[Unmet health care needs of younger and older people with intellectual, mental and multiple disabilities: A pilot study in a facility in the Ruhr area].

Introduction: Unmet health care needs are seen as a key indicator of equity in access to health care. With younger people, they can lead to poorer health outcomes in adulthood, and in older people they can be associated with an increased risk of mortality. The presence of a disability is considered a risk factor for unmet needs. Against this background, unmet health care needs of younger and older people with intellectual, mental and multiple disabilities in Essen were examined as part of a qualitative pilot study in a facility in Essen.

Method: The interview study includes the perspectives of adolescents and older people living in a residential facility for people with intellectual, mental and multiple disabilities, as well as assessments of their caregivers and managers of the institution. We conducted semi-structured guided interviews with clients and managers, and unstructured interviews with care assistants. After transcription, a qualitative content analysis and a supplementary frequency analysis were carried out. The reporting is based on the Standards for Qualitative Research (SRQR).

Results: A total of eleven interviews - five with people with intellectual, mental and multiple disabilities, four with care assistants, and two with managers - were subjected to analysis. Fourteen interviews conducted with people with intellectual, mental and multiple disabilities and one interview with a care assistant had to be excluded due to high cognitive impairment or lack of insight, amongst other reasons. The clients reported unmet needs, particularly in outpatient care: waiting times, shortcomings in both treatment and doctor-patient interaction play a decisive role. The latter manifests itself in disregarding the patients' wishes and the patients' feeling of not being taken seriously. The most frequently cited consequence of unmet needs is a change of physician. Care assistants and managers unanimously confirmed their clients' experiences in the areas mentioned and added: lack of opportunities for their clients to participate in medical consultations and lack of medical information. In addition, their clients' problems often start with accessing health care since their ability to identify and articulate complaints or treatment requests is often limited.

Conclusions: Using one residential facility in the Ruhr region as an example, the results provide indications of deficits in the health care of younger and older people with intellectual, mental and multiple disabilities as well as priorities for a sustainable improvement in their health-related living situation. One specific field of action is to increase the competencies of service providers regarding the care of people with intellectual, mental and multiple disabilities and their specific needs. In addition, doctor-patient interaction must be adapted and target group-specific communication introduced into practice providing an appropriate timeframe and better opportunities for patient participation.