Making the practice disability friendly with reasonable adjustments
Reasonable adjustments are changes or adjustments made in the delivery of health care to overcome barriers experienced by people with disability. Adjustments are informed by an understanding of the person’s cognitive, physical and communication abilities and other biopsychosocial factors (eg social situation, mental health).
Reasonable adjustments improve care for people with developmental disability by:
- minimising adverse outcomes, including trauma related to medical procedures
- enabling a more positive experience for the person and their family or support people, and for those delivering health care
- ensuring equitable access to healthcare interventions.
Examples of adjustments to facilitate physical access include ramps, rooms and equipment (eg scales) that accommodate a wheelchair.
Some service strategies to improve the consultation experience for a person with developmental disability are included in Reasonable adjustments to improve the consultation experience for a person with developmental disability; many of these strategies can be implemented by practice staff before the person’s appointment. Efforts to minimise stress before and during the GP consultation can improve communication with the person with developmental disability.
If the person was not identified before the consultation as having developmental disability, a brief initial assessment may be completed, with a plan for further appointments with the reasonable adjustments in place. Clearly record the person’s developmental disability diagnosis in the medical record.
Reception staff
Arrange for the person to see the same clinician at each visit (this may not always be possible, eg in an emergency).
Book:
- a longer consultation and anticipate multiple visits
- an early or late appointment, or ask the person or their support person to call first, to minimise waiting
- a larger consulting room, if available.
Ask the person or their support people to bring to each appointment:
- any communication aids (or person to assist with communication) if needed
- their personal health record and other relevant health information, including medications or behaviour support plan.
Ask who will accompany the person and their relationship (eg parent, support worker).
Provide a quiet waiting area or allow the person to wait outside.
Check whether the patient has any other requirements such as mobility aids or equipment, assistive technology requirements (eg hearing loop) or environmental access needs (eg light or noise preferences).
General practitioner or practice nurse
Clearly record the developmental disability diagnosis in the medical record.
Nominate a contact person who will help the person navigate the booking and consultation process; this may be a receptionist, administrator or nurse, and not necessarily the general practitioner.
Review the person’s medical history before the appointment to identify who can make decisions and opportunities for preventive health care.
Explain at the beginning of the consultation what will happen and how long it should take.
Recap and write down the key points at the end of the consultation for the person to take home.
Ensure the person attends regularly to enable building of rapport and increase familiarity with the environment; consider addressing medication reviews, health checks and care planning at these visits.