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Herrman D, Pechak CM, Berg K, Magasi S. Instructing to Impact: Exploration of Doctor of Physical Therapy Education Instruction of Social Determinants of Health and Health Equity for People With Disabilities. Phys Ther 2024; 104:pzae070. [PMID: 38738784 DOI: 10.1093/ptj/pzae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/21/2023] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE The aim of this study was to explore the instruction of social determinants of health (SDOH) for people with disabilities (PWD) in doctor of physical therapy (DPT) education programs. METHODS A sequential mixed methods study informed by a five-member disability community advisory panel was conducted. Qualitative semi-structured interviews with educators (n = 10) across 4 DPT programs in the Midwest were conducted and analyzed thematically. The qualitative findings formed the basis of the quantitative phase. An online survey was conducted with faculty of DPT programs in the United States (n = 254) with the most knowledge of instruction of SDOH and health equity for PWD (n = 74; 29% response rate). Quantitative data were analyzed with descriptive statistics and triangulated with qualitative data. RESULTS SDOH for PWD is an emerging component of instruction in DPT curricula. Five themes included: emerging instruction of SDOH for PWD; conceptual frameworks informing instruction; instructional strategies; barriers to integration of SDOH for PWD; and facilitators to integration of SDOH for PWD. Quantitative analysis revealed that 71 respondents (95.9%) included disability in health equity discussions primarily focused on health care access. Limited time (n = 49; 66.2%) was the most frequently reported barrier, and educator interest in disability health equity was the most frequently reported facilitator (n = 62; 83.7%) to inclusion of the SDOH for PWD in health equity discussions. CONCLUSION Opportunities exist in DPT curricula to build on instructional strategies, integrate SDOH frameworks, and amplify facilitators to integration of SDOH for PWD. IMPACT To meet the needs of the 67 million Americans living with disabilities, students must have the knowledge and skills to address the complex needs of this historically marginalized population. Understanding the DPT education landscape around SDOH for PWD can guide DPT educators to more fully prepare their students to recognize and ameliorate health disparities faced by PWD.
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Affiliation(s)
- Deana Herrman
- College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois, USA
| | - Celia M Pechak
- Doctor of Physical Therapy Program, The University of Texas at El Paso, El Paso, Texas, USA
| | - Kristin Berg
- Department of Disability and Human Development, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Susan Magasi
- Department of Occupational Therapy, University of Illinois-Chicago, Chicago, Illinois, USA
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Ames SG, Delaney RK, Delgado-Corcoran C, Houtrow AJ, Alvey J, Watt MH, Murphy N. Impact of disability-based discrimination in healthcare on parents of children with medical complexity. Dev Med Child Neurol 2024; 66:1226-1233. [PMID: 38327250 DOI: 10.1111/dmcn.15870] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/26/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024]
Abstract
AIM To qualitatively assess the impact of disability-based discrimination in healthcare on the parents of children with medical complexity (CMC). METHOD In this qualitative study, we conducted in-depth, semi-structured interviews with the parents of CMC. Data collection and analysis occurred iteratively; constant comparison methods were used to identify themes describing the impact of disability-based discrimination in pediatric healthcare on the parents of CMC. RESULTS Thirty participants from 15 US states were interviewed. Four themes were developed regarding the impact of disability-based discrimination in healthcare on parents. The themes were: (1) discrimination leads to a loss of trust in healthcare providers; (2) discrimination increases the burden of caregiving; (3) discrimination impacts parental well-being; and (4) racism and poverty-based discrimination amplifies disability-based discrimination. INTERPRETATION The experience of discrimination toward their child results in loss of trust and therapeutic relationship between provider and parent, causes increased burden to the family, and contributes to decreased parental well-being. These experiences are magnified in minoritized families and in families perceived to have a lower socioeconomic status based on insurance type.
