feedback

Health Check

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: Health Check Tool(PDF)

Download: Health Check Tool(Word template) Leave us your feedback

Download: EMR IDD Health Check Form (PS Suite)

Download: Steps to completing the IDD Health Check (PDF)

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.

A periodic comprehensive Health Check is one of the main recommendations in the evidence-based
(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 addresses health inequities such as higher mortality and
morbidity, lower rates of preventive and screening maneuvers, excess use of emergency departments,
and barriers to health care access of adults with IDD.
The Health Check tool is most useful when there are opportunities to have a proactive, general check-up
to get to know your patient better, undertake preventive maneuvers, plan actions for complex or
multiple problems, and to identify the need for consultations and other health and social services.
 
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 issues 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
  • 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 symptom that remains unexplained.
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.

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. If available, use information from the About My Health form.

Key information:
- abilities in communication and daily living
- cause/associated condition for ID
- social supports
- support for health decision-making
- accommodations needed in office to help encounters go well (ask advice from patient/caregiver)
- 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, including substance use
- sexual health
- safety, including abuse, self-abuse, bullying and exploitation- caregiver stress
- preparation for life stage transitions- immunizations- cancer screening
- medication (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
- cancer screening
6. Assessment and plan Document the identified health issues and formulate an action plan. Identify who is responsible for these 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.

EMR Forms

A Health Check medical record template can be downloaded in fillable and/or printable PDF or for Telus PS Suite electronic medical record (EMR). The template is 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
 
Phone or virtual encounters could be used for patient comfort and to involve caregivers who might otherwise not be able to attend a clinic visit. Consider accessibility issues when providing virtual care.
 
  • 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.

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 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.

This tool is a merged version and update to the Cumulative Patient Profile for Adults with Developmental Disabilities and the Preventive Care Checklist, 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

    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.

  • About the tool development

    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 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.

  • 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, 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.