Preliminary Results of an Interdisciplinary Behavioral Program to Improve Access to Preventative Dental Care for Adults With Intellectual and Developmental Disabilities.

Adults with intellectual and developmental disabilities (AIDD) experience significant oral health disparities, partially due to perceived behavioral issues. This article describes the preliminary outcomes of a developing interdisciplinary (dental, medical, behavioral) program involving a behavioral intervention for AIDD previously receiving preventative dental care with sedation, general anesthesia, or protective stabilization (SAS). After a baseline assessment, a board-certified behavior analyst implemented increasingly complex behavioral interventions during simulated dental visits. Prior to COVID-19 pandemic-related restrictions, there were 32 active participants; 15 (46.9%) successfully completed a focused, real dental exam with simple behavioral interventions and 17 (53.1%) remain in treatment. These preliminary results suggest that many AIDD previously receiving SAS may participate in a preventative dental exam with minimal behavioral supports, if given the opportunity.

Improved health care transition for young adults with developmental disabilities referred from designated transition clinics.

PURPOSE: Young adults with intellectual/developmental disabilities (YAIDD) are a vulnerable population during HCT due to their complex care coordination and adaptive needs, yet factors associated with transition preparedness are not well defined. We aimed to determine factors associated with health care transition (HCT) preparation satisfaction for YAIDD establishing care with an adult medical home. DESIGN AND METHODS: 408 YAIDD or their families completed the HCT Feedback Survey 2.0 upon establishing adult care. Logistic regression models were used to determine associations between a composite of six HCT Feedback Survey questions that most correlated with the 2019 National Survey of Children's Health transition questions. RESULTS: YADD who had HCT preparation visits with a designated HCT clinic were 9 times more likely to have met all six composite HCT criteria after controlling for the number of technologies required and race/ethnicity (adj OR 9.04, 95% CI: 4.35, 18.76) compared to those referred from the community. Compared to patients who were referred from the community, the odds of feeling very prepared versus somewhat or not prepared were 3.7 times higher (adj OR 3.73, 95% CI: 1.90, 7.32) among patients referred from a designated HCT program. CONCLUSIONS: YAIDD who participated in a structured HCT program prior to transfer to adult care experienced higher transition preparation satisfaction. PRACTICAL IMPLICATIONS: A structured HCT clinic model to prepare adolescents with DD for transition to adult care may improve HCT preparation satisfaction for this population.

Evidence-based approach to early outpatient treatment of SARS-CoV-2 (COVID-19) infection.

Misinformation and promotion of well-intended but disproved therapies for COVID-19 have plagued evidence-based shared decision-making throughout the COVID-19 pandemic. In times of crisis, clinicians may feel that their strong inclination to prescribe potentially harmful, unproven therapies on behalf of their patients is supported by beneficence. Clinicians should mindfully identify and avoid commission bias during this pandemic, especially as more data have accumulated to assist with clinically sound decision-making. We describe a more evidence-based approach to treatment of early outpatient COVID-19, stressing the availability of Food and Drug Administration emergency use authorization therapies and considering plausibly beneficial, nonprescription supplements that are generally regarded as safe.

Recommendations for Successful Transition of Adolescents With Inflammatory Bowel Diseases to Adult Care.

Adolescents and young adults diagnosed with inflammatory bowel diseases (IBDs) in pediatric care are vulnerable during their transition to adult care. There are 6 core elements of transition from pediatric to adult IBD care. We identified gaps in this transition and make recommendations for clinical practice and research. There have been few studies of transition policy (core element 1) or studies that tracked and monitored patients through the transition (core element 2). Several studies have assessed transition readiness (core element 3), but instruments for assessment were not validated using important outcomes such as disease control, health care use, adherence, quality of life, or continuity of care. There have been no studies of best practices for transition planning (core element 4), including how to best educate patients and facilitate gradual shifts in responsibility. A small number of longitudinal studies have investigated transfer of care (core element 5), but these were conducted outside of the United States; these studies found mixed results in short- and intermediate-term outcomes after transition completion (core element 6). We discuss what is known about the transition from pediatric to adult care for IBD, make recommendations to improve this process, and identify areas for additional research.

Transition to Adult Care.

The transition from pediatric-based to adult-based health care is often difficult, especially for individuals with chronic illness or developmental disabilities, such as cerebral palsy. This article describes the current state of health care transition, focusing on some of the elements that contribute to the complexity of this challenging life period, including: changes to health care insurance, medicolegal considerations and options for supported decision making, discussions about vocations and related barriers and resources, and important psychosocial issues faced by many patients with cerebral palsy. Evidence-based processes and practices are described that can help facilitate health care transition planning and improve outcomes.

The Prevalence of OSA Among an Adult Population With Down Syndrome Referred to a Medical Clinic.

Obstructive sleep apnea (OSA) is a common sleep disorder affecting approximately 16% of adults (24% of men and 9% of women), and, if untreated, it can cause significant complications ( Young, 2009 ). This study evaluates 56 adult patients with Down syndrome and analyzed retrospective data to determine the: (1) prevalence of OSA, (2) severity of OSA, and (3) association between body mass index (BMI) and OSA. Of those participants that had polysomnography (PSG) testing available, 82.1% were diagnosed with OSA, divided by severity into mild (45.7%), moderate (15.2%), and severe (39.1%) levels. Because of the high prevalence of OSA among our study population, we recommend that all adults with DS be screened for OSA with PSG.

Implementation of an academic adult primary care clinic for adolescents and young adults with complex, chronic childhood conditions.

PURPOSE: For the growing population of adolescents and young adults with chronic childhood conditions (AYACCC), the transition from pediatric to adult health care contains many barriers and appropriate adult-based health care options are few. In 2005, the Transition Medicine Clinic (TMC), affiliated with Baylor College of Medicine, was established in Houston, Texas. It is one of the first clinics of its kind and serves AYACCC by providing a medical home in the adult health care system. This article describes the development and implementation of the TMC, its patient population and their resource needs, and lessons learned along the way. METHODS: We retrospectively examined the electronic health records of 332 patients that established care in the TMC prior to July, 2011. Data were collected describing multiple facets of the patient population and their resource utilization, both in aggregate and for several subgroups. RESULTS: The most common primary diagnoses were cerebral palsy, spina bifida, Down syndrome, genetic conditions, and autism. Patient characteristics demonstrated the unique challenges faced by the clinic: more than 80% received Medicaid, 65% had an intellectual disability, 41% used a wheelchair, and most had multiple secondary diagnoses. Compared to typical adult primary care practices, a larger amount of clinical resources, medical technology, and specialists were used, especially for those with the most medically fragile conditions. CONCLUSIONS: The results suggest that a clinic serving AYACCC requires physicians and support staff familiar with the aforementioned issues that are willing to spend a considerable amount of time and effort outside of routine office visits in health care coordination. Because many of these patients are covered by publicly funded health insurance, enhanced reimbursement must be considered to keep clinics like the TMC self-sustaining. Future research is needed to demonstrate adult-based care delivery models, develop clinical care guidelines, and evaluate key clinical outcomes.