Health Check

A Comprehensive Health Assessment of Adults with Intellectual and Developmental Disabilities

Introduction

The Health Check is a tool to organize a comprehensive health assessment, including physical exam, for adults with intellectual and developmental disabilities (IDD). The tool provides an IDD perspective on a task that is familiar to family doctors and primary care nurse practitioners. It identifies health problems common in adults with IDD that are different from the general population, and provides tips and resources to facilitate diagnosis and management.

Download: IDD Health Check – Full form (Word template in English)

Download: Examen de santé – Formulaire complet (Word template in French)

Download: IDD Health Check – Brief form (Word template)

Download: Examen de santé – version abrégée (Word template in French)

Download: IDD Health Check – EMR template (Telus PS Suite)Leave us your feedback

This tool provides a step-by-step strategy to pro-active, comprehensive primary care. Learn how the Health Check helps to investigate new health issues, ongoing health concerns, and what to pay special attention to in patients with intellectual and developmental disabilities.

NEW! A fee code for IDD Health Check has been added to the OHIP Schedule of Benefits. Effective April 1st, 2023, Ontario physicians can select the K133 code for a periodic health visit for adults with intellectual and developmental disabilities. Additional details are available on the Ministry’s website.

Why do a comprehensive Health Check for adults with IDD?

A periodic comprehensive Health Check is one of the main recommendations in the evidence-based

Canadian consensus guidelines for primary care of adults with intellectual and developmental disabilities

(IDD). People with IDD are at risk of certain health problems and often have comorbidities, different

from asymptomatic, low risk adults for whom annual physicals are no longer recommended. In addition,

people with IDD might experience challenges in communicating their health issues. Therefore, pro-

active and preventive health care is important in these patients. Research has shown that Health Checks

increase the rates of preventive maneuvers, disease detection, and satisfaction of patients with IDD,

their caregivers and family doctors. It is intended to address health inequities experienced by adults

with IDD such as higher mortality and morbidity, lower rates of preventive and screening maneuvers,

excess use of emergency departments, and barriers to health care access.

When to use the Health Check

A Health Check is not meant for a typical short office visit when a patient presents initially with a

symptom. In that situation, think of common health problems in persons with IDD and how both

common and uncommon illnesses may present atypically in patients who communicate differently.

Common health problems include side effects of drugs; dental issues, constipation, gastroesophageal reflux, aspiration; seizure activity; sleep problems; pain (how would we know if there was pain in this patient?); co-morbidities associated with the patient’s syndrome if known; a change in social relationships or physical environment and a history of adverse life experiences or a psychiatric disorder. It may be helpful to plan a Health Check as part of the problem-solving for a non-urgent health problem that remains unexplained.

