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Learning from practice
Sharing
new commissioning work at
<a href=http://www.networks.nhs.uk/commissioningwww.networks.nhs.uk/commissioning
Commissioning
for health and well-being.
Supporting
Self Care with the Anticipatory Care Calendar
13th October 2006
Brief description
People
with a learning disability have spent decades being excluded from mainstream
society and remain almost invisible in our communities, workplaces and
in family life. As a result, the health of people with a learning
disability is significantly poorer than that of the general population.
Despite the many reports and policy recommendations about how to improve
the situation, little has been done to address the social exclusion
of this group, and their health and wellbeing continue to decline.
People
with learning disabilities are often supported by social care staff
who themselves do not have access to health care information or training,
thus, patients often arrive into health services in the late stages
of illness and disease or with preventable conditions which could be
managed more appropriately at an earlier stage. The calendar has been
devised to help track and treat changes in health and also promote regular
screening and health assessment in order to achieve a higher level of
wellness in the learning disabled population. The entire purpose
is to identify and address unmet health needs as soon as possible and
increase the quality of and access to health care for patients.
To ensure
quality, the Anticipatory Health Care Calendar was initially piloted
across two large social care providers over a three month period from
May-August 2006. 60 client records were benchmarked against set criteria
prior to the implementation of the calendar to ensure we were able to
measure improvements. All 60 people were then included in the pilot
study.
How are other
organisations and/or partnerships involved and what are they contributing
?
Warrington
Primary Care Trust have worked in partnership with Merseyside &
Cheshire Cancer Network in a nurse-led service to write health standards
into contracts for Social Care provider agencies who support patients
with learning disabilities and to ensure these standards are measured.
To enable the PCT to identify and support the health needs of people
with learning disabilities, an anticipatory care calendar has been developed
which assists social care staff to monitor the health of the clients
they support on a daily basis in order to identify changes in health
as early as possible to trigger appropriate health care interventions.
The calendar
is an easy to use, innovative approach to daily health assessment which
has been designed to alert staff to health changes and provide clear
directions about when and how to access primary care health services.
The calendar uses a 'traffic light' system with unusual observations
triggering an Amber or Red response which requires a dictated action
to contact the most appropriate health professional. A key application
of the calendar is to encourage and support social care staff to develop
a high standard of health record keeping, monitor health and ensure
clients access NHS cancer screening programmes as required. The
calendar was developed in consultation with a variety of professionals
including GP's, Specialist LD Nurses, Speech and Language Therapists
and Physiotherapists, to ensure the indicators and actions were appropriate.
The Calendar
supports staff to record observations across several physical and emotional
domains, with descriptions of status and actions to undertake if a significant
change is noted. After the three month pilot was completed, minor changes
were made and the Calendar is now in use across all 18 social care provider
agencies in Warrington.
Please cite or attach
any evidence you have of the impact on
patients' health and/or experiences,
health inequalities, primary care practice,
other NHS services, local authority services.
Numerical impact data especially welcome if available
Only 2% of
patients had a standard health record - this is now 100%.
Only 1% of
patients had health monitored daily - this is now 100%.
Only 1% of
GP/Hospital contacts were recorded - this is now 100%.
No patients
had pain assessed daily - this is now 100%.
No patients
had mobility assessed daily - this is now 100%.
Only 14% of
social care homes had a protocol to follow for patient pain - this
is now 100%.
Only 64% recorded
dietary and fluid intake daily - this is now 100%.
23 patients
were added onto the NHS Breast and Cervical Screening programmes.
28 A&E
aversions were prevented during the pilot study, with care given at
home by a Community Matron instead.
44 GP appointments
were prevented by care and advice from the Community Matrons.
8 hospital
admissions have been avoided.
9 patients
had potentially serious symptoms noted during the pilot and were referred
for diagnostic testing.
Any other benefits
?
Social Care
Staff in their evaluations stated that they now feel much more supported
and confident in observing client's health status and accessing health
care.
GP's have
reported that the Calendar has greatly assisted their differential diagnosis,
as they now have a clear monthly record of overall well-being to assist
them.
What
support from your PCT or elsewhere is critical to success of this initiative?
Individuals
with learning disabilities are less likely to attend for health screening.
