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Learning disabilities DES ‘led to improved care’

The learning disabilities DES introduced in 2008 has led to significant improvements in care of patients with intellectual disabilities, with increases in both general and specific health check-ups as well as better care planning, research has shown.

The study, published in the Lancet Psychiatry, looked at data for over 8,000 patients at 222 practices that opted into learning disabilities DES, compared with those for 918 patients in 48 practices that did not sign up to the scheme.

Over the period 2009 and 2011, practices that opted into the DES were significantly more likely to have done blood tests on their patients with learning disabilities than practices that were not incentivised. For example, cholesterol checks were done in 52% of patients with learning disabilities at practices signed up for the DES compared with 38% of those in practices that did not take part.

The incentivised practices were also more likely to have done general health measurements in patients on the learning disabilities register, such as checking smoking status – which was six times more likely in the practices that opted in to the DES than in those that did not. 

More specific assessments were also done much more frequently under the DES, with hearing tests 24 times more likely to be done in incentivised than non-incentivised practices.

And patients were six times as likely to be offered a health action plan by a practice signed up for the DES, and twice as likely to have a proper review of their medication.

However, the study also highlighted that 40% of people with specific learning disability syndromes such as Down’s syndrome were not offered a health check, despite their practice being signed up to the DES, because their condition had not been properly recorded.

Dr Marta Buszewicz, a GP in north London and lead author of the study, told Pulse that it is hoped that health checks in this patient group will improve long-term outcomes.

She said: ‘This study indicates that practices involved in the LD-DES scheme had conducted more investigations and health assessments and identified more comorbid health conditions in their patients with learning disability than those practices not involved in the scheme. We don’t yet know how much impact the health checks will have on longer-term morbidity and mortality in this population but, given they have greatly increased morbidity and mortality rates compared with controls, these factors are likely to be associated with improved health outcomes.’

She added that, although there is doubt over the cost-effectiveness of the scheme, case finding in this patient group could lead to savings by decreasing the burden on the healthcare system.

‘There is little available data on the cost-effectiveness of the LD-DES, although a Scottish study found the costs of standard care for people with learning disabilities were higher than for those receiving primary care health checks. We think that modest improvements in care through prevention and case finding could result in significant savings through reduced reliance on acute or long-term care due to poorly managed chronic health conditions, but this needs to be properly evaluated.’


Lancet Psychiatry 2014; available online 26 November