Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiry

Improving health equity: Evaluation of accessible written medication information for patients with visual impairment

BACKGROUND

Currently, there are limited options for patients with visual impairment or blindness to obtain accessible written medication information.

OBJECTIVES

The objectives of this study were to determine the availability of accessible medication guides provided by the manufacturer and identify common barriers reported by patients with visual impairment in obtaining accessible written medication information in health care settings.

DESIGN

Prospective, cross-sectional study.

SETTING AND PARTICIPANTS

Participants of the survey portion included individuals with visual impairment who were administered an online questionnaire.

OUTCOME MEASURES

Availability of accessible medication guides as verified by 39 manufacturers and accessibility assessed using a checklist based on revised Section 508 guidelines and testing with a screen reader for accessibility. To identify barriers in obtaining written medication information, respondents were recruited by Qualtrics to fill out an anonymous, online 13-question survey from September to October 2022.

RESULTS

All manufacturers did not provide an accessible medication guide or an alternative format. Common errors found by the screen reader were lack of a description for images (alternative text) and headings were not available to help with navigation. As for the survey, a total of 699 participants responded. The median age was 35 years and 49% of respondents were female. A paper copy was the most common format (38%) provided in the pharmacy and barriers identified included lack of Braille or electronic options and personnel not equipped to serve patients with visual impairment.

CONCLUSION

With the lack of accessible written medication information as a barrier to health equity, pharmacists and manufacturers need to provide alternative formats such as audio, electronic formats, or Braille to patients with visual impairment.

The impact of physical disability on the risk of gastric cancer incidence in elderly patients with diabetes: a focus on regional disparity

PURPOSE

Elderly patients with type 2 diabetes mellitus (T2DM) may have a higher risk of physical disability. This study investigated the incidence of gastric cancer according to physical disability status in elderly patients with T2DM.

METHODS

The National Health Insurance Service claims data were used. A total of 76,162 participants aged 60 years or above, diagnosed with T2DM, were included. The association between physical disability status and gastric cancer incidence was evaluated using the Cox regression analysis. Additionally, subgroup analysis was performed according to region.

RESULTS

A total of 9,154 (12.0%) individuals had physical disability. Gastric cancer incidence was more common in participants with physical disability (3.3%) than those without (2.4%). A higher risk of gastric cancer incidence was found in elderly T2DM patients with physical disability (Hazard Ratio (HR) 1.18, 95% Confidence Interval (95% CI) 1.04-1.34). Such tendencies were maintained regardless of region, although the effect of physical disability status on gastric cancer incidence was particularly significant in individuals residing in non-metropolitan areas (HR: 1.19, 95% CI: 1.01-1.40).

CONCLUSION

Elderly patients with T2DM who had physical disability showed a higher risk of gastric cancer incidence. The findings suggest a need to monitor elderly T2DM patients with disability as they may be susceptible to difficulties in accessing cancer-related healthcare.

A Review on the Feasibility and Efficacy of Home-Based Cognitive Remediation in People with Multiple Sclerosis

Cognitive impairment affects 34-65% of People with Multiple Sclerosis (PwMS), significantly impacting their quality of life. Clinicians routinely address cognitive deficits with in-clinic neuro-behavioural interventions, but accessibility issues exist. Given these challenges, coupled with the lifelong need for continuous assistance in PwMS, researchers have underscored the advantageous role of telerehabilitation in addressing these requirements. Nonetheless, the feasibility and efficacy of home-based cognitive remediation remain to be firmly established. In this narrative review, we aimed to investigate the feasibility and efficacy of digital telerehabilitation for cognition in PwMS. Thirteen relevant studies were identified and carefully assessed. Regarding the feasibility of cognitive telerehabilitation, evidence shows adherence rates are generally good, although, surprisingly, not all studies reported measures of compliance with the cognitive training explored. Considering the efficacy of rehabilitative techniques on cognitive performance in PwMS, findings are generally inconsistent, with only one study reporting uniformly positive results. A range of methodological limitations are reported as potential factors contributing to the variable results. Future research must address these challenges, as more rigorous studies are required to draw definitive conclusions regarding the efficacy of home-based cognitive remediation in PwMS. Researchers must prioritise identifying optimal intervention approaches and exploring the long-term effects of telerehabilitation.

Medical, dental, and optical care utilization among community-living people with spinal cord injury in the United States

CONTEXT/OBJECTIVE

Information about patterns of healthcare utilization for people living with spinal cord injury (SCI) is currently limited, and this is needed to understand independent community living after SCI. This study investigates self-reported healthcare utilization among community-living people with SCI and assesses disparities across demographic, socioeconomic, and injury-related subgroups.

DESIGN

Secondary analysis of cross-sectional survey data administered via telephone interview.

SETTING

6 SCI Model Systems centers in the United States (California, Colorado, New Jersey, New York, Ohio, and Pennsylvania).

PARTICIPANTS

Adults with chronic, traumatic SCI who were community-living for at least one year after the completion of an inpatient rehabilitation program (N = 617).

INTERVENTIONS

Not applicable.

OUTCOME MEASURES

Utilization of a usual source of 4 types of health care in the past 12 months: primary, SCI, dental, and optical.

RESULTS

84% of participants reported utilizing primary care in the past year. More than half reported utilizing SCI (54%) and dental (57%) care, and 36% reported utilizing optical care. There were no significant differences across key subgroups in the utilization of primary care. Participants who had been injured for 5 years or less and participants with greater educational attainment were more likely to report utilizing SCI care. Participants with higher household income levels were more likely to report using dental care. Female participants and older age groups were more likely to report using optical care.

CONCLUSION

Rates of healthcare utilization among people with SCI are below recommended rates and vary across demographic, socioeconomic, and injury-related subgroups. This information can inform future research to target barriers to using healthcare services among community-living people with SCI.

[Oncologic Care of Breast Cancer Patients with Preexisting Disabilities: Results of a Qualitative Study on Perceived Barriers, Communication Difficulties, and Needs]

Up to now, people with disabilities have received little consideration in health care with regard to their individual needs. This study gathers information on the internal perspective of breast cancer patients with a pre-existing disability with regard to needs and barriers in oncological care. For this purpose, qualitative, guideline-based interviews were conducted and analysed using qualitative content analysis. Twenty-three patients with physical disabilities, chronic physical illnesses, sensory disabilities, mental illnesses and/or intellectual disabilities were included. Depending on the type of disability, patients faced different barriers. In order to reduce the barriers experienced by people with disabilities in care, it is necessary to promote cooperation between care providers from different care sectors and to train care providers in dealing with people with disabilities.

People with Disabilities' Access to Medical Care During the COVID-19 Pandemic

Delaying and forgoing medical care intensifies the health disparities and unmet needs people with disabilities already face. While many people with disabilities were at high risk for COVID-19, less is known about their access to medical care during the pandemic. This study explored people with disabilities' access to medical care during the COVID-19 pandemic. We analyzed United States Census Bureau COVID-19 Household Pulse Survey data from the second year of the pandemic (April-July 2021) from people with (n = 38,512) and without (n = 296,260) disabilities. During the second year of the pandemic, 30.8% of people with disabilities delayed getting medical care and 28.9% forwent needed care. People with disabilities were also significantly more likely to delay and forgo medical care than people without disabilities. Attention must be drawn to the unmet needs of people with disabilities and efforts must be made to expand their access to health care.