The low proportions of women with learning disabilities who receive
cervical and breast screening has been much discussed, with less than
20% take-up of cervical screening frequently reported 1, 2, 3 4
reporting that 58% of eligible women (albeit based on very small numbers)
had received invitations to mammography; of these, 90% were screened,
or 52% of total eligible women. These figures compare with the
most recent figure of 81% for cervical screening among the eligible
population of England in the five years up to 2001/02 (Department of
Health 2003a); the take-up rate for breast screening was 75% in the
UK as a whole in 2002-03 (NHS Cancer Screening Programmes 2004.
Although
people with learning disabilities visit their GP (when ill) with similar
frequency to the general population, research has illustrated that they
are much less likely to receive regular health checks or access health
promotional/health improvement activities 5,6,7,8. Most GPs
agree that they should meet the medical needs of people with learning
disabilities as part of general medical service, although fewer agree
that they should take an active role, such as providing regular heath
checks 3,5,9,10.
Respiratory
disease has a higher prevalence and is the leading cause of death for
people with learning disabilities. Not only are rates of asthma
and chronic obstructive airways disease higher, they also tend to be
poorly controlled when compared to general patients 11,12,13, 14.
Of particular concern is the risk to health and respiratory function
from aspiration, caused by dysphagia and poor management of the condition
by care staff, leading to high incidences of aspiration pneumonia
15,16.
Cardiac
problems are well documented for some syndromic conditions associated
with learning disabilities: almost half of all people with Down's
Syndrome being affected by congenital heart problems 17,18,19.
CHD is the second most common cause of death amongst people with learning
disabilities 12 and rates of CHD are increasing due to increased
longevity and lifestyle changes associated with community living
20,21. Central to this problem is the high prevalence of
obesity which is significantly higher than the general population, with
only 10% of adults with LD having access to a healthy diet and 80% undertaking
far less exercise than advised by the Department of Health 22,23,24.
Nutritional factors are also thought to be a causative factor in the
proportionally higher rates of gastrointestinal cancer experienced by
people with LD, which is often diagnosed late, poorly managed and has
a higher mortality than the same disease in the general population
13,25,26.
The prevalence
rate of epilepsy amongst people with learning disabilities has been
reported between 20%-50% compared to prevalence rates for the general
population of 0.4%-1% 27,31. Although guidelines on
the successful management of epilepsy in people with learning disabilities
are available, seizures in this patient group are commonly multiple
and refractory to drug treatment, with a much higher incidence of complex
epilepsy requiring polytherapy 27,28, 29,30,31.
This
service improvement has been supported by the PCT facilitating engagement
with and approval from relevant PCT Boards, including the Learning Disability
Board and the Local Strategic Partnership Boards. The initiative
has particular relevance in terms of enabling care providers to meet
the national health standards that have been written into their contracts.
Moreover, this work is likely to impact on services other than Learning
Disabilities and is likely to extend to Mental Health, Elderley Care
and other vulnerable groups. The project manager has facilitated engagement
with primary care teams and clinical supervision and consultations have
been provided.
References.
1.
Djuretic, T., Laing-Morton, T, Guy, M. (1999). Cervical screening
for women with learning
disability:
Concerted effort is needed to ensure these women use preventive services.
BMJ, 318 318, 537.
2.
Pearson, V. Davis, C. Ruoff, C. Dyer, J. (1998). Only one quarter
of women with learning disability in Exeter have cervical screening.
British Medical Journal, 316; 1979
3.
Stein, K. (2000). Caring for people with learning disability: a
survey of general practitioners' attitudes in Southampton and South-West
Hampshire'. British Journal of Learning Disabilities; 28; 9-15
4.
Davies, N. Duff, M. (2001). Breast cancer screening for older
women with intellectual disability living in community group homes.
Journal of Intellectual Disability Research, 45, 253-257.
5.Kerr,
M.P. Richards, D. Glover, G. (1996). Primary care for people with
a learning disability - a Group Practice survey'. Journal of
Applied Research in Intellectual Disability;9; 347-352.
6.
Whitfield, M.L. Langan, J. Russell, O. (1996). Assessing general
practitioners' care of adult patients with learning disability: case
control study. Quality in Health Care; 5;31-35
7.
