Abstract
People with disabilities (PWD) face several challenges accessing medical services. However, the extent to which architectural and transportation barriers impede access to healthcare is unknown. In Peru, despite laws requiring that buildings be accessible for PWD, no report confirms that medical facilities comply with such regulations. Thus, we aim to provide an association between these barriers and access to medical facilities. Data from a Peruvian disability survey were analyzed. Participants were 18 years of age and older people who reported having a physical disability. Accessibility was defined by reported struggles accessing medical facilities (health or rehabilitation centers). Absence of ramps, handrails, elevators, adapted bathrooms, and information counters in medical facilities were reported as architectural barriers. The transportation barriers analyzed included struggles using buses or trains. Poisson regression models with robust variance were used to estimate prevalence ratios (PR) and to control for confounding variables. 20,663 participants were included, their mean age was 66.5 years and 57.5% were females. Architectural and transportation barriers reported were 40% and 61%, respectively. All barriers reported were more prevalent in rural compared to urban areas (p < 0.001). Inadequacy of ramps, handrails, and adapted elevators and bathrooms were associated with limited use of rehabilitation centers (p < 0.001) but not of health centers (p > 0.05). Architectural and transportation barriers represent a hindrance to seeking treatment at rehabilitation centers. Actions to improve this situation are needed.
Highlights
Disability remains a major global health issue
Healthcare access and utilization are especially important for people with disabilities (PWD), as they experience poorer health outcomes than their non-disabled counterparts for the same conditions [4,5]; their costs for medical care can be up to four times higher 6, and their use of health and long-term care services is often beyond basic healthcare needs 7
Sharing some principles with the CRPD, the American with Disabilities Act (ADA) of 1990 10 outlines standard accessibility statements to determine whether locations, including medical facilities, are suitable for PWD
Summary
Disability remains a major global health issue. Worldwide, around 15% of people have some physical or cognitive limitation [1,2], and about 80% of people with disabilities (PWD) are estimated to live in low- and middle-income countries (LMICs) 1. Sharing some principles with the CRPD, the American with Disabilities Act (ADA) of 1990 10 outlines standard accessibility statements to determine whether locations, including medical facilities, are suitable for PWD. These international policies exist, few reports indicate their fulfillment in medical facilities outside of the United States [11,12,13]. PWD often face several challenges in accessing and utilizing healthcare services, including lack of health insurance, unemployment, or dependence on caregivers [14,15]. Prior studies have recognized that absence of transportation to hospitals, as well as wheelchair inaccessibility in hospitals, represent critical barriers to PWD’s access and utilization of healthcare [1,16,17]
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