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Affiliation(s)
- Stefanie G Ames
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rebecca K Delaney
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Amy J Houtrow
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Justin Alvey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Melissa H Watt
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nancy Murphy
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Oshita JY, MacLean CD, Couture AE, Morris MA. How Health Care Organizations Are Implementing Disability Accommodations for Effective Communication: A Qualitative Study. Jt Comm J Qual Patient Saf 2024; 50:664-672. [PMID: 38879438 DOI: 10.1016/j.jcjq.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Prior studies have documented that, despite federal mandates, clinicians infrequently provide accommodations that enable equitable health care engagement for patients with communication disabilities. To date, there has been a paucity of empirical research describing the organizational approach to implementing these accommodations. The authors asked US health care organizations how they were delivering these accommodations in the context of clinical care, what communication accommodations they provided, and what disability populations they addressed. METHODS In this study, 19 qualitative interviews were conducted with disability coordinators representing 15 US health care organizations actively implementing communication accommodations. A conventional qualitative content analysis approach was used to code the data and derive themes. RESULTS The authors identified three major themes related to how US health care organizations are implementing the provision of this service: (1) Operationalizing the delivery of communication accommodations in health care required executive leadership support and preparatory work at clinic and organization levels; (2) The primary focus of communication accommodations was sign language interpreter services for Deaf patients and, secondarily, other hearing- and visual-related accommodations; and (3) Providing communication accommodations for patients with speech and language and cognitive disabilities was less frequent, but when done involved more than providing a single aid or service. CONCLUSION These findings suggest that, in addition to individual clinician efforts, there are organization-level factors that affect consistent provision of communication accommodations across the full range of communication disabilities. Future research should investigate these factors and test targeted implementation strategies to promote equitable access to health care for all patients with communication disabilities.
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Houtrow AJ, Hurwitz MB. A dearth of disability-related competencies in Accreditation Council for Graduate Medical Education's Milestones 2.0. PM R 2024. [PMID: 39177053 DOI: 10.1002/pmrj.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/20/2024] [Accepted: 06/20/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Despite the high prevalence of disability and the frequency with which people with disabilities encounter the health care system, physicians report inadequate knowledge regarding caring for their patients with disabilities. OBJECTIVE To determine the number and type of disability-related competencies in the Accreditation Council for Graduate Medical Education's Milestones 2.0. DESIGN Cross-sectional analysis of publicly available data to identify, via key word search, the presence of disability-related competencies using disability-related terms derived from the World Health Organization's International Classification of Functioning Disability and Health. SETTING Accreditation Council for Graduate Medical Education's Milestones 2.0. PARTICIPANTS N/A INTERVENTIONS: N/A MAIN OUTCOME MEASURE: Presence of disability-related competencies. RESULTS Over one-third (37.5%) of specialties had zero disability-related competencies. Nineteen (59.4%) included an Interpersonal and Communication Skills Milestone that mentions disability as a potential barrier to communication. No specialties had Systems-Based Practice or Practice-Based Learning and Improvement disability-related competencies. Physical medicine and rehabilitation (PM&R) had six disability-related competencies, preventive medicine occupational and environmental medicine had three, and otolaryngology and transition year each had two. CONCLUSIONS A minority of medical and surgical specialties had disability-related competencies outside of the Interpersonal and Communication domain. With the rising prevalence of disability and the lack of physicians with expertise in the care of people with disability, the time is now to integrate disability competencies into residencies, especially for the primary care specialties.
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Affiliation(s)
- Amy J Houtrow
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Max B Hurwitz
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA
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Barsky BA, Stein MA, Iezzoni LI. Reducing Disparities Through Online Accessibility Information. JAMA HEALTH FORUM 2024; 5:e241801. [PMID: 39093586 DOI: 10.1001/jamahealthforum.2024.1801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
This Viewpoint describes the need for more health care organizations to include disability accessibility information on their websites and to improve physical access for patients with disabilities.
