Case management and care expertise as a prevention approach for adults with intellectual disabilities – results of a randomised-controlled trial

Background and Objectives: People with intellectual disabilities have a higher risk of several chronic diseases [1], and face multiple barriers to accessing health care [2]. Therefore, they receive fewer health promotion and prevention interventions [3]. This study aimed to address this issue through the implementation and testing of the effectiveness of prevention-focused case management by nursing and health experts with a master’s degree on the health status, resilience and quality of life. Design and Methods: We conducted a randomised controlled trial with waiting list design in Hamburg, Germany. Inclusion criteria were ICD diagnosis F70-79 and age ≥18 years. Exclusion criteria were a care level >3 (according to the German Social Code XI) or being at the end-of-life. The intervention focused on four prevention domains (mobility, nutrition, stress, addiction) and consisted of 1) social space analysis, 2) four outreach visits by nursing and health experts over one year including health assessments, joint development of a prevention plan, evaluation of the plan’s implementation, and 3) individual or group counselling. The control group (CG) received usual care. Participants were allocated using computer-assisted, permuted block randomisation. Researchers were blinded during data collection and analysis. The primary outcome was health status at 12 months (t2) (WHODAS 2.0). Secondary outcomes were health status at 6 months (t1), resilience (RS-11) and health-related quality of life (HQOL) (EQ5D-VAS) at 6 and 12 months. We analysed the data using ANCOVAs. Results: 214 participants were evenly randomized. At t2, 176 participants remained (IG: n=85, CG; n=91). Health status at t2 showed a mean difference (MD) of -4.38 points in favour of the IG (p=0.009; CI -8.13 – -0.62) and a MD of -1.06 (p=0.602; CI -3.51 – 5.62) for t1. For resilience, a MD of +2.70 points (t2) in favour of the IG was obtained (p=0.05; CI -5.78 – 0.39) and a MD of +0.51 (p=0.660; CI -3.11 –2.10) for t1. We measured a MD for HQOL of -1.19 (p=0.72; CI -8.71 – 6.33) in favour of the CG at t2 and a MD of +0.72 (p= 0.805; CI - 5.88 – 7.32) in favour of the IG at t1. Conclusions: Prevention-focused case management was able to improve the health status of people with intellectual disabilities with a clinically important difference and a small to moderate effect size. The intervention has the potential to facilitate participation in prevention and therefore more equitable care for people with intellectual disabilities, thereby improving their overall health and well-being. References: [1] Liao, P., Vajdic, C., Trollor, J. & Reppermund, S., (2021), Prevalence and incidence of physical health conditions in people with intellectual disability - a systematic review, PloS One, e0256294, 8, https://doi.org/10.1371/journal.pone.0256294 [2] Doherty, A. J., Atherton, H., Boland, P., Hastings, R., Hives, L., Hood, K. et al., (2020), Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review, BJGP Open, bjgpopen20X101030, 3, https://doi.org/10.3399/bjgpopen20X101030 [3] Hanlon, P., MacDonald, S., Wood, K., Allan, L. & Cooper, S.-A., (2018), Long-term condition management in adults with intellectual disability in primary care: a systematic review, BJGP Open, bjgpopen18X101445, 1, https://doi.org/10.3399/bjgpopen18X101445