Health Check tool

Case descriptions

Case 1. A 55-year-old woman visits your office with a staff member from the home for adults with intellectual and developmental disabilities (IDD) in which she lives. She has cerebral palsy. Her family and the staff have noted a functional decline in the past few years: she now requires a wheelchair, uses fewer words, and no longer does jigsaw puzzles, which she used to enjoy.

Case 2. A 25-year-old man, unfamiliar to you, comes for a checkup with his parent. He has autism and intellectual disability and was previously followed by a developmental pediatrician on occasional visits to a multidisciplinary clinic.

Case 3. A 35-year-old single mother requests that you complete a disability form. She has a recent psychologist’s report indicating mild intellectual disability. In planning follow-up, you note that she has missed many appointments in the past for herself and for her children.

Adults with IDD have difficulty accessing health care services and present to family practices with complex health issues. A Health Check tool¹ is available to make encounters easier by providing structure and alerts for common issues (available at CFPlus).^* This is useful in 2 situations: for solving existing clinical problems and for providing anticipatory, preventive care. The latter could be provided in an annual comprehensive health assessment, which is a recommendation, based on level I evidence, of the “Primary care of adults with intellectual and developmental disabilities. 2018 Canadian consensus guidelines.”²

Development of the Health Check tool

A group of family physicians^† with general practices who are associated with the Developmental Disabilities Primary Care Program³ met and corresponded in 2018 to review resources^4,5 and revise previous versions of the tool.⁶

The tool will seem familiar to family physicians because it emphasizes multidisciplinary, comprehensive, continuing care focused on the patient-doctor relationship. The tool follows the usual steps of a family practice encounter: current concerns, past health, systems review (or risk assessment), physical examination, assessment, and planning, with emphasis on accommodations for patients with IDD. Annotations highlight issues and resources specific to this group. In particular, the routine content of the cumulative patient profile (CPP) is supplemented to increase the effectiveness of action plans. The systems review and physical examination promote a broad approach to offset key barriers to access: alternative communication needs, health literacy, and difficulty navigating the health care system.

Attempting a comprehensive health assessment for a patient with IDD is a familiar challenge for family doctors because it is similar to assessing patients with multimorbidity and complexity. Solutions include using follow-up appointments and electronic medical record (EMR) prompts. The annotations in the Health Check tool identify tools for data collection by patients and caregivers, as well as criteria to assess the need for referrals.

Where feasible, the work involved in Health Checks can be distributed in a systematic fashion. For instance, clerical staff could arrange appointments proactively, invite caregivers or individuals who can best support decision making to accompany the patient, or identify accommodations to increase accessibility in the office.⁷ A practical guide to implementation of Health Checks points out facilitators and barriers,⁸ which are also explored in pilot program evaluation reports.^9,10