Piachaud, J. Rohde, J. Pasupathy, A. (1998). Health screening for
people with Down's syndrome. Journal of Intellectual Disability
Research;42; 341-345.
8.
Department of Health (DH) (2001).Valuing People: A New Strategy
for Learning Disability for the 21st Century.
London: The Stationery Office
9.
Bond, L. Kerr, M. Dunstan, F. Thapar, A. (1997). Attitudes of general
practitioners towards health care for people with intellectual disability
and the factors underlying these attitudes. Journal of Intellectual
Disability Research; 41; 391-400.
10.
Harrison, S. Berry, L. (2005) 'Who Cares? Why primary care professionals
and specialist learning disability teams should be equal partners in
health action planning', Learning Disability Practice Journal;
8(6) 18-21
11.Puri,
B.K. Lekh, S.K. Langa, A. Zaman, R. Singh, I. (1995). Mortality
in a hospitalized mentally handicapped population: a 10-year survey'.
Journal of Intellectual Disability Research';39; 442-446
12.
Hollins, S. Attard, M.T. von Fraunhofer, N. Sedgwick, P. (1998).
Mortality in people with learning disability: risks, causes, and death
certification findings in London. Developmental Medicine &
Child Neurology;40; 50-56
13.
Evenhuis, H. Henderson, C.M. Beange, H. Lennox, N. Chicoine, B.
(2000). Healthy Ageing - Adults with Intellectual Disabilities:
Physical Health Issues. Geneva, Switzerland; World Health Organization
14.
Janicki, M.P. Davidson. P.W. Henderson, C.M McCallion,
P. Taets, J.D. Force, L.T. Sulkes, S.B. Frangenberg, E.
Ladrigan, P.M. (2002). Health characteristics and health services
utilization in older adults with intellectual disability living in community
residences. Journal
of Intellectual Disability Research; 46(4); 287
15.
Jolly, C. Jamieson, J.M. (1999). The nutritional problems of adults
with severe learning disabilities living in the community. Journal of Human Nutrition
& Dietetics; 12 (1); 29
16.
Gravestock, S. (2000). Eating disorders in adults with intellectual
disability. Journal
of Intellectual Disability Research; 44 (6);625
17.
Brookes, M.E. Alberman, E. (1996). Early mortality and morbidity
in children with Down's syndrome diagnosed in two regional health
authorities in 1988. Journal of Medical Screening; 3; 7-11
18.
Mol. B.W. (1999). Down's syndrome, cardiac anomalies, and nuchal
translucency. BMJ; 318(7176); 70-1.
19.
Hermon, C. Alberman, E. Beral, V. Swerdlow, A.J.
(2001). Mortality and cancer incidence in persons with Down's syndrome,
their parents and siblings. Annals of Human Genetics; 65;
167-176
20.
Turner, S. Moss, S. (1996). The health needs of adults with learning
disabilities and the Health of the Nation strategy. Journal
of Intellectual Disability Research; 40; 438-450
21.
Wells, M.B. Turner, S. Martin, D.M. Roy, A. (1995). Health gain
through screening - coronary heart disease and stroke: developing primary
health care services for people with intellectual disability. Journal
of Intellectual & Developmental Disability; 22; 251-263
22.
Prasher, V.P. (1995). Overweight and obesity amongst Down's Syndrome
adults. Journal of Intellectual Disability Research; 39;
437-439
23.
Robertson, J. Emerson, E. Gregory, N. Hatton, C. Turner, S. Kessissoglou,
S. Hallam, A. (2000). Lifestyle related risk factors for poor health
in residential settings for people with intellectual disabilities.
Research in Developmental Disabilities; 21; 469-486
24.
Marshall, D. McConkey, R. Moore, G.
(2003). Obesity in people with intellectual disabilities: the impact
of nurse-led health screening and health promotion activities. Journal
of Advanced Nursing; 41(2); 147-153
25.
Cooke, L.B. (1997). Cancer and learning disability. Journal of
Intellectual Disability Research; 41; 312-316
26.
Duff, M. Hoghton, M. Scheepers, M. Cooper, M. Baddeley, P. (2001).