Theoretical components of smoking cessation interventions for persons with physical disabilities: A scoping review

Rationale Persons with physical disabilities report higher cigarette smoking rates and a lower likelihood of accessing health services (e.g., smoking cessation services). Explicit and systematic application of behaviour change theory may be a promising approach to addressing these inequities and developing impactful smoking cessation interventions for persons with physical disabilities.

OBJECTIVE

This scoping review aimed to explore how behaviour change theory and intervention components have been used to design smoking cessation interventions for persons with physical disabilities.

METHODS

Electronic databases (Medline, Embase, PsycINFO, CINAHL, Web of Science) were systematically searched. Smoking cessation interventions for persons with physical disabilities were identified. Behaviour change theory and intervention components, including behaviour change techniques, intervention functions, mode of delivery, intervention source, and setting, were extracted from the included articles.

RESULTS

Among the eleven included articles, there were nine unique smoking cessation interventions for persons with physical disabilities. Three interventions mentioned theory, but none of these articles explicitly applied or tested the theory. Intervention components were consistently combined to deliver pharmacotherapy and behavioural counselling-based interventions.

CONCLUSION

The results of this review highlight the scarcity of theory-based smoking cessation interventions for persons with physical disabilities. While the interventions were not theory-based, they were evidence-based and aligned with recommendations for smoking cessation treatment (i.e., behavioural counselling plus pharmacotherapy). Future research should take a theory-based approach to intervention development to enhance the likelihood that smoking cessation interventions for persons with physical disabilities are effective, replicable, and equitable.

Primary Care in the Spinal Cord Injury Population: Things to Consider in the Ongoing Discussion

Purpose of Review

Spinal cord injury (SCI) creates unique needs that if not recognized and addressed timely can have detrimental effects on the health and quality of life (QOL) of people living with a SCI. Primary preventive health care is shown to decrease morbidity and mortality, yet the SCI population reportedly faces challenges getting access to this care. This area in SCI health care is still largely understudied with no consensus on the ideal way or which health care provider is best to provide primary care for this population.

Findings

Preventive care is generally provided by general primary care providers, but not all primary care providers are trained in recognizing and addressing spinal cord injury-specific needs. SCI providers generally are not trained in addressing all aspects of preventive care. Knowing the recommended preventive care screenings, recognizing and managing specific conditions seen after a SCI, and seamless coordination of care between general practitioners and SCI specialists are some of the interventions to help prevent health complications, decrease morbidity and mortality, improve health outcomes, and promote QOL in this patient population.

Summary

Prioritized focus on preventive care is necessary for a positive impact on the overall health and QOL in this population. Addressing the knowledge gap reported by primary care providers and SCI providers may help increase the probability of SCI patients getting their preventive and specialty care needs addressed. We present a "cheat sheet" of recommendations for the preventive care evaluation of a person living with a SCI.

Disparities in All-Cause Mortality in Older Patients with Colorectal Cancer According to Disability Status: A Nationwide Analysis

BACKGROUND

Although investigating patterns of cancer mortality is important in understanding the effect of cancer on population health, knowledge regarding mortality in cancer patients with disability is scarce. This study examined the association between disability status and all-cause mortality in older patients with colorectal cancer.

METHODS

Data were obtained from the 2008-2019 National Health Insurance Service claims data. The study population included patients with colorectal cancer aged 60 years or above. The outcome measure was all-cause 5-year and overall mortality. A survival analysis was performed using the Cox proportional hazards model to analyze the association between all-cause mortality and disability status. Subgroup analysis was conducted based on disability severity.

RESULTS

The study population consisted of 6340 patients, and disability was reported in 15.8% of the included individuals. Participants with disability had a higher risk of both all-cause 5-year (hazard ratio (HR) 1.21, 95% confidence interval (95% CI) 1.07-1.37) and overall mortality (HR 1.15, 95% CI 1.03-1.28). These findings were particularly significant in individuals with severe rather than mild disability.

CONCLUSION

Older colorectal cancer patients with disabilities showed a higher risk of overall and 5-year all-cause mortality, which was evident in individuals with severe disabilities. The findings indicated disparities in mortality according to disability status. Further, we suggest that policies that can mediate such disparities must be strengthened.

Healthcare services for people with acquired disability in South-East Queensland, Australia: Assessing potential proximity and its association with service obstacles

This study described access potential in South-East Queensland, to healthcare services commonly used by people with acquired disability; and investigated the association between service proximity and perceived service obstacles. First, we described accessibility by conducting a spatial analysis to create maps of potential accessibility to health services in South-East Queensland. Queensland statistical area level 2 (SA2) locations were combined with the residential locations of participants from a longitudinal cohort study involving people with ABI and SCI. The locations of selected health services of interest were identified from Health Direct's National Health Service Directory. Travel times via motor vehicle were modelled with Robust Gaussian Stochastic Process, to smoothly interpolate between the sparse time-to-service observations. Probabilistic predicted values were generated from the model and were used to construct service accessibility maps of South-East Queensland. Disability population data were used to identify SA2s with relatively low service access but a high disability population. Second, we examined perceived service obstacles, by investigating the relationship between potential access to services and perceived service obstacles was examined using data from 63 people with ABI or SCI discharged from the specialist state-wide rehabilitation services, located in South-East Queensland. Obstacles to accessing service in relation to resource availability, transportation and finances were collected three-months after discharge, using the Service Obstacle Scale. Travel times to the closest health service were computed for each individual and were compared to their Service Obstacle Scale responses. Access potential was highly variable, particularly for allied health services. We identified several low-access, high-disability population areas. These hotpots of poor access were generally to the north and west of greater Brisbane. Longer travel times to allied health services were associated with 260% higher odds of agreeing that resource availability was an obstacle to accessing services. Policy makers should be concerned with the hotspots of poor access identified.

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There was considerable variability in access potential, which was generally greater for allied health than medical specialist services.

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We highlighted low-access high disability population areas, which were generally in outer suburbia.

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Poorer potential access to allied health services was associated with resource availability being rated as an service obstacle.

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We did not find any evidence that proximity to allied health services was associated with transportation or finance obstacles.

Health service use among adults with cerebral palsy: a mixed-methods systematic review

AIM

To determine the proportion of adults with cerebral palsy (CP) using health services and frequency of use, and to explore experiences and perceptions of health services for this population.

METHOD

A mixed-methods systematic review was conducted using the Joanna Briggs Institute methodology. Five databases were searched to September 2020. Observational and qualitative studies were included. Two reviewers screened titles, abstracts, and full texts; extracted data; and assessed the quality of included studies. Separate meta-analyses were used to pool the proportion of adults using each service and frequency of use. A meta-aggregation approach was used to synthesize qualitative data. Quantitative and qualitative findings were integrated using the Andersen and Newman Model of health care utilization.

RESULTS

Fifty-seven studies (31 quantitative, 26 qualitative) of 14 300 adults with CP were included. The proportion of adults using services ranged from 7% (95% confidence interval [CI]: 2-13%) for urologists to 84% (95% CI: 78-90%) for general practitioners. Incidence of visits ranged from 67 (95% CI: 37-123) hospital admissions to 404 (95% CI: 175-934) general practitioner visits per 100 person-years. Qualitative themes highlighted issues regarding accessibility, caregivers' involvement, health workers' expertise, unmet ageing needs, transition, and health system challenges.

