Quality of diabetes care for adults with developmental disabilities

BackgroundGiven that individuals with developmental disabilities have a history of difficulty accessing appropriate health care, possess numerous risk factors for diabetes, and frequently have unique needs within the health care setting, it is important to conduct surveillance research to determine the quality of their diabetes care.Objective/HypothesisWe assessed the quality of diabetes care for adults with developmental disabilities enrolled in Kansas Medicaid. Developmental disability was defined in accordance with Kansas Medicaid program eligibility and included individuals with intellectual disability, cerebral palsy, autism, and/or seizure disorder.MethodsWe identified a retrospective cohort of persons with developmental disabilities who were also diabetic and continuously enrolled in Kansas Medicaid. We tracked their quality of care measures (Hb_A1c/glucose testing, cholesterol testing, eye examinations, microalbuminaria screening, and primary care visits) across the subsequent 12 months. Quality care measures were evaluated in relation to basic demographic variables and comorbid hypertension using unconditional logistic regression.ResultsAmong 5,960 adults with developmental disability, 666 had diabetes (11.2%). Annual testing rates were Hb_A1c/glucose testing, 51.7%; cholesterol, 44.3%; eye examinations, 29.3%; and microalbuminaria, 18.5%. Nearly all (93.5%) had contact with a primary care provider during the period. Comorbid hypertension was associated with higher rates of Hb_A1c, cholesterol testing, and primary care visits. Dual eligibility was associated with lower Hb_A1c/glucose testing and cholesterol testing rates but comparable rates for other measures. Caucasians were more likely to have had an eye examination but less likely to have had their microalbumin checked.ConclusionsAdults with developmental disabilities and diabetes who were enrolled in the Kansas Medicaid Program were screened at lower frequency than published national figures for key quality indicators of diabetes care. These results call for action to find approaches to improve their quality of care. Further work is needed to understand the barriers to appropriate care and incentives that will remedy these gaps. In addition, research is needed to determine the accuracy of diabetes identification, treatment, and monitoring of adults with developmental disabilities.     

Health care expenditures among working-age adults with physical disabilities: Variations by disability spans

BackgroundData on health care costs for working-age adults with physical disabilities are sparse and the dynamic nature of disability is not captured.ObjectivesTo assess the effect of 3 types of disability status (persistent disability, temporary disability, and no disability) on health care expenditures, out-of-pocket (OOP) spending, and financial burden.MethodsData from Medical Expenditure Panel Survey panel 12 (2007–2008) were used. Respondents were classified into 3 groups. Medians of average annual expenditures, OOP expenditures, and financial ratios were weighted. The package R was used for quantile regression analyses.ResultsFifteen percent of the working-age population reported persistent disabilities and 7% had temporary disabilities. The persistent disability group had the greatest unadjusted annual medians for total expenditures ($4234), OOP expenses ($591), and financial burden ratios (1.59), followed by the temporary disability group ($1612, $388, 0.71 respectively). The persistent disability group paid approximately 15% of total health care expenditures out-of-pocket, while the temporary disability group and the no disability group each paid 22% out-of-pocket. After adjusting for other factors, quantile regression shows that the persistent disability group had significantly higher total expenditures, OOP expenses, and financial burden ratios (coefficients 1664, 156, 0.58 respectively) relative to the no disability group at the 50th percentile. Results for the temporary disability group show a similar trend except for OOP expenses.ConclusionsPeople who have disabling conditions for a longer period have better financial protection against OOP health care expenses but face greater financial burdens because of their higher out-of-pocket expenditures and their socioeconomic disadvantages.     

The quality of health care for adults with developmental disabilities

OBJECTIVE: The purpose of this study was to determine the health status of adults with developmental disabilities residing in community settings and the quality of the preventive, medical, dental, and psychiatric services they receive. METHODS: Data were collected on a sample of 353 adults residing in Los Angeles, California, in 1997. Historical data were obtained from study subjects or caregivers, physical and dental examinations were performed, blood was drawn for analysis, and a psychiatrist reviewed medical records for reports of psychiatric diagnoses and consultations. RESULTS: Health markers, such as rates of obesity, and laboratory test results of routine screening panels including blood cell counts, hemoglobin, and hematocrits; blood concentrations of liver enzymes and other enzymes, cholesterol, and tryglycerides; and urinalyses were within normal limits for an adult population. However, preventive services were notably lacking, especially for individuals living at home. Fewer than half of the study subjects had received influenza vaccine; only a third of those living alone or with family or friends had received this vaccination. Chart audits revealed that about a third received psychotropic medications, but only 24% of these individuals had psychiatric consultations noted in their record. Further, 36% of this medicated group received psychotropic drugs without any identifiable diagnosis, and simultaneous receipt of two or more antipsychotics was not uncommon. CONCLUSIONS: Given that the U.S. health care system fails to ensure the provision of preventive services for all people, including the developmentally disabled, a systematic overhaul is necessary to establish an effective quality assurance program that will provide preventive medical, dental, and psychiatric services for people with developmental disabilities.     

