People with intellectual disability receive their primary health care through general practice. Communication difficulties and related challenges in history taking can mean important health issues remain under-recognised which, in turn, may lead to people living with undertreated physical or mental illness.

A systematic approach assists us to better recognise and meet the needs of this population within our practice.

All patients (of any age) with an intellectual disability (ID) are eligible for an annual Health Assessment (one per patient in any 12 month period). This is an evidence based service funded by the Medicare Benefits Schedule (MBS), which recognises the complexity of need, health disparities and unaddressed health issues experienced by this group of people. www.humanservices.gov.au/health-professionals/subjects/mbs-and-health-assessments#a7

The annual Health Assessment provides a longer consultation to enable the GP to identify and manage current health problems as well as to undertake disease prevention and health promotion interventions.

Patients (or those supporting them) might request a Health Assessment or they may be identified by the practice when they present in relation to another matter or through practice audit.

Note: Staff working in many disability support services are required to arrange an annual Health Assessment with the person’s GP. Most use the CHAP (Comprehensive Health Assessment Profile) to collect relevant information prior to the appointment. The CHAP is a health assessment tool which summarises information about the patient’s past history and guides the GP through the health assessment, highlighting commonly overlooked, difficult to manage or syndrome specific health conditions for patients with an intellectual disability.

Completion of the annual Health Assessment usually includes management of active health needs, review of medications, detection of co-morbidity, identification of risk factors and preventive health measures. Findings usually prompt further investigation, referrals and development of a GP Management Plan and Team Care Arrangements.

Check the requirements and fee for Health Assessments – Items 701, 703, 705 and 707 – through the current Medicare Benefits Schedule here:

MBS Online

Home Medication Review is valuable where there is polypharmacy, a complex medication regime, compliance concerns, drug interactions, swallowing difficulty, communication barriers, a requirement for drug level monitoring, etc.  Many patients with an ID will be eligible for a HMR.

Item number 900

Check the fee through the current Medicare Benefits Schedule here.

Chronic Disease Management Consider completion of a GP Management Plan (GPMP), Team Care arrangements (TCA) or contribution to a Multidisciplinary Care Plan where the patient has a chronic disease and complex care needs.

Item 721 GPMP, Item 723 Team Care Arrangements

Contribution to or Review of Multidisciplinary Care Plan – item 729.

Review of GPMP Item OR Review of TCA – Item 732,

Check the fee through the current Medicare Benefits Schedule here.

Mental Health: People with intellectual disabilities are at higher risk of disorders of their mental health due to bio-psycho-social risk factors. They may therefore benefit from mental health plans or referral to mental health services in the case of serious mental illness.

GP Mental Health Treatment Items – (Items 2700 to 2717)

Check the fee through the current Medicare Benefits Schedule here.

For clinical concerns re mental health or to seek advice on the appropriate use of psychotropic drugs GPs may consider referral to:

• Private Psychiatry,
• Area Mental Health Services or a
• Primary Mental Health team (PMHT)

Note: Expertise in the field of disability will vary.

• The Royal Australian and New Zealand College of Psychiatrists provides a Directory of Private Psychiatrists that can be searched according to location and special interest in working with people with developmental disability such as intellectual disability and autism. ranzcp.org/Mental-health-advice/find-a-psychiatrist.aspx
• Victorian Dual Disability Service (VDDS) can provide GPs with phone advice regarding patients with the dual disabilities of developmental disability and mental ill health. Phone advice is via +61 3 9288 2950; a response will be received within 24 hours. Direct GP referrals are not accepted.

1. Assessment and management framework for GPs: Behavioural Presentations of People with Intellectual Disability presenting with Behaviours of Concern.

http://cddh-online.monash.org/login/index.php

2. The RACGP GP learning website has 2 learning modules on caring for patients with intellectual disability:

• Developing a practice-based approach for patients with intellectual disability
• Care plans and working with services for people with intellectual disability

To access these learning modules, you need to sign up for an RACGP membership to access gplearning modules – GPlearning

3. RACGP Curriculum has a Curriculum Statement on Disability:
   http://curriculum.racgp.org.au/statements/disability/