Tools

Below are a few tools to help you: 

Reasonable adjustments

To allow for person centred health care, it is important for health professionals to consider reasonable adjustments for people to participate in their health care. 

Does your practice consider Reasonable Adjustments?

These could be: 

  • Environmental – where the appointment is and how a person accesses the appointment
  • Sensory – including light sensitivities, noise sensitivities, smell sensitivities, tactile sensitivities
  • Communicative – e.g accessible resources and planning communication throughout including before (booking and reminders), during appointments and follow up (information provided)
  • Behavioural – thinking about desensitization activities (e.g visit to health service first, social stories), timings of bookings e.g appointments at consistent times of the day.14 

Health Pathways

The CESPHN region has two HealthPathways sites - South Eastern Sydney and Sydney HealthPathways 

HealthPathways Sydney currently has a suite of intellectual disability pathways that includes:

  • Intellectual Disability in Adults - Genetics
  • Health Assessment for Adults with an Intellectual Disability
  • Mental Illness in Adults with Intellectual Disability
  • Challenging Behaviours in Adults with Intellectual Disability
  • Intellectual Disability 

Additional pathways have been identified for further localisation/development/review as part of a large-scale project in consultation with various key stakeholders in the area of intellectual disability.

The clinical content of the pathways willl be shared across both Sydney and South Eastern Sydney HealthPathways programs, however the referral and service information will reflect the processes and specific providers for each region. 

South Eastern Sydney is still working on their referral pathways which will be published upon completion.

Health professionals can request access from their respective HealthPathways site by following these links:

Digital Health tools

 Quality Improvement Activities (QIAs)

Care for people with disabilities can be effectively managed if there are clear guidelines in place for support staff and families/carers to know how to access their GP for medical care.11 Undertaking a process of regularly reviewing and refining general practice processes known as quality improvement activities (QIAs) can lead to positive changes in practices in addition to improving population health by reducing the burden of disease and health inequalities in your patients. Examples of QIAs that may be relevant in assisting with managing patients with intellectual disabilities can be found here.

For further information please email: digitalhealth@cesphn.com.au

Telehealth

Our Digital Health team is here to help GPs and allied health professionals in our area with:

  • Setting up telehealth including guidance and one-on-one information sessions to encourage all health professionals to feel confident in their ability to use video telehealth. Health professionals wanting to be set up for telehealth can complete the new clinic application form and send it to telehealth@cesphn.com.au
  • Assistance and guidance with clinical information systems so patient records can be managed and transferred electronically.
  • Assistance with registration and set up of My Health Record to assist in the streamlining of patient care
  • Support with e-prescribing, e-ordering of pathology and radiology and e-referral

For further information please email: digitalhealth@cesphn.com.au

My Health Record

General practitioners are the health professionals most commonly consulted by people with intellectual disability.

This group of patients frequently have unidentified and/or sub-optimally managed conditions that can be improved through regular health assessments specifically targeting commonly associated co-morbidity and health screening activities.12 

To improve communication and coordination of care with those involved, it is important to have relevant health information in one spot. This can be achieved through the My Health Record as it can store medical history (past and current), medications, allergies, immunisations all accessible by healthcare providers.

Carers of people with intellectual disability can be authorised representatives of the My Health Record providing access, control, and peace of mind for the person they are caring for.

Further information please click here or email: digitalhealth@cesphn.com.au

Patient Management Software 

Clinical Information Software (CIS), such as Best Practice, Medical Director etc. currently have clinical coding terminology for the overarching “Intellectual Disability” diagnosis and number of other associated conditions (this might differ by each CIS) which would come under the Intellectual Disability classification.

If you record either the diagnosis of Intellectual Disability or one of the associated conditions into the patient file, as a reason for visit or into Past Medical History, patient lists can be extracted through your CIS database search.

To some extent patients coming under Intellectual Disability diagnosis can also be identified by Clinical Audit Tools such as POLAR or PEN CAT. However, Intellectual Disability coding and management is yet to be effectively addressed by software vendors of CIS or clinical audit tools, and this  project aims to engage with software vendors at higher levels to address any gaps in the current recording or identification of patients with Intellectual Disability, those eligible for Intellectual Disability Health Assessments and any associated treatments. 

Health Assessments

Health Assessments for people with intellectual disability are encouraged as they enhance patient care.

  • People with intellectual disability comprise 2–3% of the Australian population.
  •  They are more likely to experience poorer overall health status and a shorter lifespan than the general population. 

There is emerging evidence that general practitioner delivered health assessments lead to improved health outcomes for people with intellectual disability. Health assessments lead to increased case finding and detection of life-threatening conditions, mental health issues and sensory problems, and have subsequently led to increased clinical activity, improved self-care management education, increased health risk identification and disease prevention activity.13 

Medicare Benefits Schedule (MBS) Health assessment for people with an intellectual disability

A medical practitioner may select MBS Item 701 (brief), 703 (standard), 705 (long) or 707 (prolonged) to undertake a health assessment for a person with an intellectual disability depending on the length of the consultation which will be determined by the complexity of the patient’s presentation.

A health assessment for people with an intellectual disability is for patients who have significantly subaverage general intellectual functioning (two standard deviations below the average intelligence quotient (IQ)) and who would benefit from assistance with daily living activities.

The health assessment provides a structured clinical framework for medical practitioners to comprehensively assess the physical, psychological and social function of patients with an intellectual disability and to identify any medical intervention and preventive health care required.

The health assessment must include:

  • information collection, including taking a patient history and undertaking or arranging examinations and investigations as required;
  • making an overall assessment of the patient;
  • recommending appropriate interventions;
  • providing advice and information to the patient;
  • keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
  • offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

Health assessment should cover the matters listed in the Medicare Health Assessment for people with an intellectual disability pro forma

If the health assessment is not undertaken by the patient’s usual medical practitioner or practice, a copy of the health assessment report should be forwarded to that medical practitioner or practice (subject to the agreement of the patient or his/her representative).

Medical practitioners should establish a register of patients who require annual health assessments and remind these patients when their next health assessment is due.

Further information regarding MBS Health assessments for people with an intellectual disability can be found here.

If an assessment identifies that a patient has a chronic medical condition and complex care needs, it may be appropriate for you to involve other health professionals in the patient’s care using the MBS Chronic Disease Management (formerly Enhanced Primary Care of EPC), utiliising GP Management Plans (GPMP) and Team Care Arrangements (TCAs)

Comprehensive Health Assessment Program (CHAP)

CHAP is a tool designed to prompt a comprehensive health assessment for adults with intellectual disability. This may help doctors make better diagnoses, provide appropriate treatment and ultimately ensure an overall better health.

The CHAP tool requires collaboration between the person with intellectual disability, their supporter and the GP. The GP is prompted to be aware of commonly missed, poorly managed or syndrome specific health conditions and performs a review of the persons health. On completion of the GPs review, a health action plan should be agreed upon by the GP in collaboration with those involved in providing support or the person themselves.

Further information can be found here

NDIS