Predictors of physical activity stage of change among adults with physical disabilities

PURPOSE: To use the Transtheoretical Model (TTM) constructs to examine the most important physical activity stage of change predictors for mostly inactive adults with physical disabilities. METHODS: A cross-sectional survey completed on the Internet. One hundred fifty-one individuals with physical disabilities (50% response rate) completed the survey questionnaires. Self-report standardized measures were used. RESULTS: A direct discriminant function analysis revealed that the most important stage of change predictors were the behavioral (r2 = .88) and cognitive (r2 = .50) processes of change, followed by self-efficacy (r2 = .33) and decisional balance (r2 = .13). The most accurate stages in prediction were the contemplation (76.3%), preparation (58.3%), and precontemplation (40%) stages, whereas the least accurate stages were the action (0.0%) and maintenance (8.3%) stages. CONCLUSION: Health promoters and educators may use strategies from the TTM to develop theory-driven physical activity motivational programs for the posited populace. Considering the cross-sectional design, study replication is warranted.     

Developing a physical activity education curriculum for adults with intellectual disabilities

Adults with intellectual disabilities have high rates of physical inactivity and related chronic diseases. Researchers have called for an increase in the development and evaluation of health education programs adapted to the unique needs of this population. Formative and process evaluation strategies were applied to develop a physical activity education program. The first phase of formative evaluation included a comprehensive literature review to select educational strategies and curriculum content. The theory of planned behavior was selected as a guiding framework, and meetings with stakeholders were held to assess feasibility. The second phase of formative evaluation included an assessment of materials by an expert panel and the priority population, and pilot testing. Next, field testing was implemented, followed by process evaluation and an assessment of implementation fidelity. The final curriculum was developed as a result of the completion of the aforementioned steps and led to a successful physical activity intervention.     

Health and housing among low-income adults with physical disabilities

The purpose of this study was to understand the impact of living environment on the health and access to health care of low-income working-age adults with physical disabilities. We conducted focus groups of participants with physical disabilities in the District of Columbia living in each of three housing situations (a homeless shelter, a nursing home, and an inaccessible house or apartment). Twenty-eight people participated in the focus groups. Most were male (79%) and African American (93%). Participants from a homeless shelter expressed concerns about accessibility and sanitation at the shelter. Nursing home participants expressed a need for privacy and autonomy that would foster consumer-directed care. Participants living in inaccessible apartments or houses worried about their ability to maintain daily living and social activities. Participants perceived barrier-free housing conditions to be a prerequisite for independent living and for ensuring their basic health and well-being.     

Availability of physical activity resources in the environment for adults with intellectual disabilities

BackgroundAdults with intellectual disabilities (ID) have high rates of physical inactivity, yet little is known about the prevalence of facilitators and barriers in the built environment contributing to these high rates.ObjectiveTo describe the physical activity resources available to adults with ID in both the home and day programs outside of the home.MethodsDemographic information was collected on a sample of adults with ID. A survey checklist of the physical activity environment at the participants’ home and the facility or workplace where the participant spent his/her weekdays was collected by trained research staff. Differences in the prevalence of environmental resources between those living in group homes and those living alone or with family were tested using χ² tests.ResultsA total of 103 participants had complete demographic and environmental data. Of these, only 37.9% had exercise equipment available, 39.8% had sports equipment, and 15.5% had a bicycle in the home environment. At the facility where the individual attended a day program or where the individual was employed, 55.4 had sports equipment, 50.5% had an outdoor recreation area, 41.8% had an indoor recreation area, and 41.8 had organized physical activities. Those who lived in group homes were more likely to have access to basketball hoops, sports fields, and recreation centers than those who lived alone or with family (p < .01).ConclusionsAdults with ID have few physical activity environmental resources and opportunities available to them, especially those not living in group homes. Future interventions are needed to increase physical activity opportunities in this underserved population.     

Longitudinal changes in psychosocial constructs and physical activity among adults with physical disabilities

BackgroundGiven the importance of physical activity (PA) and the low activity levels among adults with physical disabilities, it is important to understand how temporal changes in psychosocial constructs affect PA changes over time.Objective/HypothesisExamine if changes in the transtheoretical model (TTM) constructs affected changes in PA levels over time.MethodsOne hundred thirty-two adults with physical disabilities, such as multiple sclerosis and spinal cord injuries, completed a web-based survey once every 4 months, for a total of 3 time points, to assess the TTM constructs and PA. Six latent growth curve analyses were conducted using Mplus₅ to examine if longitudinal changes in the TTM constructs affected temporal changes in PA levels.ResultsAll six hypothesized models fit the sample data well (e.g., χ² = NS; RMSEA = <.001-.06). In a descending order of significance, the best predictors of the initial levels of PA were the stages of change, the behavioral processes of change, the cognitive processes of change, self-efficacy, and perceived pros. The meaningful predictors of PA changes over time were the initial levels and the slopes of the cognitive processes of change, perceived pros, and the behavioral processes of change. Although the slopes of the stages of change and perceived cons did not have a statistically significant effect on PA changes, their effects approached a medium size (.33 and .38, respectively).ConclusionsIn order to reassure the maintenance of an exercise program, interventionists need to first emphasize cognitive, motivational strategies (cognitive processes of change), such as the importance of PA and positive thoughts about exercise participation as well as exercise benefits (pros) before they implement behavioral strategies (behavioral processes of change), such as social support, goal setting, and self-rewarding.     

