Approaches to Care and General Considerations
Icons used in these guidelines
Recommendations with are strongly recommended; the symbol indicates clinicians’ top recommendations; or indicates that reviewed publications pertain to the guideline background; blue indicates a subtype that increases the strength of the recommendation.
Types of knowledge
The guideline recommendations are based on four different types of knowledge: empirical knowledge; knowledge about the health care ecosystem; clinical expert knowledge; and experiential knowledge. The subtypes of knowledge are related to the strength of recommendation.
Strength of Recommendation
These guidelines outline standards of care for which there is a good basis in current knowledge. Other factors, however, were considered for deciding whether a proposed action is “strongly recommended” or “recommended”, including availability and use of resources.
The first section of the guidelines presents a practical checklist of common health issues and general considerations for the primary care of adults with intellectual and developmental disabilities. It highlights a robust patient-centred philosophy of care that focuses on the patient, placing them at the center of planning and decision-making, while maximizing their communication and agency.
The top recommendations by clinicians can do much to close the gaps that exist in the health care of people with intellectual and developmental disabilities compared to others in the community. Some key recommendations for family physicians to follow are:
- Designate a caregiver or support person who knows your patient well and can act as a reporter, recorder, advocate and collaborator.
- Complete periodic comprehensive health assessments and, together with your patient, develop a health action plan that travels with them.
- Perform regular medication reviews. In particular, carefully monitor medications that are being used off label for behaviour management in the absence of sufficient environmental and other supports.
As family physicians, we already know how to advocate for our patients, do medication reviews, conduct physical examinations and develop health action plans. Therefore, the general recommendations in this section will feel familiar to most family physicians. Compared to primary care for those in the general population, these guidelines call on family physicians to carve out extra time and build supports in their practice, for example, by adapting their communication or accommodating for patient sensitivities. Implementing such adaptations can be challenging, but should become routine practice when seeing patients with intellectual and developmental disabilities. Overall, these guidelines encourage us to empower our patients with intellectual and developmental disabilities and to develop their autonomy.
Dr. Karen McNeil (MD CCFP FCFP), is a family physician and Assistant Professor in the Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia. She has been practicing family medicine for 29 years, with Dalhousie Family Medicine 14 years and with special focus on adults with intellectual and developmental disabilities for the last 10 years.