Kathleen Louden

November 05, 2015

CHICAGO — For patients with mobility disabilities, more than half of all primary care facilities in Illinois have accessibility issues, according to a survey of 160 providers presented here at the American Public Health Association (APHA) 2015 Annual Meeting.

And only 41% of respondents reported that they have staff members available at all times who are trained in the transfer of disabled patients onto and off of an examination table.

"There is a gap in access to primary care for individuals with mobility disabilities," said study investigator Sharon Lamp, MS, a PhD student at the University of Illinois at Chicago College of Applied Health Sciences. However, "primary care is critical in preventing and delaying the onset of additional health conditions for these patients."

"I think the less-than-optimal accessibility is due to lack of awareness among providers on how to work with patients who have a disability," Lamp told Medscape Medical News.

The survey, conducted in conjunction with the Illinois Department of Public Health, indicates that there is a need to raise awareness about physical access barriers in primary healthcare settings, Lamp and her colleagues report.

This issue persists 25 years after the Americans with Disabilities Act, which promotes improved access to primary care for all Americans, was signed into law.

Full and Equal Access to Care Required by Law

The Disabilities Act requires that providers who receive federal funding, such as Medicare and Medicaid reimbursements, provide disabled individuals "full and equal access" to their healthcare facilities and services. Under the law, there is a general requirement that medical equipment be accessible and that providers make reasonable modifications to policies, practices, and procedures to make healthcare services fully available.

Lamp and her colleagues sent their 21-item online questionnaire to members of the Illinois Primary Health Care Association, which represents federally qualified health centers operating 450 sites, the 2300 members of the Illinois Academy of Family Physicians, and the 900 members of the Illinois chapter of the American Academy of Pediatrics.

The survey questions, which were accompanied by photographs, were designed to assess access barriers in and around examination rooms.

The responses came from 160 primary care facilities that were geographically representative of all healthcare facilities in the state; 71% were in the Chicago metropolitan area, 76% of the facilities served at least 100 patients each week, and 77% of the respondents were physicians.

On the plus side, 92% of respondents reported adequate pathways to the exam room, 92% reported adequate doorway space into the exam room, and 81% reported that their exam rooms had the floor space to accommodate someone using a wheelchair or other mobility assistance device.

However, accessible diagnostic equipment and patient transfer tools were much less common.

Table. Accessible Equipment in the 160 Primary Care Facilities

Equipment in the Examination Room Percent
Height-adjustable exam table 44
Wheelchair-accessible weight scale or accompanying lift 31
Transfer elements  
   Gait belt 26
   Stabilizing elements (e.g., foam cushion, rolled-up towel, rail) 25
   Transfer board 24

 

These findings, including the shortage of accessible weight scales at most facilities, are a concern, Lamp said.

"Weight changes can indicate a serious illness," she explained. "There's a reason doctors' offices have a scale."

Stabilization and support features, such as rails, straps, and cushions, that can be used to ensure the safety of disabled patients during transfer onto and off of the exam table are crucial. "I've heard stories of patients who were scared to death when left alone on the exam table that they'd roll off," Lamp reported.

Despite efforts to improve access, these findings demonstrate that disabled patients face diminished access to healthcare.

 
If the patient cannot use the medical equipment at the doctor's office or get around the exam room, the promises of the Affordable Care Act ring hollow.
 

"If the patient cannot use the medical equipment at the doctor's office or get around the exam room, the promises of the Affordable Care Act ring hollow," Lamp said.

She and her team plan future analyses to determine whether accessibility varies by geographic location or size of the patient population served by the facility.

This study has some limitations, Lamp reported. It was a small convenience sample, there is a potential for recall bias with self-reporting, and the survey did not address other elements of physical accessibility, such as washrooms, parking, and the availability of nearby public transportation.

This is important work, said Dot Nary, PhD, from the University of Kansas in Lawrence, who was not involved in the study.

When people talk about barriers to care for disabled people, the first thing they say is, "show me the data," she told Medscape Medical News. And "now we have the data."

"There hasn't been enough attention paid to this patient population," she explained. "People are unaware of the numbers of disabled individuals or that they can be otherwise healthy and just as in need of preventive and primary care as other patients."

The investigators should be commended for their methods, said Dr Nary, adding that the results do not surprise her. Two years ago, a student of hers surveyed primary care physicians in Lawrence, Kansas, and found that not one doctor had an accessible weight scale.

 
Doctors ask their disabled patients how much they weigh. If you haven't been weighed in years, how do you know?
 

Dr Nary, who is in a wheelchair, has personal experience with this issue. "Doctors ask their disabled patients how much they weigh. If you haven't been weighed in years, how do you know?" she said.

She also said she is not surprised by the low response rate. "No one wants to admit they don't follow the Department of Justice guidelines," she explained.

But, in fact, many care providers are ignorant of the Disabilities Act requirements, said Anthony Cahill, PhD, from the University of New Mexico School of Medicine in Albuquerque, who is outgoing chair of the APHA Disability Section.

And other providers might not adhere to the law for financial reasons, he told Medscape Medical News.

Many previous studies have looked at access barriers in healthcare facilities at the state and regional levels, and have reached similar conclusions, according to Dr Cahill.

"This study confirms what we know," he said. "This is a national problem."

This project was supported by the Illinois Department of Public Health, through a cooperative agreement funded by the US Centers for Disease Control and Prevention. The authors and Dr Cahill have disclosed no relevant financial relationships. Dr Nary reports that her center receives funding from the National Institute on Disability, Independent Living, and Rehabilitation.

American Public Health Association (APHA) 2015 Annual Meeting: Abstract 320672. Presented November 1, 2015.

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