Helicobacter pylori: has the filler escaped from the institution?
A possible cause of increased stomach cancer in a population with intellectual
disability'. Journal of Intellectual Disability Research; 45;
219-225
27.
Espie, C.A. Paul, A. Graham, M. Sterrick, M. Foley, J. McGarvey, C.
(1998). The Epilepsy Outcome Scale: the development of a measure for
use with carers of people with epilepsy plus intellectual disability.
Journal of Intellectual Disability Research; 42(1); 90-96
28.
Branford, D. Bhaumik, S. Duncan, F.
(1998). Epilepsy in adults with learning disabilities. Seizure;
7; 473-477
29.
Kerr, M. Bowley, C. (2001). Evidence-based prescribing in
adults with learning disability and epilepsy. Epilepsia; 42(Suppl.
1)l; 44-45.
30.
Kerr, M. Bowley, C. (2001). Multidisciplinary and multiagency
contributions to care for those with learning disability who have epilepsy.
Epilepsia; 42(Suppl. 1); 55-56.
31.National
Institute for Clinical Excellence (NICE)
(2004). The Epilepsies: the diagnosis and management of the epilepsies
in adults and children in primary and secondary care - NICE guidelines'.
London: NICE
Problems or obstacles
to progress - and suggested solutions
Funding
for the professional printing of the Anticipatory Care Calendars to
enable the PCT to role the service out across Warrington.
Other comments
Including any lessons
learned in the development and implementation of the initiative.
All staff
and managers using the calendar received a briefing and education session
before the first pilot phase. Two Community Matrons were on call during
the pilot period to answer any health related queries and ensure rapid
access to clinical care where required. Following completion of
the pilot, a review was completed in August 2006 prior to all other
social care provider agencies adopting the calendar as their primary
client health record. Calendars were reviewed by a Community Matron
at then end of each month and any identified patterns or health needs
addressed. Slight changes have been made to the document to improve
the way in which it is used following feedback and review.
Further information:
Scott Harrison
Community Matron
Warrington PCT
01925 843872
<a href=mailto:Scott.harrison@warrington-pct.nhs.ukScott.harrison@warrington-pct.nhs.uk
Tracie Keats
Health Inequalities Project Manager
Warrington PCT
01925 843864
Tracie.keats@warrington-pct.nhs.uk
warrington_pct
Learning from practice: commissioning
and demand management examples at www.networks.nhs.uk/commissioning
Learning from practice is an initiative of NHS Networks
supported by the Department of Health, the NHS Integrated Service Improvement
Programme and the NHS Institute for Innovation and Improvement.
Learning from practice submit new entry
Learning from practice
Sharing
new commissioning work at
<a href=http://www.networks.nhs.uk/commissioningwww.networks.nhs.uk/commissioning
Commissioning
for health and well-being.
Supporting
Self Care with the Anticipatory Care Calendar
13th October 2006
Brief description
People
with a learning disability have spent decades being excluded from mainstream
society and remain almost invisible in our communities, workplaces and
in family life. As a result, the health of people with a learning
disability is significantly poorer than that of the general population.
Despite the many reports and policy recommendations about how to improve
the situation, little has been done to address the social exclusion
of this group, and their health and wellbeing continue to decline.
People
with learning disabilities are often supported by social care staff
who themselves do not have access to health care information or training,
thus, patients often arrive into health services in the late stages
of illness and disease or with preventable conditions which could be
managed more appropriately at an earlier stage. The calendar has been
devised to help track and treat changes in health and also promote regular
screening and health assessment in order to achieve a higher level of
wellness in the learning disabled population. The entire purpose
is to identify and address unmet health needs as soon as possible and
increase the quality of and access to health care for patients.
To ensure
quality, the Anticipatory Health Care Calendar was initially piloted
across two large social care providers over a three month period from
May-August 2006. 60 client records were benchmarked against set criteria
prior to the implementation of the calendar to ensure we were able to
measure improvements. All 60 people were then included in the pilot
study.
How are other
organisations and/or partnerships involved and what are they contributing
?
Warrington
Primary Care Trust have worked in partnership with Merseyside &
Cheshire Cancer Network in a nurse-led service to write health standards
into contracts for Social Care provider agencies who support patients
with learning disabilities and to ensure these standards are measured.
