A Comprehensive Health Assessment of Adults with Intellectual and Developmental Disabilities
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.
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.
|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.
- 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)
At a minimum, examine:
- vital signs
- BMI/abdominal circumference
- hearing/wax and vision screening
- heart sounds
- 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.