Steps to completing the Health Check

Steps	Practice tips and resources
1. Initial encounter	Ask for the patient’s concerns and main complaints (e.g., physical, mental health, social or financial issues) and address urgent issues. Explain the Health Check process to the patient. Together with the patient, identify someone who knows the patient well who will attend healthcare appointments, help to coordinate care, and monitor ongoing health and social needs. Introduce questionnaire(s) for patients/caregivers that will help communication for the next visit: The About My Health form provides background information that is useful to include in the Cumulative Patient Profile (CPP) and for chronic disease management The My Health Care Visit form can be used prior to the initial encounter and at any subsequent visits, whether as part of the Health Check or initiated by the patient for a specific symptom to promote understanding of the purpose and outcome of each visit. Encourage practice staff or caregivers at home to help patients complete these forms.
2. IDD-specific Cumulative Patient Profile (CPP)	Update the CPP with information important to know for adults with IDD. See the IDD Health Check full form for information to consider. If available, review information from the patient's About My Health form. Key information: - abilities in communication and daily living - cause/associated condition for intellectual disability - social supports - support for health decision-making - accommodations needed in office to help encounters go well (ask advice from patient/caregiver) - health decision-making capacity and supports for decision making - other health workers involved in care
3. Chronic disease management	Update the regular CPP/problem list.
4. Systems review / risk assessment	Assess risks that are common or important to consider for adults with IDD. Review the first section, “Preparing for my healthcare visit”, in the My Health Care Visit form, if the patient has completed it, and do a medical review of systems or functional enquiry. At a minimum, review: - usual daytime activities, physical activity, screen time, sleep - nutrition, vitamine D, calcium, diet excesses or aversions - mental health, environments, life events, trauma, and triggers for mental distress - substance use - sexual health, sexuality, intimacy and relationships - safety, including abuse, self-abuse, bullying and exploitation- caregiver stress - preparation for life stage transitions- immunizations- cancer screening - medication review (If possible, contact the patient’s pharmacist for a medication reconciliation)
Physical exam	At a minimum, examine: - vital signs - BMI/abdominal circumference - hearing/wax and vision screening - heart sounds - dentition - neuromuscular limitations and mobility - cancer screening
6. Assessment and plan	Document the identified health issues and formulate a health action plan. Identify who is responsible for the actions and a timeline for follow-up. Copy the plan for the patient or complete the second and third parts of the My Health Care Visit form (“During My Health Care Visit” and “After My Health Care Visit”) for the patient to keep. For suggestions about what elements should be included in a plan and referrals, see the notes to the full IDD Health Check medical record template.

Tips for implementing the Health Check

EMR Forms

A Health Check template can be downloaded from this page in a fillable and/or printable form or Telus PS Suite electronic medical record template (EMR). Both templates are annotated with explanations and “how-to” tips.

Identifying patients with IDD

Consider the practice-level task of identifying adults with IDD as a group to enable a practice-wide application of the Health Check or other systematic interventions for adults with IDD. Identification could start with making a list of adults with IDD based on your and your staff’s knowledge of the practice’s patients. Another method would be to search your EMR, using search terms in the tool, EMR Keyword Search Strategies. If in doubt as to whether a patient has an IDD, use a case-finding (“screening”) tool to take initial steps to recognition.

Scheduling the Health Check

A Health Check likely takes more than one encounter because of the time needed to communicate effectively with adults with IDD, to address barriers to health care and to coordinate both health and social care services. For some patients, a Health Check could be like an annual physical and accomplished over a couple of visits. For others, the Health Check could be an outline for an annual program of proactive care through regular visits every two or three months.

Invitation

Prepare staff to deal with patient and caregiver questions and possible unfamiliarity with pro-active health care. Consider stigma as a barrier. Encourage practice staff to use a telephone script when calling patients or caregivers to book a Health Check. A script can help in a situation that both patient and staff are unfamiliar with.

Team-based approach

A comprehensive health assessment takes time, especially with patients with IDD. Some parts of a Health Check can be done by other staff if available in your practice, for example:

• Clerical staff can do the initial encounter and explanation of the Health Check.

• Patients/caregivers can prepare health information in advance of the healthcare visit, through patient and caregiver engagement questionnaires (e.g., “About My Health”, “My Health Care Visit”). About My Health and My Health Care Visit are also available on the Ocean platform by CognisantMD.

• A practice nurse can enter the data into the CPP and Systems Review sections of the medical record template.

Overall, a team-based approach will make sure the limited time at the health care visit with the family doctor is being used efficiently.

Virtual care

Some patients with IDD can benefit from phone or video-based appointments. These may be appropriate for patients who have high anxiety travelling to appointments or waiting in the waiting room, are supported by caregivers who do not live locally, or have frequent routine appointments. Some patients are more difficult to engage by phone and in these cases video can be a better option to support engagement and communication. If home visits are not possible, video can be a critical tool to reach patients who are homebound and allow providers to see patients in their home environments.

