The 2018 Canadian consensus guidelines on primary care for adults with Intellectual and Developmental Disabilities outline standards of care to support clinical decision making. These guidelines are developed by family physicians, nurses, psychiatrists and other experts who are experienced in the care of people with IDD.

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How to Use and Understand the Guidelines

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.


Learn more about types and subtypes of knowledge

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.


Learn more about strengths of recommendations

Reflect on these guidelines and earn Mainpro+ credits!


Learn how to earn Mainpro+ credits

[ultimate_modal modal_title=”Reflect on these guidelines and earn Mainpro+ credits!” modal_on=”custom-selector” modal_on_selector=”.mainpro” overlay_bg_opacity=”80″ img_size=”40″]This article is eligible for Mainpro+ certified Self-Learning credits for Canadian family physicians. To earn credits, go to www.cfp.ca and click on the Mainpro+ link. You can earn certified Self-Learning Mainpro+ credits by completing a brief reflective exercise after reading an eligible article in CFP. To perform a “reflective exercise” means to think about the content of the article and to consider what impact it will have on your practice or continuing education.[/ultimate_modal]

The Developmental Disabilities Primary Care Program is supported and funded by the Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Children, Community and Social Services and Surrey Place, Toronto.

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Top Picks

These recommendations were selected by 5 clinicians (family physicians and a psychiatrist) as the most important to promote in any clinical practice or recommendations that pertain to health issues that are most commonly overlooked in patients with IDD


 Strongly recommend

A strong recommendation is one that can be supported without qualification by family physicians and other health professionals providing primary care. They can be confident that all the following conditions apply:

  1. There are at least 3 types of knowledge supporting a recommendation or at least 2, one of which is in a category subtype indicated by a blue circle or .  This condition is taken to be an indication of the breadth, depth and special relevance of knowledge.
  2. There is a greater balance of anticipated medical benefit or positive clinical impact over risk of harm;
  3. Most people with IDD and their caregivers would find the intervention to be tolerable;
  4. The family physician or other primary care provider would typically have the resources (eg, time, materials, training, supports) to engage in the approach or offer the intervention, or would be able to accommodate or advocate for the approach or intervention.
  5. The approach or intervention is an effective use of resources, taking into consideration factors such as the impact on the time, priorities and out-of-pocket expenses of patients and their caregivers and the limits of the practice or health care system.

 Recommend

These actions have a good basis in current knowledge.  Family physicians and other health professionals providing primary care will need more extensive discussion than usual, however, with patients with IDD and caregivers and/or consultation with other health professionals, ethicists or health care administrators before deciding to implement the guideline.[/ultimate_modal][ultimate_modal modal_title=”Types of Knowledge” modal_on=”custom-selector” modal_on_selector=”.knowledge-help-lp” modal_size=”medium” overlay_bg_opacity=”80″ img_size=”25″ close_icon_position=”popup-top-right”]Blue and grey circles indicate different category subtypes. Half circles or indicate that the studies pertain to the background for the guideline. In each category, only the top ranking is shown and in the following priority of highest to lowest: . Tools and other practical resources are not categorized.

Empirical

Knowledge of the outcome of exposure or intervention acquired from:


experimental studies (eg, RCT) and systematic review or meta-analysis of such studies;


observational studies (eg, case report, case-control, cross-sectional or cohort/longitudinal studies) or systematic review and meta-analysis of such studies.

Ecosystem

Knowledge, usually descriptive or employing population-level data, regarding illness prevalence, patient or caregiver characteristics, environmental or socio-economic factors, availability or use of health care resources and services. Such studies use:


Canadian data;


non-Canadian data.

Expert

Knowledge, including skills, acquired through clinical practice. It can be elicited using qualitative approaches (eg, surveys, focus groups). It includes consensus guidelines, framing statements, position papers or topic reviews developed:


through an explicit consensus process (eg, systematic review, synthesis of knowledge, consultation or discussion);


without an explicit consensus process.

Experiential

Reflections on experiences of a health condition, care approach, intervention or health care system derived from:


patients with IDD or caregivers;


other informants.

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