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Can Fam Physician. 2018 Apr;64(Suppl 2):S15-S22.

Managing complexity in care of patients with intellectual and developmental disabilities: Natural fit for the family physician as an expert generalist.

Author information

1
Assistant Professor in the Department of Family Medicine at Queen's University in Kingston, Ont. liz.grier@gmail.com.
2
Family physician at Forest Hill Family Health Centre in Toronto, Ont, and the Integrated Services for Autism and Neurodevelopmental Disorders, and Lecturer in the Department of Family and Community Medicine at the University of Toronto.
3
Associate Professor in the Department of Family Medicine at Queen's University.
4
Assistant Professor, in the Department of Family Medicine at Queen's University.
5
Adjunct Professor in the Belleville Queen's University Family Medicine Centre.
6
Resident in the Discipline of Family Medicine at McMaster University in Hamilton, Ont.
7
Family physician at the Scarborough Centre for Healthy Communities in Ontario.
8
Clinical Faculty Lecturer in the Department of Family Medicine at McGill University in Montreal, Que, and a family physician at See Things My Way Centre for Innovation in Autism and Intellectual Disabilities.
9
Clinical Assistant Professor in the Discipline of Family Medicine at Memorial University of Newfoundland in St John's.

Abstract

OBJECTIVE:

To delineate the factors inherent in caring for patients with intellectual and developmental disabilities (IDD) that lead to complexity and to provide perspectives and techniques mapped to the phases of the clinical encounter.

SOURCES OF INFORMATION:

The authors of the physical health section of the 2018 Canadian consensus guidelines on the primary care of adults with IDD consisted of family physicians, all of whom practise comprehensive family medicine with additional clinical experience in care of adults with IDD. These authors reviewed evidence on which their recommendations are based and these recommendations have undergone a rigorous peer review to ensure that they deserve special attention because they highlight what is different from what a family physician would consider to constitute "normal care" for the general population.

MAIN MESSAGE:

Additional factors across the phases of clinical encounters with patients with IDD include the need for the following: an initial assessment that identifies genetic or neurologic conditions to guide anticipatory care and isolates unique barriers to health promotion and chronic disease management; adaptations to history taking, particularly for patients who are unable to describe symptoms owing to cognitive and communication deficits; overcoming challenges to performing physical examinations and certain investigations; addressing uncertainty in the formulation of hypotheses to establish an appropriate diagnosis; and involvement of resources of the developmental services sector to provide a management plan as well as an adapted empathetic approach in order to integrate the patient's illness experience.

CONCLUSION:

Although each patient with IDD is unique, and care of patients with IDD requires knowledge of certain conditions, these considerations are readily identifiable, and family physicians as expert generalists are well equipped to provide excellent care to patients with IDD.

PMID:
29650740
PMCID:
PMC5906780
[Indexed for MEDLINE]
Free PMC Article

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