INTERPRETATION

Adults with CP used a wide range of health services but faced context-specific challenges in accessing required care. Appropriate service delivery models for adults with CP are required. This review emphasizes a need to develop an appropriate service model for adults with CP to meet their needs.

A national survey of physical activity after spinal cord injury

Physical activity is a powerful modifiable risk factor for disease and mortality. Physical activity levels in people with spinal cord injury (SCI) have not been quantified relative to uninjured individuals in a large population-based sample. We aimed to quantify and compare physical activity in people with and without SCI, and to examine the associations between physical activity, lifestyle, and socioeconomic factors. The 2010 Canadian Community Health Survey (n > 57,000) was used, which includes three measures that assess physical activity levels (i.e., leisure time activity frequency, leisure time activity intensity, and transportation time activity intensity). Bivariable and multivariable logistic regressions were performed and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were estimated. The odds of physical activity in people with SCI were 0.43 (95% CI 0.3–0.61), 0.53 (95% CI 0.36–0.75), and 0.42 (95% CI 0.28–0.61), across the three measures of physical activity, respectively. These differences persisted after adjustment for lifestyle, comorbidities, and socioeconomic factors. Physical activity is reduced in the SCI population compared with the general population. This knowledge is important to direct future research and guide the allocation of health care resources.

Current Approaches in Telehealth and Telerehabilitation for Spinal Cord Injury (TeleSCI)

Purpose of Review

Telehealth and telerehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and improve health outcomes in the spinal cord injury population. This review provides an overview of the recent literature on the topic of teleSCI and provides insights on current evidence, future directions, and considerations when using teleSCI for clinical care.

Recent Findings

TeleSCI is used most often for preventive health; management of chronic pain, anxiety, and depression; and rehabilitation-related interventions. As video telehealth becomes mainstream, growth in wearable monitors, bio and neurofeedback mechanisms, and app-based care is expected.

Summary

TeleSCI is growing in prevalence, demonstrates positive impact on health outcomes, and requires ongoing study to identify, refine, and implement best practices.

Effect of Social Determinants of Health Interventions on Adults Living with Disabilities: A Scoping Review

OBJECTIVE

To investigate social determinants of health (SDoH) interventions on individual health outcomes, population health, and cost for persons in the United States over age 18 living with disabilities and receiving long-term services and supports (LTSS) in noninstitutional settings.

DATA SOURCES

A review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted of literature from PubMed, PsycINFO, REHABDATA, and Web of Science Core Collection published between January 1997 and July 2020.

STUDY SELECTION

Search terms were based on the primary SDoH domains identified by the Centers for Medicare and Medicaid's Accountable Health Communities Model. A total of 5082 abstracts were screened based on identification criteria of persons age 18 and above living in non-institutional, community-based settings receiving LTSS.

DATA EXTRACTION

During Level 2 review, articles were reviewed based on population focus, type of LTSS (personal assistance services, home care, adult day care, home modification, durable medical equipment, community transition services, caregiver supports and/or prevention services related to home- and community-based care), SDoH intervention and association with health outcomes, population health and/or cost. A total of 1037 abstracts underwent Level 2 review, yielding 131 publications or 1.3% for full review.

DATA SYNTHESIS

Studies (n=33) designed a priori to test outcomes of interventions were rated according to Grading Recommendations Assessment Development and Evaluation (GRADE) criteria. Qualifying articles that did not include interventions (n=98) were included in our summary of the literature but were not assessed by GRADE.

CONCLUSIONS

The preponderance of research surrounding SDoH and health outcomes has focused on older adults living with disabilities, and most interventions scored low or very low using GRADE criteria. Evidence is limited to the extent SDoH interventions are measured against outcomes for persons of all ages living with disabilities. Robust evaluation of models that feature SDoH interventions in partnership with community-based organizations is recommended as home and community-based care infrastructure expands in response to the American Rescue Plan Act of 2021.

Disparities in the Diagnosis and Treatment of Gastric Cancer in Relation to Disabilities

We investigated potential disparities in the diagnosis, treatment, and survival of gastric cancer (GC) patients with and without disabilities.

Recognizing Inequity: A Critical Step of Health Literacy for People With Disability

IMPORTANCE

Receiving accommodations may require a person with physical disability (PWPD) to recognize and address disparate care when it occurs.

OBJECTIVE

To explore whether PWPDs recognize disparate health care and how their experiences contribute to the development of strategies to access care.

DESIGN

In this qualitative study, we used grounded theory methods to explore perceptions of PWPDs regarding access to health care. Ten PWPDs participated in three semistructured focus group interviews. The analysis used multiple phases of analysis and methods to ensure rigor.

SETTING

Focus groups were held at an urban university campus.

PARTICIPANTS

Four male and six female English speakers who identified as a PWPD in need of a mobility aid and who attended a primary health care visit in the past year.

RESULTS

Seven thematic categories emerged, representing a continuum of stages for recognizing health care as disparate and strategies to receiving equitable health care for PWPDs: (1) unrecognized experiences of normalization of disability discrimination (NODD), with a subtheme of medicalization; (2) knowing what you need; (3) noticing differences; (4) emerging understanding; (5) learning to take personal action; (6) NODD is systemic; and (7) taking control.

CONCLUSIONS AND RELEVANCE

The findings of this study can be used on micro, meso, and macro levels to work toward equitable health care access and outcomes for clients. What This Article Adds: Occupational therapy practitioners can use these findings to understand the health literacy demands of PWPDs in efforts to access equitable health care and, when necessary, educate clients on their potential need for accommodation, rights to care, and development of strategies for requesting accommodations.

Team-based primary care program for disabled people and changes in rate of unmet health care needs

BACKGROUND

Few studies have been conducted on the application of specific and practical methods, such as interventions, for reducing the unmet health care needs (UHCN) of disabled people.

OBJECTIVES

The study aims to evaluate the impact of the team-based primary care program (TPCP) for disabled people on UHCN.

METHOD

In 2017, we surveyed 696 disabled people who were enrolled in the TPCP at one of the 11 institutions belonging to the Korea Health Welfare Social Cooperative Federation from 2015 to 2017 to assess their unmet needs before and after enrolment. We conducted a logistic regression analysis before and after the program to evaluate the relationship between participation period and unmet needs after adjusting for physician type, gender, age, drinking, monthly income, disability type, personal assistance services and living alone.

RESULT

After using the service, the proportion of disabled people with unmet needs decreased from 42.9% to 20.4% for a medical doctor and 43.6% to 18.6% for a Korean medical (KM) doctor. After adjusting for related factors and stratifying with type of physician, the proportion of disabled people with unmet needs decreased significantly in response to the participation period for the medical doctor-involved program (P-trend < 0.001); this was not observed in the KM counterpart (P-trend = 0.6).

CONCLUSION

The TPCP for disabled people provides disease prevention, health care and health promotion activities and is crucial for solving the unmet needs.

Access to community support workers during hospital admission for people with spinal cord injury: a pilot study

STUDY DESIGN

A descriptive qualitative study.

OBJECTIVES

To evaluate a pilot project enabling people with spinal cord injury (SCI) to have their support workers accompany them into a non-SCI specialist/public hospital (excluding ICU) to perform selected care.

SETTING

The study was conducted in New Zealand.

METHODS

Interviews and focus groups with people with SCI, support workers, care agency staff, and hospital staff who participated in the pilot project.