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Affiliation(s)
- Benjamin A Barsky
- University of California College of the Law, San Francisco
- Harvard Law School Project on Disability, Harvard Law School, Cambridge, Massachusetts
| | - Michael Ashley Stein
- Harvard Law School Project on Disability, Harvard Law School, Cambridge, Massachusetts
| | - Lisa I Iezzoni
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Health Policy Research Center-Mongan Institute, Massachusetts General Hospital, Boston
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Stone EM, Jopson AD, German D, McCourt AD, McGinty EE. Interagency Coordination to Manage Co-Occurring Intellectual and Developmental Disabilities and Mental Health Conditions. Psychiatr Serv 2024; 75:770-777. [PMID: 38769909 PMCID: PMC11293977 DOI: 10.1176/appi.ps.20230451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVE The authors aimed to identify barriers to and strategies for supporting coordination between state agencies for intellectual and developmental disability (IDD) or mental health to meet the mental health needs of people with co-occurring IDD and mental health conditions. METHODS Forty-nine employees of state agencies as well as advocacy and service delivery organizations across 11 U.S. states with separate IDD and mental health agencies were interviewed between April 2022 and April 2023. Data were analyzed with a thematic analysis approach. RESULTS Interviewees reported that relationships between the IDD and mental health agencies have elements of both competition and coordination and that coordination primarily takes place in response to crisis events. Barriers to interagency coordination included a narrow focus on the populations targeted by each agency, within-state variation in agency structures, and a lack of knowledge about co-occurring IDD and mental health conditions. Interviewees also described both administrative (e.g., memorandums of understanding) and agency culture (e.g., focusing on whole-person care) strategies that are or could be used to improve coordination to provide mental health services for people with both IDD and a mental health condition. CONCLUSIONS Strategies that support state agencies in moving away from crisis response toward a focus on whole-person care should be prioritized to support coordination of mental health services for individuals with co-occurring IDD and mental health conditions.
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Affiliation(s)
- Elizabeth M. Stone
- Rutgers Institute for Health, Health Care Policy and Aging Research, Rutgers University
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School
| | - Andrew D. Jopson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Alexander D. McCourt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Emma E. McGinty
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medicine
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Salinger M, Nguyen M, Moreland CJ, Thorndike AN, Meeks LM. Internal Medicine Program Directors' Perceptions About Accommodating Residents with Disabilities: A Qualitative Study. J Gen Intern Med 2024:10.1007/s11606-024-08936-y. [PMID: 39020231 DOI: 10.1007/s11606-024-08936-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/02/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND While 26% of US adults are disabled, only 3.1 to 9.3% of practicing physicians report having a disability. Ableism within medical training and practice diminishes physician diversity and wellbeing and contributes to healthcare disparities. OBJECTIVE Explore physician barriers to disability equity and inclusion by examining internal medicine (IM) program directors' (PD) perspectives about recruiting and accommodating residents with disabilities (RWD). DESIGN Qualitative study involving semi-structured virtual interviews (conducted December 2022-September 2023; analyzed through December 2023). PARTICIPANTS PDs were recruited via email. Purposive sampling captured program diversity in size, location, and affiliations. Convenience sampling ensured PD diversity by gender, race/ethnicity, and age. APPROACH Coders analyzed thematic and discursive content of interview transcripts to characterize PD perspectives about RWDs and accommodations. KEY RESULTS Of the 15 programs represented, 4 had ≤ 49 and 8 had ≥ 100 total residents. Three were community-based; the rest had academic affiliations. On average, PDs had 17 (SD 8.2) years in practice. Most (11/15) identified as White race; 8/15 as female; and none as disabled. PDs characterized disability as a source of grit and empathy but also as an intrinsic deficit. They worried RWDs could have unpredictable absences and clinical incompetencies. Perceived accommodation challenges included inexperience, workload distribution, information asymmetry about accommodation needs or options, barriers to disclosure (e.g., discrimination concerns), and insufficient accommodation advertising. Perceived facilitators included advanced planning; clear, publicized processes; and access to expertise (e.g., occupational health, ombudsmen). CONCLUSIONS PDs held contradictory views of RWDs. PD insights revealed opportunities to alleviate PD-RWD information asymmetry in recruitment/accommodation processes, which could help align needs and improve representation and inclusion.
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Affiliation(s)
- Maggie Salinger
- Division of General Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | | | | | - Anne N Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lisa M Meeks
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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Horner-Johnson W, Akobirshoev I, Valentine A, Powell R, Mitra M. Preconception health risks by presence and type of disability among U.S. women. Disabil Health J 2024; 17:101588. [PMID: 38336500 DOI: 10.1016/j.dhjo.2024.101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Poor preconception health may contribute to adverse perinatal outcomes among women with disabilities. While prior research has found higher prevalence of preconception health risks among women with versus without disabilities, existing U.S. studies have not assessed how preconception health risks may differ by disability type. Understanding such differences is relevant for informing and targeting efforts to improve health opportunities and optimize pregnancy outcomes. OBJECTIVE This cross-sectional study examined preconception health in relation to disability type among reproductive-age women in the United States. METHODS We analyzed 2016-2019 data from the Behavioral Risk Factor Surveillance System to estimate the prevalence of 19 preconception health risk among non-pregnant women 18-44 years of age. We used modified Poisson regression to compare women with different types of disability to non-disabled women. Disability categories included: 1) hearing difficulty only; 2) vision difficulty only; 3) physical/mobility difficulty only; 4) cognitive difficulty only; 5) multiple or complex disabilities (including limitations in self-care or independent living activities). Multivariable analyses adjusted for other sociodemographic characteristics such as age and marital status. RESULTS Women with each disability type experienced a higher prevalence of indicators associated with poor preconception health compared to women with no disabilities. The number and extent of health risks varied substantially by disability type. Women with cognitive disabilities and women with multiple or complex disabilities experienced the greatest risk. CONCLUSIONS Addressing the specific preconception health risks experienced by women with different types of disabilities may help reduce adverse perinatal outcomes for disabled women and their infants.
