Abstract
Background
When compared to the general population, persons with an intellectual disability have lower life expectancy, higher morbidity, higher rates of unmet health needs, and more difficulty finding and getting health care. Organisational interventions are used to reconfigure the structure or delivery of health care services and may prove useful to decrease the noted disparities.
Objectives
To assess the effects of organisational interventions for the mental and physical health problems of persons with an intellectual disability.
Search methods
We searched the Cochrane Effective Practice and Organisation of Care Group specialised register (no year restriction), MEDLINE, EMBASE, CINAHL, other databases from January 1990 to April 2006 reference lists of included studies, and we consulted experts in the field.
Selection criteria
Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of organisational interventions aimed at improving care of mental and physical health problems of adult persons with an intellectual disability.
Data collection and analysis
Two review authors independently extracted data and assessed study quality. Missing data were requested from authors of included studies.
Main results
Eight studies met the selection criteria: six were randomised controlled trials, one was a controlled before and after study, and one was an interrupted time series. In general the studies were of acceptable methodological quality. The included studies investigated interventions dealing with the mental health problems of persons with an intellectual disability, none focused on physical health problems. Three of the studies identified effective organisational interventions and five showed no evidence of effect. Only two studies were similar enough to analyse using a meta-analysis. In the pooled analyses 25 participants received assertive community treatment and 25 received standard community treatment. Results from measures of function, caregiver burden and quality of life were non-significant.
Authors’ conclusions
There are currently no well designed studies focusing on organising the health services of persons with an intellectual disability and concurrent physical problems. There are very few studies of organisational interventions targeting mental health needs and the results of those that were found need corroboration. There is an urgent need for high quality health services research to identify optimal health services for persons with an intellectual disability and concurrent physical problem.
Plain language summary
Health care services for adults with an intellectual disability
Adults with an intellectual disability often have difficulty meeting their health care needs. Compared to the general population, they have poorer health and have more difficulty finding, getting to, and paying for health care. This difficulty is true for both physical and mental health care needs.
Efforts in the community have been made to reduce these problems for people with intellectually disabilities. In the past, people with intellectually disabilities were taken care of in special institutions. Now there is a shift towards moving people out of institutions and into the community. But with this shift, it is necessary to ensure that there are appropriate community services available. Many ways to organise the community health care services have been developed.
To determine what are the effects of different ways to organise services, a review of the literature was conducted. After searching for all relevant studies, eight studies were found. These studies were done in a variety of countries which have different health care systems overall. Therefore it is difficult to say whether a specific service works the same way in a different country.
In England, community services which provide more contact to people with intellectual disabilities and mental health problems, may provide the same benefits as a standard service.
In the United States, community services which provide more intense services to people with intellectually disabilities and mental health problems, may provide more benefits than standard services. This may be true in England for people with mild or borderline intellectual disabilities.
Overall, more research is needed to determine the effects of different ways to organise services for people with intellectual disabilities. Most studies focused on people who had intellectual disabilities and mental health problems. But there were no studies on people who had intellectual disabilities and physical problems.