To enable the PCT to identify and support the health needs of people
with learning disabilities, an anticipatory care calendar has been developed
which assists social care staff to monitor the health of the clients
they support on a daily basis in order to identify changes in health
as early as possible to trigger appropriate health care interventions.
The calendar
is an easy to use, innovative approach to daily health assessment which
has been designed to alert staff to health changes and provide clear
directions about when and how to access primary care health services.
The calendar uses a 'traffic light' system with unusual observations
triggering an Amber or Red response which requires a dictated action
to contact the most appropriate health professional. A key application
of the calendar is to encourage and support social care staff to develop
a high standard of health record keeping, monitor health and ensure
clients access NHS cancer screening programmes as required. The
calendar was developed in consultation with a variety of professionals
including GP's, Specialist LD Nurses, Speech and Language Therapists
and Physiotherapists, to ensure the indicators and actions were appropriate.
The Calendar
supports staff to record observations across several physical and emotional
domains, with descriptions of status and actions to undertake if a significant
change is noted. After the three month pilot was completed, minor changes
were made and the Calendar is now in use across all 18 social care provider
agencies in Warrington.
Please cite or attach
any evidence you have of the impact on
patients' health and/or experiences,
health inequalities, primary care practice,
other NHS services, local authority services.
Numerical impact data especially welcome if available
Only 2% of
patients had a standard health record - this is now 100%.
Only 1% of
patients had health monitored daily - this is now 100%.
Only 1% of
GP/Hospital contacts were recorded - this is now 100%.
No patients
had pain assessed daily - this is now 100%.
No patients
had mobility assessed daily - this is now 100%.
Only 14% of
social care homes had a protocol to follow for patient pain - this
is now 100%.
Only 64% recorded
dietary and fluid intake daily - this is now 100%.
23 patients
were added onto the NHS Breast and Cervical Screening programmes.
28 A&E
aversions were prevented during the pilot study, with care given at
home by a Community Matron instead.
44 GP appointments
were prevented by care and advice from the Community Matrons.
8 hospital
admissions have been avoided.
9 patients
had potentially serious symptoms noted during the pilot and were referred
for diagnostic testing.
Any other benefits
?
Social Care
Staff in their evaluations stated that they now feel much more supported
and confident in observing client's health status and accessing health
care.
GP's have
reported that the Calendar has greatly assisted their differential diagnosis,
as they now have a clear monthly record of overall well-being to assist
them.
What
support from your PCT or elsewhere is critical to success of this initiative?
Individuals
with learning disabilities are less likely to attend for health screening.
The low proportions of women with learning disabilities who receive
cervical and breast screening has been much discussed, with less than
20% take-up of cervical screening frequently reported 1, 2, 3 4
reporting that 58% of eligible women (albeit based on very small numbers)
had received invitations to mammography; of these, 90% were screened,
or 52% of total eligible women. These figures compare with the
most recent figure of 81% for cervical screening among the eligible
population of England in the five years up to 2001/02 (Department of
Health 2003a); the take-up rate for breast screening was 75% in the
UK as a whole in 2002-03 (NHS Cancer Screening Programmes 2004.
Although
people with learning disabilities visit their GP (when ill) with similar
frequency to the general population, research has illustrated that they
are much less likely to receive regular health checks or access health
promotional/health improvement activities 5,6,7,8. Most GPs
agree that they should meet the medical needs of people with learning
disabilities as part of general medical service, although fewer agree
that they should take an active role, such as providing regular heath
checks 3,5,9,10.
Respiratory
disease has a higher prevalence and is the leading cause of death for
people with learning disabilities. Not only are rates of asthma
and chronic obstructive airways disease higher, they also tend to be
poorly controlled when compared to general patients 11,12,13, 14.
Of particular concern is the risk to health and respiratory function
from aspiration, caused by dysphagia and poor management of the condition
by care staff, leading to high incidences of aspiration pneumonia
15,16.
Cardiac
problems are well documented for some syndromic conditions associated
with learning disabilities: almost half of all people with Down's
Syndrome being affected by congenital heart problems 17,18,19.