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Affiliation(s)
- Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR, 97239, USA.
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Anne Valentine
- Lurie Institute for Disability Policy, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Robyn Powell
- Lurie Institute for Disability Policy, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
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Iezzoni LI. What some physicians say about caring for patients with disability: Responses to open-ended question to nationwide physician survey. Disabil Health J 2024; 17:101635. [PMID: 38688730 PMCID: PMC11194149 DOI: 10.1016/j.dhjo.2024.101635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND For over 50 years, federal disability civil rights laws have mandated that patients with disability receive equitable health care. However, disabled patients continue to experience health care disparities. OBJECTIVE To explore physicians' views, in their own words, about caring for patients with disability. METHODS Review of responses to open-ended question at the end of a nationally representative survey of 714 outpatient physicians about their experiences caring for adult disabled patients. The open-ended question asked for additional comments participants wanted to share. Only 108 (15.1 %) survey participants provided responses suitable for analysis (e.g., legible, complete thought). All issues reported here reflect comments from ≥5 participants. RESULTS Common concerns involved high costs, too little time, insufficient space, inadequate training, and lack of adequate mental health services to care for disabled patients. Many physicians appeared frustrated by legal requirements that they cover accommodation costs. Multiple physicians described as "unfair" having to pay for sign language interpreters, especially since interpreter costs generally exceed reimbursements for patients' visits. Physicians also commented on high costs and space demands of accessible exam tables, especially for small practices, and on challenges accommodating patients with severe obesity, including concerns that patients with severe obesity could damage their exam tables. Some participants suggested that disabled patients require advocates to get good quality care. CONCLUSIONS Albeit limited by the small number of responses, these open-ended comments from our nationwide survey of physicians suggest some doctors view certain accessibility requirements as unfair to them or infeasible in their practice environments.
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Affiliation(s)
- Lisa I Iezzoni
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, United States.
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Lawrence PR, Anderson RK. Poverty and Disability: A State-Level Geospatial Analysis. Clin Nurs Res 2024; 33:344-354. [PMID: 38770759 DOI: 10.1177/10547738241249834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Individuals with disabilities are a growing yet understudied population. Nurses are in a prime position to address social determinants of health (SDOH), which is defined as the conditions in which people work, live, and learn that affect health. SDOH are largely responsible for the health inequities seen among individuals with disabilities. The purpose of this study was to explore the relationships between state-level poverty rates and state-level social determinants, such as housing, education, employment, health, and health care for adults with disabilities using geospatial, state-level data. This secondary data analysis used national data from the 2021 American Community Survey. Data on state poverty rates and rates of particular social determinants were used to examine differences between high- and low-poverty states for adults with disabilities. Rates, rather than numbers of adults with disabilities in poverty, were used to control for state size. The median poverty rate (27.8%) for adults with disabilities was used to create a dichotomous variable for low-poverty (n = 26) and high-poverty (n = 25) states. Independent samples t-tests were used to compare geospatial and SDOH data to understand differences between high- and low-poverty states. More adults with disabilities, regardless of race, live in high-poverty states, particularly those with ambulatory and cognitive disabilities. Adults with disabilities residing in low-poverty states have higher employment rates and more private insurance coverage. More adults with disabilities in high-poverty states smoke, live in mobile homes, and are less educated. Using an SDOH lens in caring for individuals with disabilities helps nurses better understand how economic stability, education, health, health care access, the built environment, and the community, rather than individual factors, impact the health of adults with disabilities. To improve the health of disabled persons, nurses must have a greater awareness of the influence that social determinants have on health for individuals with disabilities. Nurse training programs must build disability cultural competence into nursing curricula. Universal screening for SDOH, particularly for individuals with disabilities residing in high-poverty states, is pivotal for the best chance of improving the health and well-being of individuals with disabilities.