RESULTS

Twenty-five individuals participated in the study. Two themes captured participants' experiences of the pilot: 'Maintaining individualised care' and 'Role, tasks and responsibilities. Support workers were described as knowledgeable about SCI care needs and being better positioned to provide individualised care for people with SCI than general nursing staff. Participants with SCI felt less anxious having a support worker with them, and perceived less risk of acquiring secondary health complications during the hospital admission. Good communications is important to ensure there is a shared understanding of the role and responsibilities of having an unregistered support worker in the hospital environment.

CONCLUSIONS

Having their regular support worker during admission to public hospital improved the SCI-specific care received. Support workers reduced the demand on hospital nursing staff who did not always have the time or specialist SCI knowledge to provide individualised care. People with SCI may be more likely to access medical assistance earlier and not defer hospital admissions if they can have support workers accompany them into hospital.

A Primary Care Provider's Guide to Preventive Health After Spinal Cord Injury

Objective: Provide guidance for preventive health and health maintenance after spinal cord injury (SCI) for primary care providers (PCPs). Main message: Individuals with SCI may not receive the same preventive health care as the general population. Additionally, SCI-related secondary conditions may put their health at risk. SCI is considered a complex condition associated with many barriers to receiving quality primary care. Attention to routine preventive care and the unique health considerations of persons with SCI can improve health and quality of life and may prevent unnecessary health care utilization. Conclusion: PCPs are experts in preventive care and continuity of care, however individuals with SCI may not receive the same preventive care due to numerous barriers. This article serves as a quick reference for PCPs.

Can disability accommodation needs stored in electronic health records help providers prepare for patient visits? A qualitative study

Background

Embedding patient accommodation need in the electronic health record (EHR) has been proposed as one means to improve health care delivery to patients with disabilities. Accommodation need is not a standard field in commercial EHR software. However, some medical practices ask about accommodation need and store it in the EHR. Little is known about how the information is used, or barriers to its use. This exploratory-descriptive study examines whether and how information about patients’ disability-related accommodation needs stored in patient records is used in a primary health care center to plan for care.

Methods

Four focus groups (n = 35) were conducted with staff of a Federally Qualified Health Center that asks four accommodation questions at intake for the EHR. Respondents were asked how they learned about patient accommodation need, whether and how they used the information in the EHR, barriers to its use, and recommendations for where accommodation information should reside. A brief semi-structured interview was conducted with patients who had indicated an accommodation need (n = 12) to learn their experience at their most recent appointment. The qualitative data were coded using structural coding and themes extracted.

Results

Five themes were identified from the focus groups: (1) staff often do not know accommodation needs before the patient’s arrival; (2) electronic patient information systems offer helpful information, but their structure creates challenges and information gaps; (3) accommodations for a patient’s disability occur, but are developed at the time of visit; (4) provider knowledge of a regular patient is often the basis for accommodation preparation; and (5) staff recognize benefits to advance knowledge of accommodation needs and are supportive of methods to enable it. Most patients did not recall indicating accommodation need on the intake form. However, they expected to be accommodated based upon the medical practice’s knowledge of them.

Conclusions

Patient accommodation information in the EHR can be useful for visit planning. However, the structure must enable transfer of information between scheduling and direct care and be updatable as needs change. Flexibility to record a variety of needs, visibility to differentiate accommodation need from other alerts, and staff education about needs were recommended.

A survey of internal and family medicine residents: Assessment of disability-specific education and knowledge

BACKGROUND

The literature suggests that primary care physicians are inadequately educated in the care of people with disabilities. No study to date has evaluated whether internal medicine (IM) and family medicine (FM) residents have received disability-specific education or their level of comfort in caring for people with physical disabilities.

OBJECTIVES

To assess IM and FM residents' receipt of disability-specific education during medical school and residency; to evaluate their self-reported comfort in managing secondary conditions associated with physical disabilities and in coordinating therapies and services for individuals with disabilities; to gauge their interest in receiving disability-specific education.

METHODS

An on-line survey distributed to residents at a convenience sample of ten academic IM and FM residency programs in the northeastern United States. Participants (n = 176) were asked about their socio-demographic and training-specific characteristics and their self-assessed ability to manage secondary conditions associated with physical disabilities and coordinate care and services for individuals with disabilities. Chi Square tests were used to compare participant characteristics and outcomes.

RESULTS

Few participants had received disability-specific education during medical school or residency (34.6% and 11.2%, respectively), and nearly all (96.0%) expressed interest in receiving more. Small minorities reported feeling comfortable managing common secondary conditions or in coordinating therapies and services for individuals with disabilities.

CONCLUSION

Although one-fifth of adult Americans have a disability, few of our participating IM and FM residents had received disability-specific education or felt comfortable managing the care of people living with disabilities. Our results indicate a need to develop and disseminate disability-specific curricula.

A Primary Care Provider's Guide to Accessibility After Spinal Cord Injury

Individuals with spinal cord injury (SCI) continue to have shorter life expectancies, limited ability to receive basic health care, and unmet care needs when compared to the general population. Primary preventive health care services remain underutilized, contributing to an increased risk of secondary complications. Three broad themes have been identified that limit primary care providers (PCPs) in providing good quality care: physical barriers; attitudes, knowledge, and expertise; and systemic barriers. Making significant physical alterations in every primary care clinic is not realistic, but solutions such as seeking out community partnerships that offer accessibility or transportation and scheduling appointments around an individual's needs can mitigate some access issues. Resources that improve provider and staff disability literacy and communication skills should be emphasized. PCPs should also seek out easily accessible practice tools (SCI-specific toolkit, manuals, modules, quick reference guides, and other educational materials) to address any knowledge gaps. From a systemic perspective, it is important to recognize community SCI resources and develop collaboration between primary, secondary, and tertiary care services that can benefit SCI patients. Providers can address some of these barriers that lead to inequitable health care practices and in turn provide good quality, patient-centered care for such vulnerable groups. This article serves to assist PCPs in identifying the challenges of providing equitable care to SCI individuals.

A Primary Care Provider's Guide to Social Justice, the Right to Care, and the Barriers to Access After Spinal Cord Injury

People living with spinal cord injury (SCI) face numerous barriers to primary care. This article identifies these barriers as social justice issues to emphasize their significance and the inequality of primary care received by people with SCI. Primary care providers have a responsibility to provide equal and accessible care to all patients and to remediate any obstacles to care. Understanding the well-documented barriers of competence, physical, policy and procedural, communication, and attitudes impacting primary care for people with SCI will bring much-needed awareness and opportunity for meaningful change. This article is a call to action for social justice within primary care and provides helpful recommendations for removing and addressing barriers. Better health care outcomes for people with SCI are possible if primary care physicians and providers become social justice advocates for their patients with SCI.

Evaluation of a Conceptual Model Regarding Exercise Promotion Through the Patient-Provider Interaction in Multiple Sclerosis: Health Care Provider Perspectives

Nearly 80% of persons with multiple sclerosis (MS) do not engage in sufficient amounts of exercise for managing symptoms and improving quality of life. We have addressed this problem by developing a systematic line of qualitative research targeting the patient-provider interaction for promotion of exercise within comprehensive MS care. This research resulted in a conceptual model that guides health care providers in promoting exercise among persons with MS. The current study involves a final evaluation of the model based on semistructured interviews with 28 MS health care providers. Providers perceived that the model was a strong conceptualization of practice that reflected the MS illness course and supported exercise behavior change, but more steps were required to translate the model from concept into practice, including improved clarity of the model, and the development of practice models. The evaluation yielded a final conceptual model for exercise promotion in MS through the patient-provider interaction.

