Are Health Needs to be Met by GP Services for People with Learning Disabilities - Essay Example

Are Health Needs Being Met by GP Services for People with Learning Disabilities?” A Qualitative Study Examination Number: EN 460 23rd January 2007 Assessment: Research Methods 1: Project Proposal Word Count: Approx. 2000 (excluding appendix) Table of Content I. Introduction II. Research Question and Objectives III. Literature Review IV. Methodology V. Conclusion VI. References VII. Appendix I. Introduction Learning disability is a major concern around the world. Learning disabilities is the term used for the learning problems such as reading, writing, listening, speaking, reasoning, and doing mathematics and cause a person to have trouble in learning and using certain skills. It can vary from person to person. The main cause for this is that the there is differences in how a person’ brain works and how it processes information. Because of learning disability various types of problems a person can face, for example poor health, not equal opportunity and respect as other people get in the society. This paper will research the area of people with learning disabilities at same time will focus on the area of health needs being met by GP services for people with learning disability or not. II. Research Question and objectives The research question of the study is as follows: Are health needs being met by GP services for people with learning disabilities? The researcher has chosen to research the area of people with learning disabilities. Researcher because of experience of working in a PCT chose this subject area, where a large proportion of people with learning disabilities access primary health care services from independent contractors. The researcher works closely with a learning disabilities team and is carrying out research on their behalf that has a keen interest to identify the barriers for people with learning disabilities face, while accessing health services within Kensington and Chelsea PCT. As a health care practitioner, researcher is concerned that these people are discriminated against. The new government health strategy “our health, our care, our say” reinforces people rights and desires. Therefore, why not people with learning disability have a same right as other people and why they cannot access the same services. The aim of the study is to identify “Are health’s needs being met by GP services for people with learning disabilities?” The purpose of this study is to identify the most effective ways of closing the health gap and improving services so that people with learning disability problems have their physical needs met. A review of literature in this area was carried out using various search strategies (See appendix 1). III. Literature Review Learning disability is a major concern around the world. Not all people share equal opportunities for good health and evidence indicates that people in less advantaged circumstances experience poorer health [1]. The poorer health of people with learning disabilities is the major concern in present circumstances. Therefore, this proposal will review the wider causes of health inequalities and consider how these affect people with learning disabilities. “People with learning disabilities have much poorer health than the general population and the NHS has traditionally failed to serve people with learning disabilities to a greater extent than the general population.” [2] People with learning disabilities are the group of people with no voice or no one listen to them and take them seriously. These are a totally disempowered group of people and the most vulnerable group, who do not have equal access to primary care. Within the primary care health services, the physical health need of patients with learning disabilities is low. Patients with learning disabilities experience health inequalities, which increases the alarming possibility that patients who are most in need are least likely to get what they need. Patients with learning disabilities are a lot more likely to have serious physical illnesses, such as diabetes, epilepsy and heart disease compared to other people in the community and yet they receive less screening checks, such as cervical smears, routine blood pressure, cholesterol checks or mammography for their existing health conditions. [3] The physical health needs of people with learning disability must be ‘moved up’ the agenda. Social exclusion factors, such as poverty, lack of housing and unemployment have a key effect on physical health and further compound the situation and can shorten life and reduce life chances. Some data gathered in Wales showed that 9% of people with learning disabilities have diabetes. 