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Affiliation(s)
- Patricia R Lawrence
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, USA
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Garland-Thomson R. Putting a Face on WET Recipients. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:81-85. [PMID: 38635429 DOI: 10.1080/15265161.2024.2329495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
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12
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Mintz KT, Cureton A. Disability Bioethics, Social Inclusion, and Whole-Eye Transplantation. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:85-87. [PMID: 38635443 PMCID: PMC11034888 DOI: 10.1080/15265161.2024.2327884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
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Mannor KM, Needham BL. The study of ableism in population health: a critical review. Front Public Health 2024; 12:1383150. [PMID: 38694970 PMCID: PMC11061527 DOI: 10.3389/fpubh.2024.1383150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/05/2024] [Indexed: 05/04/2024] Open
Abstract
Over the past three decades, health equity has become a guiding framework for documenting, explaining, and informing the promotion of population health. With these developments, scholars have widened public health's aperture, bringing systems of oppression sharply into focus. Additionally, some researchers in disability and health have advocated for utilizing socially grounded frameworks to investigate the health of disabled people. Yet, naming ableism, much less operationalizing it for the empirical study of health, remains scant. This paper critically reviews the study of ableism as a social determinant of disabled people's health within population health research. First, we provide an orientation to the present state of this literature by looking to the past. We briefly trace a history of traditional approaches to studying disability and health and alternatives that have emerged from critiques of the individualized lens that has dominated this work. Next, we delineate the operation of ableism across social levels. We characterize how ableism has been studied in population health in terms of levels of analysis (intrapersonal, interpersonal, institutional, and structural) and measures of interest. To conclude, we discuss hinderances to and promising avenues toward population health research that advances health equity for disabled people.
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Affiliation(s)
- Kara M. Mannor
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States
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Hickey E, Man B, Helm KVT, Lockhart S, Duffecy J, Morris MA. Preferred Communication Strategies for People with Communication Disabilities in Health Care Encounters: a Qualitative Study. J Gen Intern Med 2024; 39:790-797. [PMID: 38010462 PMCID: PMC11043277 DOI: 10.1007/s11606-023-08526-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND People with communication disabilities (CDs), which includes disabilities in speech, language, voice and/or hearing, experience health and healthcare disparities. A barrier to accessing high-quality, equitable care is the lack of effective communication between patients and their providers. OBJECTIVE In designing a patient-prompted tool to facilitate communication, we analyzed qualitative feedback on communication strategies and the experience of people with CDs, caregivers, and providers in healthcare encounters. We aimed to describe communication strategies that patients with CDs find most useful and optimize a tool for patients to share their communication strategy preferences during clinical encounters. While patient-provider communication is paramount in every interaction, we aimed to highlight the intricacies of optimizing communication for this population. DESIGN We performed a qualitative study utilizing focus groups and interviews with patients with CDs, their caregivers, and healthcare providers. PARTICIPANTS A total of 46 individuals participated in focus groups or interviews; 26 participants self-reported a CD, nine were caregivers, and 11 were providers. Participants represented diverse types of CDs, including stuttering, aphasia, hearing loss, and people with autism or cerebral palsy who use assistive technology to communicate. APPROACH Analysis of qualitative interview and focus group data was guided by a qualitative content analysis approach. KEY RESULTS We identified three themes: (1) While communication strategies should be individualized, participants agreed upon a consolidated list of best strategies and accommodations. We used this consolidated list to finalize tool development. (2) Patients and providers preferred disclosure of the CD and desired communication strategies before the appointment. (3) Providers often do not use communication strategies and accommodations during clinical encounters. CONCLUSIONS For patients with CDs, it is critical to acknowledge and document the CD and individualize communication strategies during healthcare visits to facilitate communication. Studies are needed to evaluate whether improved communication strategy usage leads to improved health outcomes for this population.
