chronic Disease Prevention in Canada |
| spelling | doaj.art-ba030861e14547e4a0ee6498a8f92f472022-12-21T20:28:36ZengPublic Health Agency of CanadaHealth Promotion and Chronic Disease Prevention in Canada2368-738X2018-10-01381034935710.24095/hpcdp.38.10.01stringBarriers and facilitators to improving health care for adults with intellectual and developmental disabilities: what do staff tell us?Avra Selick0Janet Durbin1Ian Casson2Jacques Lee3Yona Lunsky4Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, CanadaProvincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, CanadaDepartment of Family Medicine, Queen’s University, Kingston, Ontario, CanadaSunnybrook Research Institute, Toronto, Ontario, CanadaDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, Toronto, Ontario, CanadaIntroduction: Adults with intellectual and developmental disabilities (IDD) have high rates of morbidity and are less likely to receive preventive care. Emergency departments and primary care clinics are important entry points into the health care system. Improving care in these settings can lead to increased prevention activities, early disease identification, and ongoing management. We studied barriers and facilitators to improving the care of patients with IDD in three primary and three emergency care sites in Ontario. Methods: Data sources included structured implementation logs at each site, focus groups (n = 5) and interviews (n = 8). Barriers and facilitators were coded deductively based on the Consolidated Framework for Implementation Research (CFIR). Synthesis to higher level themes was achieved through review and discussion by the research team. Focus was given to differences between higher and lower implementing sites. Results: All sites were challenged to prioritize care improvement for a small, complex population and varied levels of implementation were achieved. Having national guidelines, using local data to demonstrate need and sharing evidence on value were important engagement strategies. Factors present at higher implementing sites included strong champions, alignment with site mandate, and use of electronic prompts/reminders. Lower implementing sites showed more passive endorsement of the innovation and had lower capacity to implement. Conclusion: Providing effective care for small, complex groups, such as adults with IDD, is critical to improving long-term health outcomes but is challenging to achieve. At a systemic level, funding incentives, access to expertise and improved electronic record systems may enhance capacity.https://doi.org/10.24095/hpcdp.38.10.01intellectual disability, developmental disabilities, implementation, primary health care, emergency medical services, quality improvement, barriers and facilitatorscongestive |
| spellingShingle | Avra Selick Janet Durbin Ian Casson Jacques Lee Yona Lunsky Barriers and facilitators to improving health care for adults with intellectual and developmental disabilities: what do staff tell us? Health Promotion and Chronic Disease Prevention in Canada intellectual disability, developmental disabilities, implementation, primary health care, emergency medical services, quality improvement, barriers and facilitatorscongestive |
| title | Barriers and facilitators to improving health care for adults with intellectual and developmental disabilities: what do staff tell us? |
| title_full | Barriers and facilitators to improving health care for adults with intellectual and developmental disabilities: what do staff tell us? |
| title_fullStr | Barriers and facilitators to improving health care for adults with intellectual and developmental disabilities: what do staff tell us? |
| title_full_unstemmed | Barriers and facilitators to improving health care for adults with intellectual and developmental disabilities: what do staff tell us? |
| title_short | Barriers and facilitators to improving health care for adults with intellectual and developmental disabilities: what do staff tell us? |
| title_sort | barriers and facilitators to improving health care for adults with intellectual and developmental disabilities what do staff tell us |
| topic | intellectual disability, developmental disabilities, implementation, primary health care, emergency medical services, quality improvement, barriers and facilitatorscongestive |
| url | https://doi.org/10.24095/hpcdp.38.10.01 |
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