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A medical practitioner may select MBS Item 701 (brief), 703 (standard), 705 (long) or 707 (prolonged) to undertake a health assessment for a person with an intellectual disability depending on the length of the consultation which will be determined by the complexity of the patient’s presentation.
A health assessment for people with an intellectual disability is for patients who have significantly subaverage general intellectual functioning (two standard deviations below the average intelligence quotient (IQ)) and who would benefit from assistance with daily living activities.
The health assessment provides a structured clinical framework for medical practitioners to comprehensively assess the physical, psychological and social function of patients with an intellectual disability and to identify any medical intervention and preventive health care required.
Components of the health assessment for people with an intellectual disability
The health assessment must include:- information collection, including taking a patient history and undertaking or arranging examinations and investigations as required;
- making an overall assessment of the patient;
- recommending appropriate interventions;
- providing advice and information to the patient;
- keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
- offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.
Medical practitioners should establish a register of patients who require annual health assessments, and remind these patients when their next health assessment is due. If an assessment identifies that a patient has a chronic medical condition and complex care needs, it may be appropriate for the GP to involve other health professionals in the patient’s care using the MBS Chronic Disease Management items.
Consent
The patient must be given an explanation of the health assessment process and its likely benefits. Consent for the health assessment must be noted on the patient record. Should the patient not have sufficient understanding to comprehend or make decisions about the health assessment, or cannot communicate their consent, then the practitioner must get consent from the patient’s legal guardian.Restrictions on providing the health assessment for people with an intellectual disability
A health assessment provided for people with an intellectual disability may be provided once every twelve months to an eligible patient. During the course of the 12 months following the assessment, the patient’s GP should review and adjust treatment of the patient as necessary, as part of normal medical care.Medical practitioners should not conduct a separate consultation in conjunction with a health assessment unless it is clinically necessary (ie. the patient has an acute problem that needs to be managed separately from the assessment).
Other Requirements
Where the patient has a carer, the medical practitioner may find it useful to consider having the carer present for the assessment or components of the assessment (subject to the patient’s agreement) to provide information about the efficacy and side effects of medication and the patient’s symptomatology.It may be relevant to consult with or refer to disability professionals. For example, case managers who have responsibility for assessing and facilitating appropriate accommodation, and disability support services and psychologists who have responsibility for developing strategies to address challenging behaviours.
The medical practitioner should keep a record of the health assessment and offer a copy of a written report about the health assessment to the relevant people involved with the patient, including the patient’s carer and relevant disability professionals.
Guidelines and Resources
Medical practitioners are encouraged to use relevant guidelines and resources, such as:- Information about MBS primary care items at the MBS Primary Care Items page or phone Medicare Australia provider enquiry line on 132 150.
- Item descriptors and explanatory notes at MBS Online.
- The Comprehensive Care for People with Intellectual Disability active learning program for general practitioners and practice nurses at the GP Learning website (Category 1 activities).
- Health Guidelines for Adults with an Intellectual Disability
- Offices of the Public Advocate in each State and Territory for information on guardianship and administration.
- RACGP guidelines for preventive activity in general practice - red book and/or green book.