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Affiliation(s)
- Erin Hickey
- University of Illinois at Chicago, Chicago, IL, USA.
| | - Bernice Man
- University of Illinois at Chicago, Chicago, IL, USA
| | - Kaila V T Helm
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven Lockhart
- Adult and Child Center for Health Outcomes Research and Delivery Service, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | | | - Megan A Morris
- Adult and Child Center for Health Outcomes Research and Delivery Service, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
- Divisions of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, CO, USA
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Stone EM, Wise E, Stuart EA, McGinty EE. Experiences of health care services among people with cognitive disabilities and mental health conditions. Disabil Health J 2024; 17:101547. [PMID: 37949697 PMCID: PMC11210385 DOI: 10.1016/j.dhjo.2023.101547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND People with cognitive disabilities such as intellectual and developmental disabilities face significant barriers to accessing high-quality health care services. Barriers may be exacerbated for those with co-occurring mental health conditions. OBJECTIVE This study compares patient experiences of health care services between adults with and without cognitive disabilities and, among people with a cognitive disability, those with and without co-occurring mental health conditions. METHODS Cross-sectional analyses were conducted using 2021 Medical Expenditure Panel Survey data, a national U.S. survey, to examine differences in Consumer Assessment of Healthcare Providers and Systems measures. RESULTS Adults with cognitive disabilities reported lower satisfaction with health care services compared to the general population (7.62 (95% confidence interval (CI): 7.41-7.83) vs. 8.33 (95% CI: 8.29-8.38) on scale from 0 to 10). Adults with cognitive disabilities were less likely to report that providers listened carefully to them (odds ratio (OR): 0.55, 95% CI: 0.42-0.71), explained things in a way that was easy to understand (OR: 0.48, 95% CI: 0.35-0.66), showed respect for what they had to say (OR: 0.38, 95% CI: 0.29-0.51), spent enough time with them (OR: 0.52, 95% CI: 0.40-0.69), or gave advice that was easy to understand (OR: 0.40, 95% CI: 0.28-0.58) compared to the general population. Among adults with cognitive disabilities, there were no differences based on co-occurring mental health conditions. CONCLUSIONS Adults with cognitive disabilities report lower satisfaction with health care services driven by worse experiences with the health care system. Policies to increase provider capacity to support this population should be prioritized.
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Affiliation(s)
- Elizabeth M Stone
- Center for Health Services Research, Rutgers Institute for Health, Health Care Policy, and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, USA; Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, 671 Hoes Lane, Piscataway, NJ, 08854, USA.
| | - Elizabeth Wise
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Elizabeth A Stuart
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Emma E McGinty
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medicine, 402 E. 67th St., New York, NY, 10065, USA
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Mudrick NR, Blackwell J, Breslin ML, Wang X. Change Is Slow: Acquisition of Disability-Accessible Medical Diagnostic Equipment in Primary Care Offices over Time. Health Equity 2024; 8:157-163. [PMID: 38505762 PMCID: PMC10949941 DOI: 10.1089/heq.2023.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction The lack of disability-accessible medical diagnostic equipment (MDE) in primary care impedes the receipt of quality medical care by people with mobility impairments. Cross-sectional surveys and observational studies have found <40% of medical offices have disability-accessible examination tables or weight scales. Although government agencies and advocates recommend primary care acquisition of the accessible MDE, the rate of acquisition is unknown. Methods Using panel data, the research examined if primary care offices audited for disability accessibility increased accessible examination table and scale presence between the first and second audit. Data for 2006-2009 (Time 1 [T1]) and 2013-2016 (Time 2 [T2]) came from 1293 primary care practices associated with Medicaid managed care organizations. Permutations of presence or absence of a height-adjustable examination table and accessible weight scale were analyzed to assess rate of change across time periods. Results More practices had disability-accessible examination tables or weight scales at the second observation, although total presence was low (12.9%, 7.9%). Practices added equipment between time periods; however, ∼60% of practices with accessible MDE at T1 no longer had it available at T2. Discussion The acquisition rate of accessible MDE was low, despite prior auditing. Studying change in accessible MDE presence in primary care offices requires attention to equipment acquisition and its retention. Health Equity Implications Stronger federal enforcement of Medicaid and Americans with Disabilities Act (ADA) access requirements, with regular standardized auditing of medical office accessibility, may be required to produce a more equitable health care experience for disabled people.