A 3D printing approach toward targeted intervention in telerehabilitation

Neuromuscular impairment requires adherence to a rehabilitation regimen for maximum recovery of motor function. Consumer-grade game controllers have emerged as a viable means to relay supervised physical therapy to patients' homes, thereby increasing their accessibility to healthcare. These controllers allow patients to perform exercise frequently and improve their rehabilitation outcomes. However, the non-universal design of game controllers targets healthy people and does not always accommodate people with disability. Consequently, many patients experience considerable difficulty assuming certain hand postures and performing the prescribed exercise correctly. Here, we explore the feasibility of improving rehabilitation outcomes through a 3D printing approach that enhances off-the-shelf game controllers in home therapy. Specifically, a custom attachment was 3D printed for a commercial haptic device that mediates fine motor rehabilitation. In an experimental study, 25 healthy subjects performed a navigation task, with the retrofit attachment and without it, while simulating disability of the upper limb. When using the attachment, subjects extended their wrist range of motion, yet maintained their level of compensation. The subjects also showed higher motivation to repeat the exercise with the enhanced device. The results bring forward evidence for the potential of this approach in transforming game controllers toward targeted interventions in home therapy.

Accessibility facilitators and barriers affecting independent wheelchair transfers in the community

PURPOSE

The purpose of this study is to identify facilitators and barriers to wheelchair transfers in the community and to identify specific places and surfaces in the community where increasing transfer accessibility could enable greater participation.

METHODS

This study enrolled 112 wheeled mobility device users who completed a survey describing barriers to independent transfers. Descriptive statistics (means, standard deviations, and percentages) were used to report the survey results.

RESULTS

The majority of subjects (≥50% of the sample) who were impacted by the following features found them to be helpful while transferring: presence of transfer aids, presence of grab bars, large enough transfer surface size, storage space for a wheeled mobility device (WMD), large amounts of space and clearance for legs and feet, soft surfaces, and enough space next to the transfer surface. Ninety percent (90.5%) felt their participation was limited when surfaces higher than their WMD were encountered. Participants also reported feeling limited in their participation due to lack of transfer accessibility at a variety of community destinations, including medical facilities (35.1%), modes of transportation (38.5-52.1%), pools and hot tubs (45.4%), dressing rooms (50.0%), amusement parks (49.1%), and boating areas (52.1%).

CONCLUSION

Improving accessibility for independent transfers in the community may support greater participation and lead to a better quality of life. Study findings provide insight into changes that would make the built environment more accessible and safer for wheelchair users who independently transfer.Implications for rehabilitationTransferring independently is one of the most physically demanding tasks for wheelchair users, and physical and environmental factors may affect transferability in the community.Identifying environmental facilitators and barriers to transfers may improve accessibility for wheelchair users, allowing for greater community participation, reduced risk of falls and injuries, and improvements to quality of life.

Preventive care among primary care patients living with spinal cord injury

Objective: Context/Objective: Family physicians may lack the knowledge or resources to adequately support patients with spinal cord injury (SCI). Our objectives were to determine patterns of preventive care for patients with SCI in a primary care setting (i.e. cancer screening, influenza vaccinations, general physicals, bone mineral density tests), and determine physicians' level of comfort with providing primary care to patients with SCI.Design: i) Retrospective chart review, ii) Survey of physicians in the family practice.Setting: Six primary care practice sites in Ontario, Canada.Participants: All adult rostered patients of the family practice with SCI; All family physicians in the six sites.Outcome Measures: Proportion of patients up-to-date on cancer screening, proportion of patients with influenza vaccinations, general physicals, bone mineral density tests; physicians' level of comfort with providing care to patients with SCI.Results: Sixty patients were included in analyses. Rates of cancer screening were generally poor. The highest uptake was seen for cervical cancer screening, where 50% of eligible women were up-to-date on Pap tests. Only 36.7% of patients were up-to-date on colorectal cancer screening. Only 14 (23.3%) patients had a documented general physical exam in their electronic record. There was a recorded flu vaccination for 55% of patients, and of those, there was a median of 19 months since last vaccination. Fifteen physicians (21.4%) responded to the survey. Ten physicians reported at least one patient with SCI, with the maximum being 20 patients. Comfort level in managing SCI-relevant conditions varied and was lowest for spasticity, respiratory issues and autonomic dysreflexia, where only 27.3% of respondents had some level of comfort.Conclusion There are many opportunities to improve the preventive care of patients living with SCI.

Barriers to, and facilitators of, access to cancer services and experiences of cancer care for adults with a physical disability: A mixed methods systematic review

BACKGROUND

Cancer services need to be inclusive and accessible to everybody, including people with disabilities. However, there is evidence suggesting that people with disabilities experience poorer access to cancer services, compared to people without disabilities.

OBJECTIVES

To investigate the barriers and facilitators of access to cancer services for people with physical disabilities and their experiences of cancer care.

METHODS

A mixed-method systematic review was conducted following the Evidence for Policy and Practice Information and Co-ordinating Centre approach. We used the Mixed Methods Appraisal Tool (MMAT -Version 11) to assess the quality of the included studies. We employed thematic synthesis to bring together data from across both qualitative and quantitative studies and we assessed the strength of synthesised findings using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach.

RESULTS

Seven quantitative studies and 10 qualitative studies (across 18 publications) were included. The findings highlighted a dearth of research on the experiences of men with disabilities. Furthermore, only one study explored experiences of cancer treatment, with all other studies focusing on cancer screening. Five synthesised findings were identified that reflected barriers and facilitators, highlighting both what makes access to services difficult and what are the strategies that could improve it.

CONCLUSIONS

Knowing what works for people with disabilities can enable the delivery of appropriate services. The findings of this review suggest that the mere existence of services does not guarantee their usability. Services need to be relevant, flexible, and accessible, and offered in a respectful manner.

Utilization of and Relationships With Primary Care Providers During the Transition to Medicaid Managed Care

The objective of this study was to determine whether seniors and disabled adults in Illinois’s Medicaid managed care (MMC) were more likely to see, maintain longitudinal relationships with, and have continuity of care with a primary care provider (PCP) compared with fee-for-service (FFS) Medicaid enrollees. Medicaid PCP service claims for 13,221 MMC and 54,625 FFS enrollees were analyzed using an inverse propensity score weighted difference-in-differences design to match the groups by demographic characteristics and historical Medicaid utilization. All data came from Medicaid claims data and corresponding administrative records. Regression analyses showed that enrollment in MMC was significantly related to each of the three outcomes; MMC enrollees were more likely than the FFS group to see a PCP during the 1-year post-period and have high levels of continuity of care with a single PCP. However, FFS enrollees were more likely to maintain a relationship with their PCP providers from the pre-period through the post-period. Therefore, while more people in MMC than FFS visit a PCP each year, for people in MMC, it is often a new provider relationship, which can be problematic for people with disabilities. Additional training for PCPs, to prepare them for working with people with disabilities, and additional efforts to expand the MMC network of providers are needed.