Note that video/phone visits may not be appropriate for new patients, if the health issue is new or complex, if the patient/caregiver does not have access to necessary technology, if the patient doesn’t have a private space to participate, or if the patient is unable to be included in the virtual interaction. For patients with IDD who are less able to describe their symptoms, a physical exam may play a more important role in their care.

Phone or video visits can also be used as one component of a health check to increase efficiency and make the appointment more manageable for the patient. For example, the patient history can be obtained through an initial phone call with the caregiver and then a shorter in-person appointment can be conducted with the patient.

Why an IDD Health Check?

In the video Implementing Health Check family physician Dr. Ian Casson explains the importance of proactive healthcare for adults with intellectual and developmental disabilities. It highlights key elements for implementing the IDD Health Check in your practice: identifying patients with IDD; inviting people with IDD for a comprehensive health review; and using tools and resources for implementation. Developed by Health Care Access and Developmental Disabilities (H-CARDD), CAMH, Toronto, 2016 [4:20 minutes]

Clinical leads

headshot of Dr. Ian Casson

Dr. Ian Casson (MD, MSc, CCFP, FCFP), is a family doctor and chair of the Developmental Disabilities Member Interest Group of the College of Family Physicians of Canada

Authors

Terry Broda, Nurse Practitioner, Montreal, Quebec.

Meg Gemmill, MD, CCFP, Department of Family Medicine, Queen’s University, Kingston, Ontario.

Laurie Green, MD, CCFP(EM), FCFP, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario.

Elizabeth Grier, MD, CCFP, Department of Family Medicine, Queen’s University, Kingston, Ontario.

Amy Hung, MD, CCFP, Burnaby, B.C.

Jessica Ladouceur, MD, CCFP, Department of Family Medicine, Queen’s University Kingston, Ontario.

Amanda Lepp, MD, PhD, CCFP, Jordan Station, Ontario.

Ullanda Neil, MD, CCFP, Scarborough, Ontario.

Michelle Ross, MD, CCFP, Vancouver, B.C.

Bill Sullivan, MD, CCFP(COE), FCFP, PhD, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario.

Alicia Thatcher, MD, CCFP, Regina, Saskatchewan.

This tool is designed to make it easier for family doctors to provide care for adults with IDD. It identifies important health issues and provides practice tips for patients with IDD, in the context of methods familiar to Canadian family doctors: the usual clinical problem-solving steps (history, physical, assessment and plan) and medical record strategies (eg, the Cumulative Patient Profile). It can facilitate strengths of family practice, such as continuity and comprehensiveness of care, and the patient-doctor relationship.

It selects from and supplements the 2018 Canadian Consensus Guidelines for Primary Care of Adults with Intellectual and Developmental Disabilities (Canadian Family Physician 2018; 64:254-79) based on the experience and consensus of family doctors in general practices who made up the Developmental Disabilities Primary Care Program’s Health Check Tool group. The content and process of Health Checks were tested at Queen’s University’s Department of Family Medicine’s IDD Program, St Michael’s Hospital Academic Family Health Team and through the Health Care Access Research and Developmental Disabilities research program.

The Telus PS Suite EMR version of the Health Check tool was developed with the assistance of the e-Health Centre of Excellence, Waterloo, Ontario and through a grant funded by the College of Family Physicians of Canada (2021).

This tool is a merged version and update to the Cumulative Patient Profile for Adults with Developmental Disabilities and the Preventive Care Checklist (male/female), published in Sullivan WF, Developmental Disabilities Primary Care Initiative Scientific and Editorial Staff, editors. Tools for the primary care of people with developmental disabilities. Toronto: MUMS Guideline Clearing House; 2011, p.30-41.

The Health Check was revised based on a consensus conference organized by the Developmental Disabilities Member Interest Group of the College of Family Physicians on June 18, 2020 and subsequently by a working group of family physicians from across Canada, 2020-2022.

Supporting materials
- Why an IDD Health Check?
  