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Affiliation(s)
- Nancy R. Mudrick
- School of Social Work, Syracuse University, Syracuse, New York, USA
| | - Julia Blackwell
- School of Social Work, Syracuse University, Syracuse, New York, USA
| | - Mary Lou Breslin
- Disability Rights Education & Defense Fund, Berkeley, California, USA
| | - Xiafei Wang
- School of Social Work, Syracuse University, Syracuse, New York, USA
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17
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Frizell CA, Graham D, DuVentre A, Brown SD. Embracing Neuro-Inclusivity Within Physician Assistant/Associate Education: Challenging Organizational Cultural Norms and Navigating Communication Challenges. J Physician Assist Educ 2024:01367895-990000000-00128. [PMID: 38306305 DOI: 10.1097/jpa.0000000000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
ABSTRACT Effective communication in health care education is essential for creating an inclusive learning environment. This manuscript examines the crucial role of communication in physician assistant/associate (PA) education, particularly in the context of neurodiverse individuals, who constitute approximately 20% of the global population. A groundbreaking study by Nouri et al reveals a 3.1% overall disability prevalence among US practicing physicians, emphasizing the necessity for a comprehensive understanding of diversity in the health care profession. Considering the intersectionality of marginalized identities, this research sheds light on potential challenges health care providers face, underscoring the importance of promoting inclusivity and support for neurodiverse individuals in the PA profession. The increasing presence of neurodivergent students in postsecondary institutions, despite academic strengths, holds relevance for PA education. Recognizing the barriers and stigmas associated with neurodiversity is crucial for fostering inclusive environments within PA programs and sponsoring institutions. This manuscript explores the challenges faced by neurodiverse individuals in PA education and proposes strategies for cultivating a neuroinclusive culture through effective communication. With a focus on celebrating and using the strengths of all learners, regardless of neurodiversity, the overarching goal is to contribute to a paradigm shift in PA education, enriching the educational experience for students, educators, and support staff.
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Affiliation(s)
- Carl A Frizell
- Carl A. Frizell, DMSc, MSPAS, PA-C, is a graduate student at University of Central Arkansas, Conway, Arkansas
- Devin Graham, BA, is a graduate student at University of California, Irvine, Irvine, California
- Amber DuVentre, MS, CNP, is a member of Southern States Communication Association, Knoxville, Tennessee
- Sheena D. Brown, PhD, MSCR, is a volunteer with South College PA Program, Atlanta, Georgia
| | - Devin Graham
- Carl A. Frizell, DMSc, MSPAS, PA-C, is a graduate student at University of Central Arkansas, Conway, Arkansas
- Devin Graham, BA, is a graduate student at University of California, Irvine, Irvine, California
- Amber DuVentre, MS, CNP, is a member of Southern States Communication Association, Knoxville, Tennessee
- Sheena D. Brown, PhD, MSCR, is a volunteer with South College PA Program, Atlanta, Georgia
| | - Amber DuVentre
- Carl A. Frizell, DMSc, MSPAS, PA-C, is a graduate student at University of Central Arkansas, Conway, Arkansas
- Devin Graham, BA, is a graduate student at University of California, Irvine, Irvine, California
- Amber DuVentre, MS, CNP, is a member of Southern States Communication Association, Knoxville, Tennessee
- Sheena D. Brown, PhD, MSCR, is a volunteer with South College PA Program, Atlanta, Georgia
| | - Sheena D Brown
- Carl A. Frizell, DMSc, MSPAS, PA-C, is a graduate student at University of Central Arkansas, Conway, Arkansas
- Devin Graham, BA, is a graduate student at University of California, Irvine, Irvine, California
- Amber DuVentre, MS, CNP, is a member of Southern States Communication Association, Knoxville, Tennessee
- Sheena D. Brown, PhD, MSCR, is a volunteer with South College PA Program, Atlanta, Georgia
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Azizatunnisa L, Rotenberg S, Shakespeare T, Singh S, Smythe T. Health-worker education for disability inclusion in health. Lancet 2024; 403:11-13. [PMID: 38048789 DOI: 10.1016/s0140-6736(23)02707-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Luthfi Azizatunnisa
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Sara Rotenberg
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Tom Shakespeare
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Satendra Singh
- University College of Medical Sciences, University of Delhi, Delhi, India
| | - Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; Department of Health and Rehabilitation Sciences, Stellenbosch University, South Africa
