Planning for community physician services prior to deinstitutionalization of mentally retarded persons

This study assessed the need for physician services among a group of institutionalized mentally retarded individuals in anticipation of their transfer to community residential facilities and subsequent management of their care by community-based physicians. The clients' personal physicians in the institution identified every chronic condition which required physician services, and recommended the kind of physician and frequency of visits for the management of each condition. Key informants reviewed these estimates and determined if there were sufficient physicians in their communities to provide this care. Thirty-two percent of the conditions but only 8 percent of the clients could be managed by a primary care physician. The most frequently required specialties were neurology, orthopedics, and ophthalmology. While primary care services and many of the necessary specialty services were available in the community to meet the needs of these individuals, several specialties essential to the medical care of this group were not available. These included orthopedics for the multiply-handicapped, neurology including behavioral neurology, and psychiatry. Deinstitutionalization policies which rely solely upon community physician services will lead to inadequate medical care in the community for some mentally retarded individuals. In these situations, alternative approaches to care must be developed.