Related factors and use of free preventive health services among adults with intellectual disabilities in Taiwan

Yen et al. BMC Health Services Research 2014, 14:248 http://www.biomedcentral.com/1472-6963/14/248 RESEARCH ARTICLE Open Access Related factors and use of free preventive health services among adults with intellectual disabilities in Taiwan Suh-May Yen1,2, Pei-Tseng Kung3†, Li-Ting Chiu1 and Wen-Chen Tsai1*† Abstract Background: This study aimed to investigate the utilization of preventive health services in the adults with intellectual disabilities from the nationwide database. Methods: The research method of this study is secondary data analysis. The data was obtained from three nationwide databases from 2006 to 2008. This study employed descriptive statistics to analyze the use and rate of preventive health services by intellectual disabled adults. Chi-square test was used to determine the relationship between the utilization of preventive health services and these variables. Multivariate logistic regression analysis was used to explore the factors that affect intellectual disabled adults’ use of preventive health services. Results: Our findings indicated 16.65% of people with intellectual disabilities aged over 40 years used the preventive health services. Females were more frequent users than males (18.27% vs. 15.21%, p <0.001). The utilization rate decreased with increasing severity of intellectual disabilities. The utilization was lowest (13.83%) for those with very severe disability, whereas that was the highest (19.38%) for those with mild severity. The factors significantly influencing utilization of the services included gender, age, and marital status, urbanization of resident areas, monthly payroll, low-income household status, catastrophic illnesses status and relevant chronic diseases and severity of disability. Conclusions: Although Taiwan’s Health Promotion Administration (HPA) has provided free preventive health services for more than 15 years, people with intellectual disabilities using preventive health care tend to be low. Demographics, economic conditions, health status, relevant chronic diseases, environmental factor, and severity of disability are the main factors influencing the use of preventive healthcare. According to the present findings, it is recommended that the government should increase the reimbursement of the medical staff performing health examinations for the persons with intellectual disabilities. It is also suggested to conduct media publicity and education to the public and the nursing facilities for the utilization of adult preventive health services. Keywords: Intellectual disabilities, Disability, Preventive health service, Adult health examination Background The global prevalence of intellectual disabilities was 10.37 per 1,000 populations [1]. In the end of 2011, there were 98,046 people with intellectual disabilities, accounting for 0.4% of the total population in Taiwan [2]. According to a survey conducted in 2006, 89.5% of people with intellectual disabilities in Taiwan lived with family members * Correspondence: † Equal contributors 1 Department of Health Services Administration, China Medical University, No. 91 Hsueh-Shih Road, Taichung 40402, Taiwan Full list of author information is available at the end of the article and 78.0% had no paid employment [3]. People with intellectual disabilities had a shorter life expectancy than did the general population [4,5]. Standardized mortality ratios for adults with moderate or severe intellectual disabilities were 3 times higher than those for the general population [6]. A study in the Netherlands determined that people with intellectual disabilities had 2.5 times more health problems than did those without intellectual disabilities [7]. Numerous people with intellectual disabilities developed neurological, digestive, dermatological, and mental © 2014 Yen et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Yen et al. BMC Health Services Research 2014, 14:248 http://www.biomedcentral.com/1472-6963/14/248 disorders, as well as obesity, diabetes, and cardiovascular disease [8-11]. People with intellectual disabilities might be unaware of physical problems and might have difficulty verbally expressing such conditions. Patients with intellectual disabilities are often rushed to hospitals for treatment when their physical conditions become severe. Therefore, people with intellectual disabilities must expend more time and effort in receiving medical care and may not be able to obtain required appropriate treatments [12-14]. Previous studies have demonstrated that the intellectually disabled persons were less likely to receive preventive health services than the others [15-18]. For instance, only 25% of women with learning disabilities in Exeter (a city in southwestern England) underwent cervical screening [19], and in Wales, only 31%–41% of people with learning disabilities received annual health assessments in 2006 and 2009 [20]. People with intellectual disabilities have substantial health needs, and have been reported to benefit from regular health assessments. A randomized controlled study conducted in Australia showed that people with intellectual disabilities who regularly received health assessments were newly diagnosed with diseases at a rate that was 1.6 times that of those who did not receive regular health assessments [21]. A study in the United States suggested that an increase in preventive services could avert the loss of more than 2 million life-years annually [22]. Increasing clinical preventive health services could effectively lower subsequent medical expenses [23-26]. Previous studies have indicated that sex, marital status [27], educational level, age, income, health status, severity of disability, and urbanization level influence the use of preventive health services among disabled people [28]. To reduce exorbitant medical expenses and improve unequal access to health care, free preventive health services for adults have been promoted since 1995 in Taiwan. The services include medical examinations, health education, blood, and urine tests. All adults aged over 40 years are accessible to this free service. Frequency limitations of this service varied according to different age ranges, i.e., once per three years for the persons aged 40–64 years and once per year for those who aged over 65 years. The examination outcomes are reported to patients, and primary care physicians suggest necessary additional diagnoses, treatments, or follow-ups. There were 21,042 adults with intellectual disabilities met the requirements in 2 (...truncated)