Background
Adults with an intellectual disability often have difficulty in receiving the healthcare they need. Compared to other adults who do not have an intellectual disability, they have poorer health and have more difficulty finding, getting to, and paying for healthcare. This happens for both physical and mental healthcare needs.
Review question
We conducted a review of the literature to assess the effects of different ways to organise services. This is the first update of a previously published review.
Study characteristics
We searched for all relevant studies until 4 September 2015. We found seven studies, six of which we identified previously and one retrieved for this update. All of the studies assessed the impact of the intervention on the mental health of persons with an intellectual disability; none considered the physical health. Those studies used different interventions, including giving persons with an intellectual disability more health services, psychological support, and treating them at home, instead of at the hospital. Studies mainly looked at how the interventions helped the behavioural problems of those with an intellectual disability, how much burden they caused the care givers, and how much they cost. No study assessed adverse events.
Key results
Community-based behaviour therapy might decrease behavioural problems. We are uncertain whether other interventions make any difference in reducing behavioural problems. There was limited evidence about how those interventions helped care givers to deal with the burden of caring for their relatives with an intellectual disability, or how much they might cost compared with the usual care already provided.
Authors' conclusions
There is little information on different ways to organise services for people with intellectual disabilities. Most studies focused on people who had intellectual disabilities and mental health problems. There were no studies on people who had intellectual disabilities and physical problems.
There is very limited evidence on the organisation of healthcare services for persons with an intellectual disability. 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.
When compared to the general population, persons with an intellectual disability have lower life expectancy, higher morbidity, and more difficulty finding and obtaining healthcare. Organisational interventions are used to reconfigure the structure or delivery of healthcare services. This is the first update of the original review.
To assess the effects of organisational interventions of healthcare services for the mental and physical health problems of persons with an intellectual disability.
For this update we searched CENTRAL, MEDLINE, EMBASE, CINAHL and other databases, from April 2006 to 4 September 2015. We checked reference lists of included studies and consulted experts in the field.
Randomised controlled trials of organisational interventions of healthcare services aimed at improving care of mental and physical health problems of adult persons with an intellectual disability.
We employed standard methodological procedures as outlined in the Cochrane Handbook of Systematic Reviews of Interventions, in addition to specific guidance from the Cochrane Effective Practice and Organisation of Care (EPOC) Group.
We identified one new trial from the updated searches.
Seven trials (347 participants) met the selection criteria. The interventions varied but had common components: interventions that increased the intensity and frequency of service delivery (4 trials, 200 participants), community-based specialist behaviour therapy (1 trial, 63 participants), and outreach treatment (1 trial, 50 participants). Another trial compared two active arms (traditional counselling and integrated intervention for bereavement, 34 participants).
The included studies investigated interventions dealing with the mental health problems of persons with an intellectual disability; none focused on physical health problems. Four studies assessed the effect of organisational interventions on behavioural problems for persons with an intellectual disability, three assessed care giver burden, and three assessed the costs associated with the interventions. None of the included studies reported data on the effect of organisational interventions on adverse events. Most studies were assessed as having low risk of bias.
It is uncertain whether interventions that increase the frequency and intensity of delivery or outreach treatment decrease behavioural problems for persons with an intellectual disability (two and one trials respectively, very low certainty evidence). Behavioural problems were slightly decreased by community-based specialist behavioural therapy (one trial, low certainty evidence). Increasing the frequency and intensity of service delivery probably makes little or no difference to care giver burden (MD 0.03, 95% CI -3.48 to 3.54, two trials, moderate certainty evidence). It is uncertain whether outreach treatment makes any difference for care giver burden (one trial, very low certainty evidence). There was very limited evidence regarding costs, with low to very low certainty evidence for the different interventions.