People with intellectual disability constitute approximately 2% of the population. They die prematurely, and often have a number of unrecognised or poorly managed medical conditions as well as inadequate health promotion and disease prevention.
A cluster randomised controlled trial with matched pairs was carried out. The participants were adults with intellectual disability (n=453 in 34 clusters). The intervention was a health assessment program to enhance interactions between the adult with intellectual disability, their carer, and their general practitioner (GP). It promoted the systematic gathering of a health history and, subsequently, access to a GP for a guided health review and development of a health action plan. It also provided information about the health of adults with intellectual disability. Follow-up was for one year post-intervention, with outcomes extracted from GPs' clinical records. Interviews of adults with intellectual disability, their residential support staff and GPs were performed prior to and after the intervention period.
Increased health promotion, disease prevention and case-finding activity was found in ther intervention group. Compared with the control group there was a 6.6-fold increase in detection of vision impairment [95% confidence interval 1.9-40]; a 30-fold increase in hearing testing [4.0-230]; an increase in immunisation updates (tetanus/diphtheria a nine-fold increase [4.2-19]), and improvements in women's health screening (Papanicolau smears were eight times more common [1.8-35]). The intervention increased detection of new disease by 1.6 times [0.9-2.8]. Residential support staff and GPs largely supported the implementation of the health assessment process however interviews of adults with intellectual disability were uninformative.
The Comprehensive Health Assessment Program (CHAP) produced a substantial increase in GPs' attention to the health needs of adults with intellectual disability with noncomitantly more disease detection, and the process was supported by residential support staff and GPs. The presumption that these will yield longer-term health benefits, while suggestive, remains unexamined.