Factors Influencing Utilization of Physiotherapy Service among Children with Cerebral Palsy in Jalandhar District of Punjab

Background:

Physiotherapy plays a central role in the management of children with cerebral palsy (CP); however, literature describing the use of physiotherapy service and the factors affecting utilization of physiotherapy service for this group of children in the Indian context remain unexplored.

Aims and Objectives:

To describe the utilization of physiotherapy services and explore the factors affecting utilization of physiotherapy services among children with CP of Jalandhar district of Punjab.

Methodology:

During June 2009 to March 2012 interview of family members of 248 children with CP (male = 159; female = 89) was conducted using a schedule focusing on demography, constraints of resources, expectations, beliefs, awareness, and service utilization. Cross tabulation with Chi-square, univariate, and multivariate logistic regression analysis were the tools of statistical analysis.

Results:

44.4% children had not received any physiotherapy in their life time. In univariate analysis exposure to physiotherapy was found significantly associated with age of diagnosis (odds ratio [OR] = 2.47), finance constraint (OR = 2.27), personal constraint (OR = 2.54), transportation constraint (OR = 3.01), lack of advice for rehabilitation (OR = 2.36), ignorance about condition (OR = 11.94), and rehabilitation services (OR = 2.88). Multivariate model (χ² = 57.16, df = 15, P < 0.001, pseudo R² Cox and Snell = 0.22, Nagelkerke = 0.27) identified two main predictor variables of nonexposure to physiotherapy-ignorance about condition (OR = 7.3) and expectation of normalcy (OR = 0.43).

Conclusion:

The main drivers for the use of physiotherapy among children with CP in Jalandhar district of Punjab were awareness about the condition of CP and expectation of normalcy which demonstrated a complex relationship with sociodemographic factors.

Barriers to accessing cancer services for adults with physical disabilities in England and Wales: an interview-based study

OBJECTIVES

The aim of this study was to explore the barriers to accessing cancer services faced by adults with pre-existing physical disabilities.

DESIGN

Cross-sectional, exploratory qualitative study. Data were collected by semistructured interviews and analysed thematically.

SETTING

Participants were recruited through statutory and third sector organisations in England and Wales between October 2017 and October 2018.

PARTICIPANTS

18 people with a diagnosis of cancer and a pre-existing physical disability.

RESULTS

The findings illustrate that people with physical disabilities in England and Wales face a variety of barriers to accessing cancer services. The overall theme that emerged was that participants experienced a lack of attitudinal and institutional preparation both from healthcare professionals and healthcare facilities. This overall theme is illustrated through three subthemes: lack of acknowledgment of disability, unseeing disability and physical inaccessibility.

CONCLUSIONS

As the population ages and increasing numbers of people live with cancer and disability, it is important to develop knowledge to respond to the needs of this population. The mere existence of services does not guarantee their usability. Services need to be relevant, flexible, and accessible and offered in a respectful manner. It is important that healthcare professionals work towards inclusive healthcare provision, enabling the utilisation of services by all. Necessary steps to be taken include better communication between the various professionals and across the different teams involved in patients' care, raising awareness of how physical disability can affect or interact with cancer-related treatment and creating more accessible physical environments.

Presence of Accessible Equipment and Interior Elements in Primary Care Offices

Purpose: To describe the disability accessibility level of primary care office interiors and the presence of accessible examination equipment.

Methods: Data from on-site audits of 3993 primary care offices in California for 2013–2016 are descriptively analyzed. Architectural access is assessed using an instrument based on ADA Accessibility guidelines (ADAAG), along with noting accessibility of examination equipment.

Results: Compliance across architectural elements was ∼85%. Accessible examination tables and scales were observed in 19.1% and 10.9% of offices, respectively.

Conclusions: Proactive accessibility auditing makes visible the infrequent presence of accessible examination equipment. It offers data for tracking progress to increase medical office disability access.

The Role of Social Interactions in Motor Performance: Feasibility Study Toward Enhanced Motivation in Telerehabilitation

BACKGROUND

Robot-mediated telerehabilitation has the potential to provide patient-tailored cost-effective rehabilitation. However, compliance with therapy can be a problem that undermines the prospective advantages of telerehabilitation technologies. Lack of motivation has been identified as a major factor that hampers compliance. Exploring various motivational interventions, the integration of citizen science activities in robotics-based rehabilitation has been shown to increase patients' motivation to engage in otherwise tedious exercises by tapping into a vast array of intrinsic motivational drivers. Patient engagement can be further enhanced by the incorporation of social interactions.

OBJECTIVE

Herein, we explored the possibility of bolstering engagement in physical therapy by leveraging cooperation among users in an environmental citizen science project. Specifically, we studied how the integration of cooperation into citizen science influences user engagement, enjoyment, and motor performance. Furthermore, we investigated how the degree of interdependence among users, such that is imposed through independent or joint termination (JT), affects participation in citizen science-based telerehabilitation.

METHODS

We developed a Web-based citizen science platform in which users work in pairs to classify images collected by an aquatic robot in a polluted water canal. The classification was carried out by labeling objects that appear in the images and trashing irrelevant labels. The system was interfaced by a haptic device for fine motor rehabilitation. We recruited 120 healthy volunteers to operate the platform. Of these volunteers, 98 were cooperating in pairs, with 1 user tagging images and the other trashing labels. The other 22 volunteers performed both tasks alone. To vary the degree of interdependence within cooperation, we implemented independent and JTs.

RESULTS

We found that users' engagement and motor performance are modulated by their assigned task and the degree of interdependence. Motor performance increased when users were subjected to independent termination (P=.02), yet enjoyment decreased when users were subjected to JT (P=.005). A significant interaction between the type of termination and the task was found to influence productivity (P<.001) as well as mean speed, peak speed, and path length of the controller (P=.01, P=.006, and P<.001, respectively).

CONCLUSIONS

Depending on the type of termination, cooperation was not always positively associated with engagement, enjoyment, and motor performance. Therefore, enhancing user engagement, satisfaction, and motor performance through cooperative citizen science tasks relies on both the degree of interdependence among users and the perceived nature of the task. Cooperative citizen science may enhance motivation in robotics-based telerehabilitation, if designed attentively.

Our Peers-Empowerment and Navigational Support (OP-ENS): Development of a Peer Health Navigator Intervention to Support Medicaid Beneficiaries With Physical Disabilities

People with disabilities (PWD) are a health disparities population who experience well-documented physical, structural, attitudinal, and financial barriers to health care. The disability rights community is deeply engaged in advocacy to promote health care justice for all PWD. As the community continues to work toward systems change, there is a critical need for community-directed interventions that ensure individuals with disabilities are able to access the health care services they need and are entitled to. Peer health navigator (PHN) programs have been shown to help people from diverse underserved communities break down barriers to health care. The PHN model has not been systematically adapted to meet the needs of PWD. In this article, we describe the collaborative process of developing Our Peers—Empowerment and Navigational Supports (OP-ENS), an evidence-informed PHN intervention for Medicaid beneficiaries with physical disabilities in Chicago, IL, USA. Our Peers—Empowerment and Navigational Supports is a 12-month community-based PHN intervention that pairs Medicaid beneficiaries with physical disabilities (peers) with disability PHNs who use a structured recursive process of barrier identification and asset mapping, goal setting, and action planning to help peers meet their health care needs. Our Peers—Empowerment and Navigational Supports was developed by a collaborative team that included disability rights leaders, representatives from a Medicaid managed care organization, and academic disability health care justice researchers. We highlight both the conceptual and empirical evidence that informed OP-ENS as well as the lessons learned that can assist future developers.

