Spring 2016
Helping Women with Intellectual Disabilities

synapse: University of Nevada, Reno School of Medicine

Elissa J. Palmer, M.D.

Elissa J. Palmer, M.D., chair of family and community medicine in Las Vegas. Photo by Edgar Antonio Núñez.

Story by Jordan Miszlay

The School of Medicine plans to use a portion of grant money from a settlement brokered by the State of Nevada Attorney General's Office to develop a Clinical Health Assessment and Promotion Program to address women's health issues. This new initiative focuses on preventative health care in the subpopulation of women with intellectual or developmental disabilities in Las Vegas.

The State of Nevada obtained the settlement with pharmaceutical companies Wyeth, Pfizer and Pharmacia & Upjohn relating to claims regarding postmenopausal hormone therapy products.

Under the direction of Elissa Palmer, M.D., family medicine chair in Las Vegas, the School of Medicine and Opportunity Village formed a partnership to improve the health and well-being of the people helped by the not-for-profit organization that annually serves more than 3,000 children and adults with intellectual disabilities through vocational training, community job placement and life skill enrichment in southern Nevada.

Palmer explained that population studies of women with disabilities have demonstrated that they do not receive the same level of preventative health care as their peers.

"For women with intellectual disabilities, the new grant-supported Clinical Health Assessment and Promotion Program will determine appropriate evidence-based, gender-specific preventative health care recommendations and develop and distribute training curricula for care providers," she explained.

While many of the clients at Opportunity Village are seen by School of Medicine doctors, it became apparent that clients were not receiving proper preventative care prior to seeing their physician.

"One of the things that is very difficult with clients who have intellectual disabilities is that they cannot always communicate their health care needs," Palmer explained.

"Usually you can tell when an individual is ill, but what happens is that these clients have various complicated health problems, so when they see a physician, the physician is always dealing with the complicated problem and the preventative health care doesn't always get addressed," she said.

Palmer plans to alleviate this problem by focusing on two main goals. The first is to enhance the education of care providers on evidence-based preventative health care recommendations for women with intellectual disabilities and then to expand access to these services for women with intellectual or development disabilities at Opportunity Village.

Specifically, for women who are clients at Opportunity Village campuses in southern Nevada (801 clients between the ages of 18 and 70 years, 49 percent of whom are women), the program will create a process to identify the women in need of services; educate these women, their families and care providers on the recommendations; collaborate with the women's primary care provider through an interdisciplinary team to enhance care delivery; and deliver on-site screenings to increase access.

Connecting with community providers through the project is instrumental. The School of Medicine's Department of Family and Community Medicine will collaborate with students, residents, fellows and faculty internally through an organized plan of curricular delivery and care delivery elective opportunities. For students, scholarly research opportunities will be available between the first and second years of undergraduate medical education.

Working in conjunction with the University of Nevada, Las Vegas Department of Athletics, William Rosenberg, M.D., the jointly-appointed UNLV head team physician and School of Medicine sports medicine fellowship director will work to lend expertise to the curriculum pertaining to exercise in this special population.

Furthermore, Palmer plans to use this program not only to improve preventative care in Nevada, but also nationwide.

"We are trying to make sure that we are educating medical students and physicians, we are developing curricula that can be used not just at Opportunity Village, but elsewhere, to enhance the care given to patients with developmental disabilities. We are working on the national level so that this curricula could be spread within the family medicine community," she said.

Currently, Palmer and her team are developing and distributing the guidelines for this program nationally. The development of guidelines allows physicians from different regions to implement the program in a way that would be effective for their respective communities.