The social skill difficulties of young adults with physical disabilities

Adolescence is generally considered to be a time of increased social activity and the rapid expansion of a teenager's social circle. By contrast, a young person with a physical disability is likely to lack social independence, become socially isolated and experience difficulties in maintaining social relationships. The present study indicates that while both able-bodied and physically disabled young people experience difficulties in social situations, those with physical disabilities experience difficulties that are more severe in nature. Overall, 75% of the disabled group and 70% of the comparison group experienced difficulties in social situations. However, 37% of the disabled group experienced difficulties that were severe in nature compared to only 3% of the comparison group. Whilst these problems are of sufficient magnitude to warrant intervention, programmes of social skills training for people with physical disabilities are not yet generally available. It is recommended that training programmes in social skills should be made available to teenagers with physical disabilities.     

Dependency and family care of young adults with disabilities

This paper presents findings on the independence skills of young adults with severe disabilities obtained in a recent survey. Most young people in the sample were heavily dependent on others for help with personal care and mobility. Many also required a considerable amount of supervision because of severe behaviour disturbance. The main burden of daily care was borne by the young adults' mothers. Suggestions are made for fostering independence in self-care and wider social skills.     

Agreement of accelerometer and a physical activity questionnaire in adults with intellectual disabilities

Purpose

To assess the level of agreement between accelerometer and proxy-respondent questionnaire measurement of the physical activity levels of adults with intellectual disabilities.

Methods

In Glasgow, UK, from May to September 2009, the main carer of participants with intellectual disabilities was asked to complete the International Physical Activity Questionnaire—Short Version, detailing the participants' regular physical activity levels. Participants were also invited to wear an ActiGraph GT1M accelerometer for seven consecutive days, during all waking hours. The level of agreement from the two measurements was compared using the Bland-Altman method.

Results

There is limited agreement between physical activity and sedentary behavior measured with accelerometer and proxy-respondent questionnaire. The 95% limits of agreement for both moderate activity and sedentary activity were − 44.48 to 34.20 min per day and − 8.41 to 6.79 h per day, respectively. As physical activity increased above 10 min per day, the agreement between the accelerometer and International Physical Activity Questionnaire—Short Version data decreased further.

Conclusion

It remains uncertain whether questionnaire methods have sufficient reliability for use in surveillance of physical activity levels of adults with intellectual disabilities.     

Quality participation: Perspectives of physical activity service providers for veterans with disabilities

BackgroundCurrent physical activity promotion efforts have focused on increasing the number of available programs and frequency of veterans’ participation in physical activity (quantity of participation). The perspectives of service providers who provide physical activity programming for veterans with disabilities regarding quality participation have yet to be explored.ObjectiveThe objective of this study was to explore the perspectives of service providers regarding what constitutes quality participation in the physical activity domain for veterans with disabilities.MethodsTwenty-two service providers with experience delivering physical activity programming for military personnel with disabilities were recruited using maximum variation sampling to participate in semi-structured interviews. The interviews explored their experiences of delivering physical activity programming to service members and veterans with disabilities, as well as their perspective of what constitutes a quality physical activity experience for their program participants. Data were analyzed using reflexive thematic analysis.ResultsFour themes were identified: 1) a sense of community and shared values; 2) drivers of their own experiences; 3) forging new strengths; and 4) responsibility to the community.ConclusionsThese findings could provide researchers and service providers, including practitioners and rehabilitation specialists, with the foundations necessary for designing, implementing and evaluating physical activity programs that support full participation for veterans with disabilities.     

Personalised social care for adults with disabilities: a problematic concept for frontline practice

This paper explores the complexities and contradictions of frontline practice that pose problems for personalised social care through enhanced choice. It draws on semi-structured interviews with community care workers, social workers, occupational therapists and care managers in a social service department. Practitioners interviewed were asked about their current assessment and documentation system, including the assessment documents currently used; how they approached information gathering and the topics they explored with service users; and their experience of documenting assessment and care management. The paper argues that the validity and sustainability of personalised social care in frontline practice relies on developing a thorough understanding of the complex and implicit assessment processes operating at the service user/practitioner interface and the inevitable tensions that arise for practitioners associated with the organisational context and broader service environment. The findings demonstrate the variability among practitioners in how they collect information and more importantly, the critical role practitioners occupy in determining the kinds of topics to be explored during the assessment process. In so doing, it shows how practitioners can exert control over the decision-making process. More importantly, it provides some insight into how such processes are shaped by the constraints of the organisational context and broader service environment. Complexities and contradictions may be an inherent part of frontline practice. The issues discussed in this paper, however, highlight potential areas that might be targeted in conjunction with implementing personalised social care through enhanced choice for people with disabilities.