  In the video Implementing Health Check family physician Dr. Ian Casson explains the importance of proactive healthcare for adults with intellectual and developmental disabilities. It highlights key elements for implementing the IDD Health Check in your practice: identifying patients with IDD; inviting people with IDD for a comprehensive health review; and using tools and resources for implementation. Developed by Health Care Access and Developmental Disabilities (H-CARDD), CAMH, Toronto, 2016 [4:20 minutes]
Meet the team

Clinical leads

Dr. Ian Casson (MD, MSc, CCFP, FCFP), is a family doctor and chair of the Developmental Disabilities Member Interest Group of the College of Family Physicians of Canada

Authors

Terry Broda, Nurse Practitioner, Montreal, Quebec.

Meg Gemmill, MD, CCFP, Department of Family Medicine, Queen’s University, Kingston, Ontario.

Laurie Green, MD, CCFP(EM), FCFP, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario.

Elizabeth Grier, MD, CCFP, Department of Family Medicine, Queen’s University, Kingston, Ontario.

Amy Hung, MD, CCFP, Burnaby, B.C.

Jessica Ladouceur, MD, CCFP, Department of Family Medicine, Queen’s University Kingston, Ontario.

Amanda Lepp, MD, PhD, CCFP, Jordan Station, Ontario.

Ullanda Neil, MD, CCFP, Scarborough, Ontario.

Michelle Ross, MD, CCFP, Vancouver, B.C.

Bill Sullivan, MD, CCFP(COE), FCFP, PhD, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario.

Alicia Thatcher, MD, CCFP, Regina, Saskatchewan.
About the tool development

This tool is designed to make it easier for family doctors to provide care for adults with IDD. It identifies important health issues and provides practice tips for patients with IDD, in the context of methods familiar to Canadian family doctors: the usual clinical problem-solving steps (history, physical, assessment and plan) and medical record strategies (eg, the Cumulative Patient Profile). It can facilitate strengths of family practice, such as continuity and comprehensiveness of care, and the patient-doctor relationship.

It selects from and supplements the 2018 Canadian Consensus Guidelines for Primary Care of Adults with Intellectual and Developmental Disabilities (Canadian Family Physician 2018; 64:254-79) based on the experience and consensus of family doctors in general practices who made up the Developmental Disabilities Primary Care Program’s Health Check Tool group. The content and process of Health Checks were tested at Queen’s University’s Department of Family Medicine’s IDD Program, St Michael’s Hospital Academic Family Health Team and through the Health Care Access Research and Developmental Disabilities research program.

The Telus PS Suite EMR version of the Health Check tool was developed with the assistance of the e-Health Centre of Excellence, Waterloo, Ontario and through a grant funded by the College of Family Physicians of Canada (2021).
Version history

This tool is a merged version and update to the Cumulative Patient Profile for Adults with Developmental Disabilities and the Preventive Care Checklist (male/female), published in Sullivan WF, Developmental Disabilities Primary Care Initiative Scientific and Editorial Staff, editors. Tools for the primary care of people with developmental disabilities. Toronto: MUMS Guideline Clearing House; 2011, p.30-41.

The Health Check was revised based on a consensus conference organized by the Developmental Disabilities Member Interest Group of the College of Family Physicians on June 18, 2020 and subsequently by a working group of family physicians from across Canada, 2020-2022.

All rights reserved. No part of this website may be reproduced, stored in a retrieval system or transmitted in any form or by any means without the prior written permission of the copyright owner, Surrey Place. Contact the Developmental Disabilities Primary Care Program at Surrey Place at ddpcp@surreyplace.ca for permission to adapt information and tools to your local practice setting.

Health Check

Health Check

A Comprehensive Health Assessment of Adults with Intellectual and Developmental Disabilities

Introduction

Related Guidelines

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Why do a comprehensive Health Check for adults with IDD?

When to use the Health Check

Steps to completing the Health Check

Tips for implementing the Health Check

Clinical leads

Authors

Clinical leads

Authors

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