Case Preparation

Health Disparities

A comprehensive government document addresses health disparities specific to the population of individuals with intellectual disabilities: “Closing the Gap: A National Blueprint to Improve the Health of Persons with Mental Retardation” (U.S., 2001). This document can be found at: https://www.ncbi.nlm.nih.gov/books/NBK44346/. Many forms of health disparities affect the population of individuals with intellectual disabilities, including a lower life expectancy, increased morbidity rates (i.e. epilepsy, behavioral disorders), an increase in negative determinants of health (i.e. high levels of obesity, low employment), difficulty accessing services, and a lack of quality services. “Closing the Gap” and Kerr (2004) suggest that health disparities for individuals with intellectual disabilities are due to four major factors: a lack of understanding of their special health care needs by health care providers, problems with getting health care services, difficulties growing up and living with disabilities, and healthy lifestyle issues.

Persons with intellectual disabilities often have concerns about the attitudes of their health care professionals and the quality of their health services (Kerr, 2004). Physicians and providers may be unwilling to accept the individual with intellectual disabilities as a patient.  They may prefer to interact directly with a family member and only indirectly with the patient. Because there are numerous gaps in the scientific knowledge base regarding health care needs of this population, the quality of health services is compromised.  This lack of knowledge of the population translates into a lack of knowledge usable by caregivers, physicians, and other health care providers. For example, providers may not be aware of a patient’s special health needs, leading to inaccurate diagnoses or overmedication. “Closing the Gap” recommends developing practice guidelines and methods to measure quality care in all medical institutions for patients with intellectual disabilities (U.S., 2001).

Physicians who specialize in caring for patients with intellectual disabilities may not be widely available, leading to the next health disparity: getting health care services. Not only are physicians who specialize in intellectual disabilities difficult to identify, patients may also have difficulties making travel arrangements for appointments - whether it be to the next city or across the country. Patients’ decreased mobility, along with sensory impairment and communication difficulties, may create more barriers (Kerr, 2004). In addition to accessing medical care, individuals with intellectual disabilities often have trouble paying for the care they need. While Medicaid offers extensive coverage for children, after becoming an adult, the coverage dwindles drastically (U.S., 2001).

When an individual with intellectual disabilities becomes an adult, the family may have to assume more responsibilities for the patient’s health and well-being.  These responsibilities may have been previously managed by health care providers and the government.  Families must coordinate multiple services to care for the individual and offer financial support to the person due to the losses in Medicaid coverage (U.S., 2001).  As persons with intellectual disabilities grow older, they face expected age-associated conditions as well as conditions specific to their population, such as premature dementia.  Problems with medication needs or mobility may be incorrectly perceived as an issue associated with the intellectual disability rather than the simple factor of age.

The last major disparity involves the roles of health providers, individuals with intellectual disabilities and their caregivers in preventing illness, secondary disabilities and maintaining good health. The disparities are even more overwhelming when the individuals with intellectual disabilities are from minority communities.  These persons come from different cultures, may speak different languages, and often have a low socioeconomic status (U.S., 2001).

The U.S. Public Health Service recommends several changes to help reduce health disparities for persons with intellectual disabilities.  They advise giving priority attention to research for individuals with intellectual disabilities.  They also urge collaboration between various types of health care providers to expand knowledge of specialized care.  Addressing the health care needs of individuals in this population may be more suitable for settings that provide interdisciplinary health care services.  Bigham, Thompson, and Scannell (2007) reported that persons with intellectual disabilities, as well as their caretakers, supported the creation of a national directory listing healthcare providers specialized in their population. A Provider Directory was created by the American Academy of Family Physicians. Establishing standards of clinical practice and evaluation of services for persons with intellectual disabilities are also recommended. Further, “Closing the Gap” suggests the need to change the financing of health care for this group, and to address the public’s misconceptions (U.S., 2001).

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