40% of women and 35% of men with learning disabilities were found to be obese. The percentage of women with learning disabilities who took up cervical smear tests was 13% compared to the 84% in GP practices as a whole. [3] It is anticipated that more consideration from primary health care services should be offered to address these concerns. Although the fact that more people with a learning disability visits their GP, over 50% of people with learning disabilities said they had trouble when trying to use services. [4] A body of evidence, which shows that people with learning disabilities experience significantly worse health outcomes than others, has prompted this research. For example, one piece of research found that, for people with learning disabilities, the risk of dying before the age of 50 is 58 times greater than it is for the UK population in general [3]. Sometimes there may be impairment-related reasons for this, but such reasons would not appear to explain why inequalities appear to be so pronounced. This study intends to find out whether people within these groups are able to get the help they need from the providers of primary health services such as doctor’s surgeries, screening facilities and providers of public health information, what can be done to remove health inequalities, and whether existing solutions to the problems are effective or adequate. Some of the problems includes are: Attitudes of reception staff. Inflexible appointment system Inaccessible entrance to surgeries Inaccessible information Tendency of some staff to neglect the physical health problems and focus exclusively on the person’s learning disability. Being struck off the GP’s register because they were deemed to be “too demanding” Access to health assessments and treatments Training requirements of staff. [3] Disproportion and poorer health cannot be explained by the learning disability alone. Therefore, it is essential that this issue is tackled across the country and the inequalities from front line providers, such as GPs, their staff and the primary care team members address these longstanding inequalities and potentially avoid these troubles. Improving the quality of people’s experience and their trust and confidence in health services at primary care level needs to be addressed. Those who have learning disabilities and mental health problems have experienced specific health inequalities, which have been widely documented. The NHS Health Scotland, Alborz et al, Horwitz et al have carried out major reviews in US and Ouellette-Kuntz et al in Canada in respect to people with learning disabilities [5]. Much of the evidence in relation to mental health is located in primary research reports. Key issues have been drawn together by Cohen [6], and Seymour [7]. Although the evidence indicates differences both within and between the two groups, there are also several points of commonality. People with learning disabilities are discriminated on grounds of disability being seen first often then their physical health problems as a primary condition for treatment. People with learning disabilities have higher than average rates of physical illness. GP Surgeries are being inaccessible to people with severe disabilities. “People with learning disabilities have an increased risk of early death compared with the general population. Mortality rates are particularly high for those with severe impairments.”[8] IV. Methodology The researcher proposes to undertake a study to understand the reasons of health inequalities among people with learning disabilities in a primary care setting in West London. Total population of Kensington & Chelsea is approximately 190,000. There are 170 people with learning disabilities living in the borough. In addition, 172 people with learning disabilities have been placed outside of the borough. The study will be undertaken with GP practice’s patients and are from a wide range of ethnic backgrounds. The study will take place between January 2007 and June 2007 and will involve qualitative study and some quantitative study in forms of questionnaires, which will be sent to different percipients who will be involved in this study. Researcher will going to study 42 GP practices and will seek the views of GP Practice staff as well as feedback from the service users using GP services. Sample (1): 42 GP’s across Kensington & Chelsea to be interviewed and sent a questionnaire (See Appendix 2). Sample (2): All people with learning disability, who will be identified by the disease register from the practice computer system using specific read codes. These read codes are 918e (all learning disability register) and 13Z4E (learning difficulty). Two questionnaires, one for people with learning disabilities or mental health problems and the other one for health care professionals, will be established. Respondents will be asked to share both positive and negative experience of primary health care. The questionnaires will be distributed widely involving 42 GP Practices within Kensington and Chelsea primary care trust (PCT), where a member of staff would be asked to fill out the questionnaire. The responses to the questionnaire will be analysed. The result of the study will be analysed and reported to the learning disability group. This study will enlighten the reason of inequalities and will contribute to developing a better practice to achieve a healthier life for people with learning disabilities within primary care settings. Inclusion criteria: 42 GP Practices within Kensington & Chelsea PCT Services user with learning disabilities including mild