Utilisation of mammography by women with mobility impairment in the UK: secondary analysis of cross-sectional data

OBJECTIVES

Research has shown that people with physical impairment report lower utilisation of preventive services. The aim of this study was to examine whether women with mobility impairments have lower odds of using mammography compared with women with no such impairment, and explore the factors that are associated with lower utilisation.

SAMPLE AND DESIGN

We performed secondary analysis, using logistic regressions, of deidentified cross-sectional data from the European Health Interview Survey, Wave 2. The sample included 9491 women from across the UK, 2697 of whom had mobility impairment. The survey method involved face-to-face and telephone interviews.

OUTCOME MEASURES

Self-report of the last time a mammogram was undertaken.

RESULTS

Adjusting for various demographic and socioeconomic variables, women with mobility impairment had 1.3 times (95% CI 0.70 to 0.92) lower odds of having a mammogram than women without mobility impairment. Concerning women with mobility impairment, married women had more than twice the odds of having a mammogram than women that had never been married (OR 2.07, 95% CI 1.49 to 2.88). Women in Scotland had 1.5 times (95% CI 1.08 to 2.10) higher odds of undertaking the test than women in England. Women with upper secondary education had 1.4 times (95% CI 1.10 to 1.67) higher odds of undergoing the test than women with primary or lower secondary education. Also, women from higher quintiles (third and fifth quintiles) had higher odds of using mammography, with the women in the fifth quintile having 1.5 times (95% CI 1.02 to 2.15) higher odds than women from the first quintile.

CONCLUSIONS

In order to achieve equitable access to mammography for all women, it is important to acknowledge the barriers that impede women with mobility impairment from using the service. These barriers can refer to structural disadvantage, such as lower income and employment rate, transportation barriers, or previous negative experiences, among others.

Identification of targets for improving access to care in persons with long term physical disabilities

BACKGROUND

People with long-term physical disability (LTPD) continue to experience difficulties in accessing health care despite the focus of highlighting disparities in the last two decades.

OBJECTIVES

To describe health care utilization, accommodations and barriers experienced while accessing health care, and reasons why individuals delay or skip health care among people with LTPD.

METHODS

The current study was a part of a larger longitudinal survey administered to individuals with physical disability associated with one of four long-term conditions (MS; SCI; PPS; MD). Measures included demographics, health care utilization, barriers to health care, and reasons for delaying or skipping medical care from the sixth wave of data from 2015 to 2016.

RESULTS

Roughly 90% of all participants (N = 1159) saw at least one medical provider within 12 months. The most encountered barrier participants reported experiencing within that time was an office that did not have a safe transfer device to move them to an exam table (69%). Participants' physical function, quality of life, status of living with a spouse, diagnostic condition, and sex (male) were significantly associated with endorsing a barrier in accessing health care. The inability to afford out of pocket expenses was the highest reported reason for delaying health care.

CONCLUSIONS

People with LTPD access a variety of health care, including rehabilitation services, and continue to experience barriers when doing so. While understanding barriers individuals experience when accessing health care is important, it is equally important to document the type of care they delay or skip due to barriers.

Evaluation of a Conceptual Model to Guide Health Care Providers in Promoting Exercise Among Persons With Multiple Sclerosis

Fewer than 20% of persons with multiple sclerosis (MS) engage in enough exercise to manage MS symptoms and improve function. To address this problem, the authors developed a conceptual model to promote exercise among persons with MS through the patient-provider interaction within health care settings. The current qualitative study evaluated and refined the conceptual model based on 32 semistructured interviews involving persons with MS. The data were subject to inductive, semantic thematic analysis. Participants highlighted that the conceptual model was a necessary addition to current MS care and noted multiple strengths regarding its design (e.g., structure) and content (e.g., patient-provider interaction). Furthermore participants noted areas of the conceptual model that could be improved (e.g., less focus on neurologists as exercise promoters). This comprehensive evaluation yielded a refined conceptual model for exercise promotion in MS through the patient-provider interaction.

Use of Colorectal Cancer Screening Among People With Mobility Disability

GOALS

We aimed to assess use of colorectal cancer screening (CRCS) as per United States Preventive Task Force guidelines among people with mobility disability using a nationally representative data set.

BACKGROUND

Individuals with mobility disability have decreased access to health care services, but the impact of mobility disability on CRCS has not been investigated.

STUDY

Data from the 2013 National Health Interview Survey were used to estimate sociodemographic characteristics of adults with mobility disability, prevalence of CRCS, and odds of CRCS given mobility disability among Americans aged 50 to 75.

RESULTS

In total, 56.8% of the entire sample (n=81,953,585) were up-to-date with CRCS. Mobility disability was not associated with CRCS status on univariable analysis but was significantly associated after adjustment for covariates including age and comorbidities, with an inverse relationship between the degree of mobility disability and odds of CRCS. Odds ratio for CRCS given progressively severe disability were 0.78 (0.66 to 0.93), 0.71 (0.53 to 0.94), 0.65 (0.31 to 1.19).

CONCLUSIONS

The present study indicates reduced CRCS among people with mobility disability and highlights the need for CRCS to be especially targeted toward this group. Future research should identify the specific systemic, social, and/or physical barriers to CRCS for this subgroup so that they can be addressed.

Barriers to Healthcare Participation in Persons With Disabilities in Appalachia: A Qualitative Pilot Study

OBJECTIVES:

A study exploring facility-related barriers to healthcare participation (the level to which an individual is engaged or involved in their own healthcare activities from simply keeping appointments to following treatment regimens) in persons with disabilities in Appalachia from the perspectives of four stakeholder groups, (1) adults with disabilities, (2) caregivers of persons with disabilities, (3) advocates for persons with disabilities, and (4) providers who treat persons with disabilities.

BACKGROUND:

Persons with disabilities potentially face additional barriers to healthcare participation than those without disabilities. Understanding and addressing the barriers to participation could assist in improving healthcare outcomes among the disabled population.

METHODS:

A qualitative study was conducted involving scripted focus groups with four stakeholder groups with expertise/experience in disabilities. The objective was to assess perceptions of impacts of clinical design elements on healthcare participation.

RESULTS:

Participants identified and characterized six major categories of facility- and nonfacility-related barriers they felt impacted healthcare participation, with priority differences reported between each group.

CONCLUSIONS:

The healthcare facility is perhaps the most visible tool the provider has at his or her disposal to deliver effective healthcare. Understanding the interactions persons with different disabilities have with the physical facility and the messages, both intentional and unintentional, the state of the facility sends can provide useful insights into delivering more effective healthcare to this population.

Improving primary care for persons with spinal cord injury: Development of a toolkit to guide care

OBJECTIVE

To identify a set of essential components for primary care for patients with spinal cord injury (SCI) for inclusion in a point-of-practice toolkit for primary care practitioners (PCP) and identification of the essential elements of SCI care that are required in primary care and those that should be the focus of specialist care.

DESIGN

Modified Delphi consensus process; survey methodology.

SETTING

Primary care.

PARTICIPANTS

Three family physicians, six specialist physicians, and five inter-disciplinary health professionals completed surveys.

