Standardized care programs for chronic diseases can be very complex for some patient groups, such as people with intellectual disabilities. They often have difficulty recognizing disease symptoms and understanding the consequences of their condition. And yet chronic conditions are more common in this group. To gain more insight into the care provided to these patients, Van den Bemd and colleagues made a comparison between care for chronic conditions in patients with and in patients without an intellectual disability (Br J Gen Pract. 2023;73:e744-e751 ).
The researchers included adults from the Nivel Primary Care Registers who had a diagnosis of ‘cardiovascular disease’, ‘diabetes’ or ‘COPD’ in 2018. They matched patients who had an intellectual disability according to the medical record or linked registrations with five control patients without an intellectual disability. They did this based on gender, chronic condition and 10-year age group. The researchers looked at data from all these patients from the period 2015-2018. They examined who participated in care programs and analyzed the differences between the groups in terms of the frequency of consultations, the number of medication prescriptions and routine measurements such as LDL and HbA1c.
The included 2653 patients with an intellectual disability were more than 57% male and on average almost 55 years old. Of these, around 60% had diabetes, 32% cardiovascular disease and 28% COPD. The indication for a care program was approximately 70% – also in the control group. In both groups, approximately the same number of patients participated in care programs for cardiovascular disease and COPD (about 44 and 40%, respectively); for diabetes, more people with intellectual disability participated (69.8 vs. 62.6%; odds ratio (OR): 1.44; 95% CI: 1.27-1.64).
Patients with an intellectual disability – both in care programs and outside them – had an above-average consultation 2.5-3 times more often than the control group. Only people with diabetes and an intellectual disability who were not in a care program had an above-average number of prescriptions more often than the matched patients (OR: 1.46; 95% CI: 1.10-1.95). Of the patients enrolled in care programs, all groups underwent routine measurements on average about the same number of times. Outside of care programs, people with intellectual disability and cardiovascular disease were less likely to have LDL controls compared to controls (30.1 vs. 41.1%; OR: 0.60; 95% CI: 0.42-0.87) and people with intellectual disabilities and diabetes had more HbA1c checks (36.8 vs. 24.8%; OR: 1.85; 95% CI: 1.34-2.55).
The researchers conclude that people with a chronic condition and an intellectual disability do not appear to be undertreated in terms of consultations, medication or check-ups. This is despite the fact that healthcare programs do not specifically take their needs into account.