Care of the Adult with Intellectual Disability in Primary Care

Citation

Downing, J. (2012), "Care of the Adult with Intellectual Disability in Primary Care", Advances in Mental Health and Intellectual Disabilities, Vol. 6 No. 5. https://doi.org/10.1108/amhid.2012.54206eaa.002

Care of the Adult with Intellectual Disability in Primary Care

Article Type: Book review From: Advances in Mental Health and Intellectual Disabilities, Volume 6, Issue 5

Peter Lindsay,Radcliffe Publishing,Milton Keynes, (2011),288 pp,ISBN-10 1846194792ISBN-13 9781846194795

This publication is described as an adaptation of Management Guidelines:  Developmental Disability, Version 2 (2005) and its editor is a practicing GP in Leeds who is also the Royal College of General Practitioners (RCGP) Curriculum Guardian for Intellectual Disability and a member of the RCGP Intellectual Disability Special Interest Group.  Its cover states that it is the first book of it’s kind, a claim that is easy to confirm by a quick internet search.

The book is divided into three parts.  The first contains six chapters described as an over-view of intellectual disability care.  It provides a truly rich introduction to the subject area including various definitions, epidemiology and thoroughly condensed evidence based account of the greater and different health needs of the population.  Having read the first three chapters this reviewer readily and enthusiastically recommended the work to colleagues in the field.  There are two chapters outlining the communication difficulties experienced by adults with Intellectual disability and providing simple and immediate solutions to enhance face to face consultations with patients with learning disability that can almost instantly be put into practice in the primary care setting.

Part two is entitled “Routine Care” with chapters covering the transitions of people with intellectual disability into adult services from paediatric teams and in later life and the specific health issues that arise with each stage.  It contains two comprehensive chapters on challenging behaviour including overview of an appropriate diagnostic model (Murtagh, 2003), consideration of simple positive approaches to the behavioural problem, and the use of medication to ameliorate it (strongly advising practitioners not to be drawn into collusive habitual prescribing to improve quality of life of others without proper assessment and giving detailed account of the potentially damaging beliefs and attitudes sometimes adopted by unqualified paid carers), and also a further two chapters on the assessment and treatment of psychiatric disorders in the patient group with significant specialist information pertaining to the additional complication of sensitivity to medications experienced by people with intellectual disability.  Another particularly useful chapter considers the introduction of annual health checks and evidence base that backs up their necessity.  It details what is required and also provides the read codes that correlate with Quality and outcomes framework by which general practice is both partially funded and productivity measured.  Preventative healthcare and health promotion is another very relevant and stimulating chapter identifying how a primary care practitioner can make a significant contribution to the improvement of general health and wellbeing of the patient group.  A chapter within this section gives a comprehensive overview of the mental capacity act (2005) but this chapter in particular would have benefitted with this chapter being expanded to offer the general practitioner guidance and practical examples of how to proceed when difficulties present.A chapter within this second section covering epilepsy has epidemiological data that is different to both the National Institute for Health and Clinical Excellence population benchmark and the Joint Epilepsy Council (2005) evidence on prevalence.  The reader might then wish to question other guidance within the chapter, such as a rather judgmental guide to recognising pseudo-seizures.

The third section of the book is given to 12 chapters on Specific disorders associated with intellectual disability, with each chapter covering the specific health issues pertaining to a genetic syndrome or other condition associated with intellectual disability.  Whilst some of the genetic syndromes are so rare it would be unusual for a community team covering a wide geographical area to meet a person with it (for example Noonan Syndrome prevalent in less than 1 in 10,000 births), and the chapter on Down Syndrome fails to identify congenital heart abnormalities as a significant medical condition.  There is a chapter on Foetal alcohol syndrome which has rapidly become the greatest non-genetic cause of Intellectual Disability in the UK.  The chapter on Prader-Willi syndrome contains a very relevant and useful health checklist for people with the syndrome but this has not been adopted across all of the conditions.

Over-all whilst the book is a useful and relevant contribution to the library and is a good resource for the GP, it is very disappointing that there is almost no reference made to the work of the Community Team for Adults with Intellectual Disabilities, nor to resources available to primary care practitioners such as the Strategic Health Facilitator – who’s raison d’etre is to improve standards of practice in primary care and increase numbers of individuals with intellectual disability receiving annual health checks and Health Action Plans.  Also sadly lacking is an over-view of the current direction of travel as a result of Valuing People (DH, 2001) and Valuing People Now (DH, 2009) in terms of person-centred approaches, personalisation and self-directed care.  The Social Model of Disability covers only the briefest of paragraphs in the first chapter as if it has no relevance for primary care professionals despite the fact that the care they are required to provide is always within the social context.

Jackie Downing.  MA.  B.Sc Hons.  RNLD.Lead Nurse for Adults with Learning Disabilities, (Community Adult Directorate), Guy’s & St Thomas’ NHS (Foundation) Trust,Jackie.downing@nhs.net