Challenges


Medical issues among patients with IDD can be challenging and complex for community-based clinicians due to the presence of multiple chronic conditions and the atypical presentation of symptoms. A person with IDD often presents with nontraditional symptoms, compared with unaffected individuals, which can pose a challenge for community-based clinicians who are not experienced in providing care to patients with IDD. Many community-based clinicians have limited experience with providing care for the specific medical issues commonly experienced by individuals with IDD. There is also little support or consultation opportunities for community-based clinicians who need resources to assist with care for patients with IDD, especially in rural areas. 


It is imperative for community-based clinicians to be familiar with the common medical conditions and usual presenting symptoms among persons with IDD, as well as evidence-based treatment regimens that promote quality, safety, and availability of necessary medical and social resources. This will assist the community-based clinician in addressing the health care needs of at-risk individuals with IDD more effectively, with the overall goal being the prevention of institutionalization. Increased awareness among community-based clinicians will also influence a more patient-centered approach to care that will lead to an individualized plan of care and improved outcomes. A holistic, patient-centered approach to care may also increase the available support of people with IDD by encouraging active involvement among family and community members. 



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Common Themes


There are common themes among individuals with IDD from a health care standpoint. The global theme is that the approach to assessment, treatment, and management of patients with IDD is different from that of the general population. A common theme among individuals with IDD is that they often present with symptoms that are subtle and not obvious. Also, side effects of treatment regimens can be different for the average individual. Common chief complaints include “He is just not acting right,” and “He has quit eating.” Another common theme is that individuals with IDD rely heavily on family and caregiver support, meaning that much of your history will come from them rather than from the individual with IDD.


An additional common theme among patients with IDD includes the extreme importance and challenges of conducting the history of present illness (HPI) during the assessment. The HPI is extremely important because it provides vital information to assist with the determination of needed diagnostic testing, diagnosis, and treatment. However, the challenge is that an HPI cannot always be obtained when treating individuals with IDD. When gathering an HPI from the family or caregiver of a patient with IDD, there are several core questions to ask, as outlined in Table 1.1.


Table 1.1 Common core questions to ask while obtaining an HPI of a patient with IDD

When did the symptoms start?
Have new medications been given?
Have there been new routines or a change in daily routine?
Has there been vomiting?
When was the last bowel movement?


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