CHD is the second most common cause of death amongst people with learning
disabilities 12 and rates of CHD are increasing due to increased
longevity and lifestyle changes associated with community living
20,21. Central to this problem is the high prevalence of
obesity which is significantly higher than the general population, with
only 10% of adults with LD having access to a healthy diet and 80% undertaking
far less exercise than advised by the Department of Health 22,23,24.
Nutritional factors are also thought to be a causative factor in the
proportionally higher rates of gastrointestinal cancer experienced by
people with LD, which is often diagnosed late, poorly managed and has
a higher mortality than the same disease in the general population
13,25,26.
The prevalence
rate of epilepsy amongst people with learning disabilities has been
reported between 20%-50% compared to prevalence rates for the general
population of 0.4%-1% 27,31. Although guidelines on
the successful management of epilepsy in people with learning disabilities
are available, seizures in this patient group are commonly multiple
and refractory to drug treatment, with a much higher incidence of complex
epilepsy requiring polytherapy 27,28, 29,30,31.
This
service improvement has been supported by the PCT facilitating engagement
with and approval from relevant PCT Boards, including the Learning Disability
Board and the Local Strategic Partnership Boards. The initiative
has particular relevance in terms of enabling care providers to meet
the national health standards that have been written into their contracts.
Moreover, this work is likely to impact on services other than Learning
Disabilities and is likely to extend to Mental Health, Elderley Care
and other vulnerable groups. The project manager has facilitated engagement
with primary care teams and clinical supervision and consultations have
been provided.
References.
1.
Djuretic, T., Laing-Morton, T, Guy, M. (1999). Cervical screening
for women with learning
disability:
Concerted effort is needed to ensure these women use preventive services.
BMJ, 318 318, 537.
2.
Pearson, V. Davis, C. Ruoff, C. Dyer, J. (1998). Only one quarter
of women with learning disability in Exeter have cervical screening.
British Medical Journal, 316; 1979
3.
Stein, K. (2000). Caring for people with learning disability: a
survey of general practitioners' attitudes in Southampton and South-West
Hampshire'. British Journal of Learning Disabilities; 28; 9-15
4.
Davies, N. Duff, M. (2001). Breast cancer screening for older
women with intellectual disability living in community group homes.
Journal of Intellectual Disability Research, 45, 253-257.
5.Kerr,
M.P. Richards, D. Glover, G. (1996). Primary care for people with
a learning disability - a Group Practice survey'. Journal of
Applied Research in Intellectual Disability;9; 347-352.
6.
Whitfield, M.L. Langan, J. Russell, O. (1996). Assessing general
practitioners' care of adult patients with learning disability: case
control study. Quality in Health Care; 5;31-35
7.
Piachaud, J. Rohde, J. Pasupathy, A. (1998). Health screening for
people with Down's syndrome. Journal of Intellectual Disability
Research;42; 341-345.
8.
Department of Health (DH) (2001).Valuing People: A New Strategy
for Learning Disability for the 21st Century.
London: The Stationery Office
9.
Bond, L. Kerr, M. Dunstan, F. Thapar, A. (1997). Attitudes of general
practitioners towards health care for people with intellectual disability
and the factors underlying these attitudes. Journal of Intellectual
Disability Research; 41; 391-400.
10.
Harrison, S. Berry, L. (2005) 'Who Cares? Why primary care professionals
and specialist learning disability teams should be equal partners in
health action planning', Learning Disability Practice Journal;
8(6) 18-21
11.Puri,
B.K. Lekh, S.K. Langa, A. Zaman, R. Singh, I. (1995). Mortality
in a hospitalized mentally handicapped population: a 10-year survey'.
Journal of Intellectual Disability Research';39; 442-446
12.
Hollins, S. Attard, M.T. von Fraunhofer, N. Sedgwick, P. (1998).
Mortality in people with learning disability: risks, causes, and death
certification findings in London. Developmental Medicine &
Child Neurology;40; 50-56
13.
Evenhuis, H. Henderson, C.M. Beange, H. Lennox, N. Chicoine, B.
(2000). Healthy Ageing - Adults with Intellectual Disabilities:
Physical Health Issues. Geneva, Switzerland; World Health Organization
14.
