Commentary: Beyond Educational Initiatives: How Can We Change Health Care to Improve the Health of Persons With Disabilities?

Dr. Weinrich is director, National Center for Medical Rehabilitation Research, National Institutes of Health, Bethesda, Maryland.
Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 2.93). 09/2011; 86(9):1069-70. DOI: 10.1097/ACM.0b013e3182263429
Source: PubMed


Minihan and colleagues discuss necessary elements of an educational program to instruct generalist physicians in the care of individuals with disabilities. To support these physicians adequately in practice will require significant adaptations of health care financing, recognition of the unique medical needs of persons with disabilities, and efficient utilization of experienced clinical resources. The author outlines what remains to be addressed in the pursuit of better health for patients with disabilities as the U.S. health care system evolves.

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    ABSTRACT: Purpose: To describe the characteristics of and accommodations used by the deaf and hard-of-hearing (DHoH) physician and trainee population and examine whether these individuals are more likely to care for DHoH patients. Method: Multipronged snowball sampling identified 86 potential DHoH physician and trainee participants. In July to September 2010, a Web-based survey investigated accommodations used by survey respondents. The authors analyzed participants' demographics, accommodation and career satisfaction, sense of institutional support, likelihood of recommending medicine as a career, and current/anticipated DHoH patient population size. Results: The response rate was 65% (56 respondents; 31 trainees and 25 practicing physicians). Modified stethoscopes were the most frequently used accommodation (n = 50; 89%); other accommodations included auditory equipment, note-taking, computer-assisted real-time captioning, signed interpretation, and oral interpretation. Most respondents reported that their accommodations met their needs well, although 2 spent up to 10 hours weekly arranging accommodations. Of 25 physicians, 17 reported primary care specialties; 7 of 31 trainees planned to enter primary care specialties. Over 20% of trainees anticipated working with DHoH patients, whereas physicians on average spent 10% of their time with DHoH patients. Physicians' accommodation satisfaction was positively associated with career satisfaction and recommending medicine as a career. Conclusions: DHoH physicians and trainees seemed satisfied with frequent, multimodal accommodations from employers and educators. These results may assist organizations in planning accommodation provisions. Because DHoH physicians and trainees seem interested in primary care and serving DHoH patients, recruiting and training DHoH physicians has implications for the care of this underserved population.
    Academic medicine: journal of the Association of American Medical Colleges 12/2012; 88(2). DOI:10.1097/ACM.0b013e31827c0d60 · 2.93 Impact Factor
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    ABSTRACT: Background Early, frequent encounters with people with disabilities may improve medical students' knowledge, attitudes and skills regarding their care. We developed and implemented a longitudinal four-year curriculum addressing caring for people with disabilities. Objectives/hypothesis To test differences in mean scores between intervention and control groups on individual post-survey items regarding attitudes toward people with disabilities, and to conduct exploratory procedures to examine individual factors that may account for group differences. Methods Students at two U.S. medical schools, one with the new curriculum, and one with no specific disabilities curriculum, were surveyed in Year 1 of medical school, prior to curriculum introduction, and again at the end of Year 3, using a validated 30-item instrument measuring medical students' self-reported attitudes and comfort toward people with disabilities. We compared mean item ratings between the two groups using χ2 and ANOVA. Principal components analysis was then used to construct linear composite variables that were then regressed on potential predictors of attitudes and comfort level. Results The intervention led to significant or near-significant improvement in several factors. However, male students in the intervention group, particularly those who encountered people with disabilities in a clinical context, had a tendency to more frequently agree with negative statements (β = .628, p = .005). Conclusions Exposure of medical students to a longitudinal curriculum for caring for people with disabilities led to significant improvement in several factors related to comfort and attitudes. The gender-related reinforcement of some negative attitudes merits further investigation and caution when implementing the curriculum in the future.
    Disability and Health Journal 01/2013; 7(1). DOI:10.1016/j.dhjo.2013.08.006 · 1.29 Impact Factor