摘要：Introduction: Adults with intellectual and developmental disabilities (IDD) have high
rates of morbidity and are less likely to receive preventive care. Emergency departments
and primary care clinics are important entry points into the health care system.
Improving care in these settings can lead to increased prevention activities, early disease
identification, and ongoing management. We studied barriers and facilitators to
improving the care of patients with IDD in three primary and three emergency care sites
in Ontario.
Methods: Data sources included structured implementation logs at each site, focus
groups (n = 5) and interviews (n = 8). Barriers and facilitators were coded deductively
based on the Consolidated Framework for Implementation Research (CFIR). Synthesis
to higher level themes was achieved through review and discussion by the research
team. Focus was given to differences between higher and lower implementing sites.
Results: All sites were challenged to prioritize care improvement for a small, complex
population and varied levels of implementation were achieved. Having national guidelines,
using local data to demonstrate need and sharing evidence on value were important
engagement strategies. Factors present at higher implementing sites included strong
champions, alignment with site mandate, and use of electronic prompts/reminders.
Lower implementing sites showed more passive endorsement of the innovation and had
lower capacity to implement.
Conclusion: Providing effective care for small, complex groups, such as adults with
IDD, is critical to improving long-term health outcomes but is challenging to achieve. At
a systemic level, funding incentives, access to expertise and improved electronic record
systems may enhance capacity.
