The management of people with learning disabilities consulting in primary care with common conditions: an electronic health records study

Research question Do people with learning disability (pwLD) receive different care when consulting in primary care for common conditions and is this associated with outcomes? Background Life expectancy for pwLD is estimated to be 19 years less than the general population. For pwLD from ethnic minorities, life expectancy is 34 years. Some differential in life expectancy is likely explained by differences in underlying physical health, some may be due to differences in care (e.g. differing propensity to prescribe or offer remote consultation. This is not well-understood. Aims and objectives This study aims to understand patterns of care for pwLD when consulting for common conditions in primary care. Objectives are to understand whether: common reasons for consultation differ in pwLD and people without; there are differences in i) care received during (professional consulted, mode of consultation, receipt of prescription) and ii) outcomes of (re-consultation, admission) consultations between pwLD and people without; outcomes of consultations for common conditions differ in pwLD who have and have not received good preventative care. All objectives will be investigated in relation to the key socio-demographic factors of age, sex, deprivation and ethnicity. Methods We will use data from the Clinical Practice Research Datalink (CPRD) and linked datasets. We will form a matched cohort study of people with and without LD. Eligible individuals will be aged ≥5 years, permanently registered with a practice (01/01/2018-31/12/2022) and contributing research-quality data. LD with be defined as membership of the LD register or presence of a code for a condition known to be associated with LD. We have defined common reasons for consultation in the general population and supplemented these with those our carer group felt were especially relevant to pwLD. Separately for people with and without LD, we will compare the proportions of: coded consultations accounted for by each of the defined common conditions; people consulting with each of the common conditions according to staff group and mode of consultation; people in whom a consultation for one of the common conditions results in i) a prescription, ii) re-consultation for the same condition within 30 days, and iii) hospitalisation with 30 days. We will model the probability of each outcome separately for staff group and mode of consultation. "Good preventative care" will be defined annually as having received a health check, influenza vaccination and Sars-Cov2 vaccination (2021-2022 only). We will compare the proportion of consultations for common conditions resulting: a prescription; re-consultation within 30 days; hospitalisation within 30 days; by good preventative care status. All analyses will be stratified by age group, sex, IMD quintile and ethnicity, and presented separately for each calendar year. Timelines This study will be delivered in 12 months. Anticipated Impact and Dissemination Key outputs include: New evidence regarding the care received by pwLD for common conditions, including equity across sociodemographic groups. Animation and easy-read summary of results to share with pwLD.