Janicki, M.P. Davidson. P.W. Henderson, C.M McCallion,
P. Taets, J.D. Force, L.T. Sulkes, S.B. Frangenberg, E.
Ladrigan, P.M. (2002). Health characteristics and health services
utilization in older adults with intellectual disability living in community
residences. Journal
of Intellectual Disability Research; 46(4); 287
15.
Jolly, C. Jamieson, J.M. (1999). The nutritional problems of adults
with severe learning disabilities living in the community. Journal of Human Nutrition
& Dietetics; 12 (1); 29
16.
Gravestock, S. (2000). Eating disorders in adults with intellectual
disability. Journal
of Intellectual Disability Research; 44 (6);625
17.
Brookes, M.E. Alberman, E. (1996). Early mortality and morbidity
in children with Down's syndrome diagnosed in two regional health
authorities in 1988. Journal of Medical Screening; 3; 7-11
18.
Mol. B.W. (1999). Down's syndrome, cardiac anomalies, and nuchal
translucency. BMJ; 318(7176); 70-1.
19.
Hermon, C. Alberman, E. Beral, V. Swerdlow, A.J.
(2001). Mortality and cancer incidence in persons with Down's syndrome,
their parents and siblings. Annals of Human Genetics; 65;
167-176
20.
Turner, S. Moss, S. (1996). The health needs of adults with learning
disabilities and the Health of the Nation strategy. Journal
of Intellectual Disability Research; 40; 438-450
21.
Wells, M.B. Turner, S. Martin, D.M. Roy, A. (1995). Health gain
through screening - coronary heart disease and stroke: developing primary
health care services for people with intellectual disability. Journal
of Intellectual & Developmental Disability; 22; 251-263
22.
Prasher, V.P. (1995). Overweight and obesity amongst Down's Syndrome
adults. Journal of Intellectual Disability Research; 39;
437-439
23.
Robertson, J. Emerson, E. Gregory, N. Hatton, C. Turner, S. Kessissoglou,
S. Hallam, A. (2000). Lifestyle related risk factors for poor health
in residential settings for people with intellectual disabilities.
Research in Developmental Disabilities; 21; 469-486
24.
Marshall, D. McConkey, R. Moore, G.
(2003). Obesity in people with intellectual disabilities: the impact
of nurse-led health screening and health promotion activities. Journal
of Advanced Nursing; 41(2); 147-153
25.
Cooke, L.B. (1997). Cancer and learning disability. Journal of
Intellectual Disability Research; 41; 312-316
26.
Duff, M. Hoghton, M. Scheepers, M. Cooper, M. Baddeley, P. (2001).
Helicobacter pylori: has the filler escaped from the institution?
A possible cause of increased stomach cancer in a population with intellectual
disability'. Journal of Intellectual Disability Research; 45;
219-225
27.
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Problems or obstacles
to progress - and suggested solutions
Funding
for the professional printing of the Anticipatory Care Calendars to
enable the PCT to role the service out across Warrington.
Other comments
Including any lessons
learned in the development and implementation of the initiative.
All staff
and managers using the calendar received a briefing and education session
before the first pilot phase. Two Community Matrons were on call during
the pilot period to answer any health related queries and ensure rapid
access to clinical care where required. Following completion of
the pilot, a review was completed in August 2006 prior to all other
social care provider agencies adopting the calendar as their primary
client health record. Calendars were reviewed by a Community Matron
at then end of each month and any identified patterns or health needs
addressed. Slight changes have been made to the document to improve
the way in which it is used following feedback and review.
Further information:
Scott Harrison
Community Matron
Warrington PCT
01925 843872
<a href=mailto:Scott.harrison@warrington-pct.nhs.ukScott.harrison@warrington-pct.nhs.uk
Tracie Keats
Health Inequalities Project Manager
Warrington PCT
01925 843864
Tracie.keats@warrington-pct.nhs.uk
warrington_pct
Learning from practice: commissioning
and demand management examples at www.networks.nhs.uk/commissioning
Learning from practice is an initiative of NHS Networks
supported by the Department of Health, the NHS Integrated Service Improvement
Programme and the NHS Institute for Innovation and Improvement.