learning disability. GP Service used between January 2003 – December 2005 Exclusion Criteria: Aged under 18 Newly registered patients (They wouldn’t have the experience of the service usage within Kensington & Chelsea PCT) Those who have not used services within primary care for past three years Areas to be covered in the Study Two questionnaires will be sent, one to GP’s practices and one to service users. Both questionnaires will consist of the following questions in two parts. A) Primary Care Practitioner / GP: experience of treating physical healthcare needs of people with learning disabilities. B) Service User Questionnaire: Experience of using GP services. In this investigation, researchers are focusing on primary care services. These services include visits to GPs, flu jabs, screening for cancer, “stop smoking” services, family planning, and health promotion. Researcher aim to find out through this questionnaire, if the primary care services are providing an efficient service for those with learning disabilities and to ensure that there is no prejudice or discrimination of any sort while the GP practice provides its services. Data Collection and Analysis Practices will be allocated a code number for the data collection sheet. The data will be anonymous using code numbers. The researcher will examine all questionnaires for common themes, and group them into categories. The study will follow recognised qualitative and quantitative methods. Patient’s data will also be coded. The data will be anonymous using code numbers. The researcher will examine all questionnaires for common themes, and group them into categories. The study will be undertaken within the research ethical principle. Participation in the research study will be entirely voluntary. Having sent the questionnaire to all the GP practices, they are free to withdraw at any time and without giving reasons. Consent The patients will be given sufficient verbal and written & pictorial information about the purpose of the study. Researcher will ensure that the consent form is designed and written in understandable language for people with learning disabilities, which will include pictures. The patients will also be given the choice and freedom to discontinue their participation at any time during the study period. The patients will be asked to sign the consent form, before conducting any study. Signed consent form will be kept in a safe place. If the study findings are published, any identifiable data will not be used. Patients will receive a copy of the consent form and the information sheet. Clients who do not understand the written word will have pictures drawn in the consent form explaining the reasons for this study. V. Conclusion The study will help to develop a special tool for the best practice and the necessary steps to achieve a full healthy life for people with learning disabilities. In addition, NHS has made a major contribution to improve health and has an important part to play in reducing inequalities in behavioural risks and in general physical health. This study will identify the most effective ways of closing the health gap and improving services so that people with learning disability problems have their physical needs met. Reference: 1) Acheson D. Independent Inquiry into health inequalities in Health Report. London: The stationary office; 1998. 2) Department of Health: Valuing People Support Team. Valuing People [homepage on the Internet]. United Kingdom: Department of Health; [updated 2004 July; cited 2007 Jan 4]. Available from: http://www.doh.gov.uk/vpst [http://valuingpeople.gov.uk/index.jsp] 3) Disability Rights Commission. You Can Make a Difference- The DRC [homepage on the Internet]. Stratford upon Avon, CV37 9BR: DRC 2006; [updated 2006; cited 2007 Jan 4]. Available from: http://www.drc-gb.org/makeadifference 4) MENCAP. Mencap-The UK’s leading learning disability charity [homepage on the Internet]. England: 2004 Royal Mencap Society; [updated 2004 Aug 1; cited 2007 Jan 4]. Available from: http://www.mencap.org.uk 5) Alborz A, McNally R, Swallow a et al. From the Cradle to the Grave: A literature review of access to health care for people with learning disabilities across the lifespan. London: National Coordinating Center for NHS services delivery and organization. [updated 2003; cited 2007 Jan 5]. Available from: http://www.sdo.Ishtm.ac.uk/pdf/acess_alborz_report.pdf 6) Cohen A, Hove M. The physical health of patients with mental illness: a neglected area. Mental Health Promotion update: Department of Health, issue 2003; 2: 15-16. 7) Seymour L. Not All in the Mind. The physical health of mental health service users. Radical mentalities – briefing paper 2. London: Mentality; 2003. 