Primary Care for Adults With Physical Disabilities: Perceptions From Consumer and Provider Focus Groups

Program in Geriatrics, University of California, 101 City Drive South, Irvine, CA 92868, USA.
Family medicine (Impact Factor: 1.17). 11/2008; 40(9):645-51.
Source: PubMed


Family physicians lack data on how best to address the needs of adults with physical disabilities. We undertook this study to understand how consumers, educators, and other professionals perceive primary care for people with disabilities.
We conducted six focus groups, three with 27 health professionals in primary care practices affiliated with an urban university medical center and three with 19 local adults, ages 21-64 years, with physical disabilities. From transcribed recordings, three investigators conducted separate content analyses. Independent author reviews and participant review confirmed saturation and agreement for major themes.
All groups perceived that generalist physicians and other health professionals need more education about disability issues. Multiple barriers limit care, including physical access and transportation, funding, limitations in professionals' knowledge and attitudes, communication gaps, and health systems failures. Both consumers and professionals recommended reducing barriers by educating professionals and trainees about disabilities and resources, improving provider-patient communication, enhancing physical access (eg, high-low examination tables, wide automatic doors, high-contrast signs and lighting, wheelchair scales), and increasing appointment times.
Primary care must address the unmet needs of people with disabilities. Family medicine educators can begin by teaching learners how to coordinate care, access resources, and communicate about disability issues.

Download full-text


Available from: Laura Mosqueda, Dec 26, 2013
    • "Stereotypes and social misconceptions were also barriers that influenced health care providers delivery of their care, referral of women with disability to screening services, and interactions with the client or patient (Armour, Thierry, & Wolf, 2008; Iezzoni, Frakt, & Pizer, 2011; Morrison, George, & Mosqueda, 2008). Social misconceptions included beliefs such as: women with disability did not need mammograms or Pap smears as they were less likely to develop cancer, were not sexually active, or were unable to have screening equipment used properly on them as a result of their disability (Lin et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This review critically examined the barriers to breast and cervical cancer screening services for women with physical disability and discussed ways forward to change practice. When compared to the rest of the community, women with disability were less likely to use preventive health screening services for multiple reasons. Moreover, women with disability live longer than in previous years, and as age is linked to an increased risk of developing cancer, it is imperative that the barriers to screening for these women become a focus of discussion. We designed an integrative literature review to investigate this. Multiple databases were systematically searched for literature published between 2001 and 2013. Search terms used were a combination (AND/OR) of key terms. After excluding duplicates and papers not meeting the eligibility criteria, 25 papers were systematically and critically reviewed. Socio-demographic factors were associated with less access to preventive health screening for women with disability. The literature reviewed indicated that this was complicated further by three prominent barriers: health insurance, healthcare workers and physical barriers. Socio-demographic, health insurance, health workers and physical barriers impair access for disabled women to breast and cervical cancer screening, which are vital measures in the timely detection of breast and cervical cancers and preventable morbidity and mortality. Measures are needed to address these limiting factors for women with disability so that they can be active participants in healthcare, rather than being marginalized because of their disability.
    No preview · Article · Sep 2015 · Women & Health
  • Source
    • "Several recommendations to enhance health examination utilization in these marginalized subgroups have been reported. For the disabled, transportation is an important barrier to access to health services in addition to financial constraints and communication difficulties [42,43]. Free transportation is widely available in Taiwan [44], however it is used less frequently by people with disabilities. "
    [Show abstract] [Hide abstract]
    ABSTRACT: People with visual disabilities have increased health needs but face worse inequity to preventive health examinations. To date, only a few nationwide studies have analyzed the utilization of preventive adult health examinations by the visually disabled population. The aim of this study was to investigate the utilization of health examinations by the visually disabled population, and analyze the factors associated with the utilization. Visual disability was certified by ophthalmologists and authenticated by the Ministry of the Interior (MOI), Taiwan. We linked data from three different nationwide datasets (from the MOI, Bureau of Health Promotion, and National Health Research Institutes) between 2006 and 2008 as the data sources. Independent variables included demographic characteristics, income status, health status, and severity of disability; health examination utilization status was the dependent variable. The chi-square test was used to check statistical differences between variables, and a multivariate logistic regression model was used to examine the associated factors with health examination utilization. In total, 47,812 visually disabled subjects aged 40 years and over were included in this study, only 16.6% of whom received a health examination. Lower utilization was more likely in male subjects, in those aged 65 years and above, insured dependents and those with a top-ranked premium-based salary, catastrophic illness/injury, chronic diseases of the genitourinary system, and severe or very severe disabilities. The overall health examination utilization in the visually disabled population was very low. Lower utilization occurred mainly in males, the elderly, and those with severe disabilities.
    Full-text · Article · Dec 2013 · BMC Health Services Research
  • Source
    • "Patients with disabilities report faulty communication, and express the need for better communication with health care providers [8, 9]. Individuals with disabilities want to be treated as equals in the patient-provider relationship and argue that a lack of education regarding disabilities is a major cause of miscommunication [8]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Empathy is an important component of the provider-patient relationship. In the United States one in five persons has a disability. Persons with disabilities perceive gaps in health care providers' understanding of their health care preferences and needs. The purpose of this study was to use valid and reliable assessment methods to investigate the association between empathy and attitudes toward persons with disabilities and advocacy. An educational module was developed to enhance health care students' capacity for informed empathy. Pre- and post-assessment measures included the Attitude toward Disabled Persons scale (ATDP), the Attitudes toward Patient Advocacy Microsocial scale (AMIA) and the Interpersonal Reactivity Index (IRI). ATDP (t(94) = -5.95, p = .000) and AMIA (t(92) = -5.99, p = .000) scores increased significantly after the education module. Correlations between the pre- or post-module ATDP or AMIA scores and the IRI scores were not significant. Empathy in general may not be sufficient to ensure optimal attitudes toward persons with disabilities or advocacy in pre-health care professionals. However, a curriculum based on informed empathy and focused on the experiences of persons with disabilities can result in more positive attitudes toward and advocacy for people with disabilities.
    Full-text · Article · Mar 2013
Show more