OUTCOME MEASURES

Importance of care elements for inclusion in the toolkit (9-point scale: 1 = lowest level of importance, 9 = greatest level of importance) and identification of most responsible physician (family physician, specialist) for completing key categories of care. Open-ended comments were solicited.

RESULTS

There was consensus between the respondent groups on the level of importance of various care elements. Mean importance scores were highest for autonomic dysreflexia, pain, and skin care and lowest for preventive care, social issues, and vital signs. Although, there was agreement across all respondents that family physicians should assume responsibility for assessing mental health, there was variability in who should be responsible for other care categories. Comments were related to the need for shared care approaches and capacity building and lack of knowledge and specialized equipment as barriers to optimal care.

CONCLUSION

This study identified important components of SCI care to be included in a point-of-practice toolkit to facilitate primary care for persons with SCI.

Emergency department utilization among people with disabilities in Korea

BACKGROUND

According to prior studies, it is possible to consider the emergency care utilization due to ambulatory care sensitive conditions (ACSCs) as a proxy measure of access to primary care but there was no confirmed study among people with disabilities.

OBJECTIVE/HYPOTHESIS

We examined overall emergency department (ED) utilization patterns among people with disabilities compared with the general population and estimated factors affecting ED utilization. Additionally, we examined whether there were any differences in ED visits due to ACSCs according to type and severity of disability.

METHODS

The nationally representative Korean Health Panel Survey was used. Data from 14,616 individuals who participated in the survey from 2008 to 2012 were analyzed. The frequency and causes of emergency visits were examined between individuals with and without disabilities. A generalized regression model with Poisson distribution was applied to identify factors that affect ED visits.

RESULTS

In 2012, people with disabilities were about two times as likely to visit the ED compared to people without disabilities, and people with external disability represented the largest proportion of people with disabilities. According to generalized linear model, disability was a strong predictor of ED visits, along with lower education level, being elderly, having a chronic disease, and being less healthy. Overall, ED visits due to ACSCs were about three times higher in the disabled group than in the non-disabled group.

CONCLUSIONS

Public health authorities should consider strengthening the primary care system to avoid unnecessary and preventable ED utilization among all Korean people, including people with disabilities.

Perceptions and attitudes towards the implementation of a disability evaluation system based on the international classification of functioning, disability, and health among people with disabilities in Taiwan

PURPOSE

To explore the perceptions and attitudes among people with disabilities towards the newly implemented International Classification of Functioning, Disability and Health-based disability evaluation system (the new system) in Taiwan.

METHOD

Using a self-administered questionnaire, we conducted a nationwide survey. The questionnaire focused on the domains of quality, satisfaction, and revision of the new system. In total, 1073 persons (age, ≥18 years) with disabilities or their primary caregivers, who experienced both the old and the new system, responded to the questionnaire.

RESULTS

Most participants were satisfied with the new system overall (58.7%) and the subscale of quality of structure (91.3%) and quality of outcome (63.6%). However, only 20.5% of the participants were favourable to the quality of process. The probability of being satisfied with the system overall was low for the quality of process subscale (adjusted odds ratio range, 0.3 ∼ 0.4) and its item of long interval (0.2 ∼ 0.6). Contrariwise, the probability was high for the other subscales (3.9 ∼ 13.7) and the item of identifying needs (21.9 ∼ 23.4).

CONCLUSIONS

Persons with disabilities and their primary caregivers have positive attitudes towards the new system. It is important to simplify the assessment tools and procedures to improve the system's quality of process and facilitate its usability. IMPLICATIONS FOR REHABILITATION Persons with disabilities have positive attitudes towards the newly implemented International Classification of Functioning, Disability, and Health-based disability evaluation system in Taiwan. The system that provides comprehensive information about functioning and disability of persons with disabilities is able to capture the difficulties and needs of those individuals in their daily lives. The system hence helps people to mitigate the effects of disability and guide rehabilitation. The assessment items and processes of the system, however, were perceived to be complicated, time-consuming, and inconvenient. Simplifying the assessment items and processes, such as developing a short form version of the assessment tool and increasing the service time, may facilitate the usability of the system.

Developing a Model of Care for Healing Pressure Ulcers With Electrical Stimulation Therapy for Persons With Spinal Cord Injury

Background: Electrical stimulation therapy (EST) has been shown to be an effective therapy for managing pressure ulcers in individuals with spinal cord injury (SCI). However, there is a lack of uptake of this therapy, and it is often not considered as a first-line treatment, particularly in the community. Objective: To develop a pressure ulcer model of care that is adapted to the local context by understanding the perceived barriers and facilitators to implementing EST, and to describe key initial phases of the implementation process. Method: Guided by the Knowledge-to-Action (KTA) and National Implementation Research Network (NIRN) frameworks, a community-based participatory research (CBPR) approach was used to complete key initial implementation processes including (a) defining the practice, (b) identifying the barriers and facilitators to EST implementation and organizing them into implementation drivers, and (c) developing a model of care that is adapted to the local environment. Results: A model of care for healing pressure ulcers with EST was developed for the local environment while taking into account key implementation barriers including lack of interdisciplinary collaboration and communication amongst providers between and across settings, inadequate training and education, and lack of resources, such as funding, time, and staff. Conclusions: Using established implementation science frameworks with structured planning and engaging local stakeholders are important exploratory steps to achieve a successful sustainable best practice implementation project.

Changing the Paradigm in Public Health and Disability through a Knowledge Translation Center

People with disabilities are a health disparity population that face many barriers to health promotion opportunities in their communities. Inclusion in public health initiatives is a critical approach to address the health disparities that people with disabilities experience. The National Center on Health, Physical Activity and Disability (NCHPAD) is tackling health disparities in the areas of physical activity, healthy nutrition, and healthy weight management. Using the NCHPAD Knowledge Adaptation, Translation, and Scale-up Framework, NCHPAD is systematically facilitating, monitoring, and evaluating inclusive programmatic, policy, systems, and environmental (PPSE) changes in communities and organizations at a local and national level. Through examples we will highlight the importance of adapting knowledge, facilitating uptake, developing strategic partnerships and building community capacity that ultimately creates sustainable, inclusive change.

Health care access and quality for persons with disability: Patient and provider recommendations

BACKGROUND

Significant disparities in health care access and quality persist between persons with disabilities (PWD) and persons without disabilities (PWOD). Little research has examined recommendations of patients and providers to improve health care for PWD.

OBJECTIVE

We sought to explore patient and health care provider recommendations to improve health care access and quality for PWD through focus groups in the physical world in a community center and in the virtual world in an online community.

METHODS

In all, 17 PWD, 4 PWOD, and 6 health care providers participated in 1 of 5 focus groups. Focus groups were conducted in the virtual world in Second Life^® with Virtual Ability, an online community, and in the physical world at Agape Community Center in Milwaukee, WI. Focus group data were analyzed using a grounded theory methodology.

RESULTS

Themes that emerged in focus groups among PWD and PWOD as well as health care providers to improve health care access and quality for PWD were: promoting advocacy, increasing awareness and knowledge, improving communication, addressing assumptions, as well as modifying and creating policy. Many participants discussed political empowerment and engagement as central to health care reform.

CONCLUSIONS

Both PWD and PWOD as well as health care providers identified common themes potentially important for improving health care for PWD. Patient and health care provider recommendations highlight a need for modification of current paradigms, practices, and approaches to improve the quality of health care provision for PWD. Participants emphasized the need for greater advocacy and political engagement.