8) Helene OK, Nathalie G, Suzanne L, Patricia M, Carol F, and Jeanette JAH. Addressing health disparities through promoting equity for individuals with intellectual disability. Queen’s University, Kingston, Canada: Healthcare Equity for Intellectually Disabled Individual Program; 2004. [cited 207Jan 5] available from www.igh.ualberta.ca/RHD/Synthesis/Disabilities.htm Appendix 1 A variety of search strategies and databases were used to obtain literature. Government documents were searched using the Department of Health website www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy. PubMed was searched using the terms “People with learning disability”. The Disability Rights commission website was searched which provided very useful data and all the previous research done on this area. Appendix 2 In this investigation, focus will be on GP services used by people with learning disability. These services include visits to GP’s, flu jabs, screening for cancer, “stop smoking” services, family planning, and health promotion etc. Information about Your Practice 1. What are your job title / profession? 2. What is the name of your locality and Neighbourhood, which you are based? 3. How many doctors are there in your practice? 4. How many patients do you have registered with learning disabilities? Questionnaire 1: GP Services 1. What do you believe the physical health problems in people with learning disability are? 2. From your experience of providing care to users with a learning disability, what do you believe the reasons for poor health for people with learning disabilities are? 3. From your experience of providing primary health services please tell us about any difficulties you believe that people with learning disabilities have in using your services. 4. Have you had any positive or negative experience of health promotion to people with learning disability problems? Yes No 5. Please also tell us about measures you have in place in your practice / surgery / clinic to make it easier for people with learning disability to receive health care. 6. Are there any possible solutions / changes; you would like to make in your practice for people with learning disabilities? Questionnaire 2: Service Users. The study aims to find out through this questionnaire if the primary care services are providing an efficient service for those with learning disabilities and to ensure that there is no prejudice or discrimination of any sort while the GP practice provides its services. If you have learning disabilities or are a carer to someone with a learning disability and have used GP services, we would like to learn about how your physical healthcare needs have been dealt with by your GP and other primary care practitioners like practice nurses, health visitors and district nurses. Please indicate (by ticking the box) whether you are: The patient A carer for someone with a learning difficulty 1. Have you/or the person you are caring for got a GP (family doctor)? 2. When was the last time you/or the person you are caring for saw a GP / family doctor or a nurse at a doctor’s surgery or health centre (not a hospital)? Last month 2/3months 6months over 6 months 3. Have you been visited by GP at home since Last month 2/3months 6months over 6 months 4. What were the reasons for this home visit? 5. Please tell us how, the doctor, the practice nurse, receptionist or other did anything supportive or helpful to you/or the person you are caring for as a person with a learning disability when you/or the person you are caring for attend the surgery or make contact with the surgery. 6. Please tell us your experience of meeting and talking to GP / practice nurse see your health problems. 7. Did you find them helpful yes No 8. How long were you with the doctor? 8minutes 10 minutes longer 9. Were you given a health check in the last 6 months? Yes No Please tick BP Height Weight Sugar Cervical cytology (women only) 10. Please tell us about the kind of difficulties you/or the person you are caring for have had in meeting & talking to the GP / Practice Manager / Nurse / or receptionist. More Information about You 11. Do you/or the person you are caring for have a learning disability? Yes No 12. Do you/or the person you are caring for have any other disability or long-term health problem? Yes No 13. Are you/the person you are caring for male or female? Male Female 14. How would you describe yourself in terms of your ethnic membership group? Bangladeshi Black African Black Caribbean Black Other Chinese Indian Irish Pakistani White Other (please state) 15. Please tell us about your/or the person you are caring for living situation: I live on my own I live with family, partner or friends I live in sheltered housing I live in a group home I am homeless I live in a hostel I live in a residential home or nursing home Other (please state) 16. How old are you/or the person you are caring for? 17. What is your/or the person you are caring for postcode? Thank you for your participation. Please be informed that none of the information you have given here will be disclosed to any parties other then myself and that this questionnaire is for research purposes only. No identifiable data will be used in final report. We may want to contact you for more information about the answers you have given me. If you are happy for us to do this, please provide us with the following details. This information will not be passed on to anyone else. Name: Contact details (e-mail, phone number or address) Please return this questionnaire by 31st January 2007 in the envelope provided. Thank you for your help Read More