Accommodations for Patients with Disabilities in Primary Care: A Mixed Methods Study of Practice Administrators

Jennifer R Pharr

doi:10.5539/gjhs.v6n1p23

Abstract

Structural barriers that limit access to health care services for people with disabilities have been identified through qualitative studies; however, little is known about how patients with disabilities are accommodated in the clinical setting when a structural barrier is encountered. The purpose of this study was to identify how primary care medical practices in the United States accommodated people with disabilities when a barrier to service is encountered. Primary care practice administrators from the medical management organization were identified through the organization’s website. Sixty-three administrators from across the US participated in this study. Practice administrators reported that patients were examined in their wheelchairs (76%), that parts of the exam where skipped when a barrier was encountered (44%), that patients were asked to bring someone with them (52.4%) or that patients were refused treatment due to an inaccessible clinic (3.2%). These methods of accommodation would not be in compliance with requirements of the Americans with Disabilities Act. There was not a significant difference (p>0.05) in accommodations for patients with disabilities between administrators who could describe the application of the ADA to their clinic and those who could not. Practice administrators need a comprehensive understanding of the array of challenges encountered by patients with disabilities throughout the health care process and of how to best accommodate patients with disabilities in their practice.

Highlights

1.1 Importance of the ProblemPeople with disabilities experience unmet health care needs which lead to health disparities
Structural barriers that limit access to health care services for people with disabilities have been identified through qualitative interviews, little is known about how patients with disabilities are accommodated in the clinical setting when a barrier to service is encountered
Practice administrators were asked: Can you briefly describe the purpose of the Americans with Disabilities Act (ADA) as you understand it? Four themes emerged from this question

Summary

Introduction

1.1 Importance of the ProblemPeople with disabilities experience unmet health care needs which lead to health disparities. Of interest for this study are structural barriers that people with disabilities encounter when accessing health care services These include: inadequate disability parking, lack of ramps or ramps with too steep of a grade, narrow doorways, heavy doors without automatic opening capabilities, lack of elevators, cramped waiting rooms, examination rooms that are too small in which to maneuver a wheelchair, scales that cannot accommodate a wheelchair, examination tables that are not height adjustable, inaccessible diagnostic equipment and inaccessible restrooms (Becker et al, 1997; Kroll et al, 2006; Mele et al, 2005; Scheer et al, 2003; Story et al, 2009)

Objectives

Methods

Results

Discussion

Conclusion