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Buning GE, James TG, Richards B, McKee MM. Self-Reported Accommodation Needs for Patients with Disabilities in Primary Care. Jt Comm J Qual Patient Saf 2024; 50:59-65. [PMID: 38052659 DOI: 10.1016/j.jcjq.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND People with disabilities experience barriers to engaging with health care due to inaccessible social and physical environments at primary care clinics. Despite legal mandates, identification and provision of necessary accommodations for this population at primary care clinics are poor. The objective of this cross-sectional study was to assess patient-reported disability status and accommodation needs among patients at a primary care clinic. METHODS An electronic health record-based Disability and Accommodations Questionnaire assessing disability status, types, and accommodation needs was developed by subject matter experts at Michigan Medicine and the University of Michigan Council for Disability Concerns. The questionnaire underwent multiple rounds of reviews and revisions before its use in clinical settings. A paper-based questionnaire was administered to all patients presenting for a wellness-based visit at an academic health system primary care clinic in southeast Michigan. Data were collected between March 2022 and August 2022. RESULTS Approximately 13% of the 541 patients self-reported a disability, with 54.2% indicating at least one needed accommodation. The most commonly reported disabilities were mental health and hearing-related disabilities, by 4.8% and 4.6% of patients, respectively. The most frequently requested accommodations were communication- or language-based (for example, presence of an American Sign Language interpreter, assistive listening devices), cognitive-based (for example, inclusion of a support person with care decisions), and mobility-based (for example, assistance with transfers). CONCLUSION The Disability and Accommodations Questionnaire helped identify the presence of a disability, its types, and any requested accommodations requested at a primary care health center.
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20
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Gray C, Egelfeld J, Vashi A. Access to and accessibility of care for rural Veterans with disabilities: A qualitative evaluation of VA healthcare experiences. Disabil Health J 2024; 17:101515. [PMID: 37620242 DOI: 10.1016/j.dhjo.2023.101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Persons with disabilities experience significant physical, attitudinal, and communication-based barriers to accessing care. These challenges are exacerbated for rural-dwelling persons with disabilities. Although US Veterans experience disabilities at a higher rate than non-Veterans and are also more likely to dwell in rural locations, research examining the accessibility of VA care for rural Veterans with disabilities is limited. OBJECTIVES With a focus on access and accessibility, we sought to explore the experiences of rural Veterans with disabilities who receive care at VA. METHODS We conducted 30 qualitative interviews with rural-dwelling Veterans who experience at least one of three types of disabilities: hearing loss, vision loss, and mobility loss. Using a descriptive qualitative approach, we focused on creating a taxonomy of potential access barriers experienced among this population. RESULTS Participants reported experiencing access barriers in five main areas, including policies and operational processes at VA clinics; navigating VA campuses and clinics; limited transportation and parking options; communicating with healthcare personnel and occasional negative interactions; and challenges due to pandemic-related changes in policies and procedures. CONCLUSION These findings suggest that Veterans with disabilities may experience a host of challenges and access barriers while navigating the VA Healthcare system. While these challenges have been reported among individuals with disabilities receiving care in other healthcare settings, they have not been assessed in VA specifically. Given its focus on caring for Veterans with service-aggravated conditions and its commitment to equity and inclusion, addressing access barriers among Veterans with disabilities should be a high priority for VA.
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Affiliation(s)
- Caroline Gray
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA, USA; 795 Willow Rd., C-102, Menlo Park, CA 94025, USA.
| | - Jacqueline Egelfeld
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA, USA; 795 Willow Rd., Menlo Park, CA 94025, USA.
| | - Anita Vashi
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA, USA; 795 Willow Rd., Menlo Park, CA 94025, USA; Department of Emergency Medicine, University of California, 505 Parnassus Ave, San Francisco, CA 94143, USA.
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21
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Collins RN, Lo J, Lee S, Bedi HS, Awan OA. Disability in Radiology. Acad Radiol 2023:S1076-6332(23)00561-5. [PMID: 37996364 DOI: 10.1016/j.acra.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Rayven-Nikkita Collins
- MS Candidate in Anatomy and Neurobiology (2023), Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts (R.-N.C.)
| | - Jessica Lo
- Medical Doctorate Student (2025), Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts (J.L.)
| | - Sharon Lee
- PGY-2 Diagnostic Radiology Resident, AdventHealth Orlando, Orlando, Florida (S.L.)
| | - Harprit S Bedi
- Clinical Associate Professor of Radiology, Boston University School of Medicine, Boston, Massachusetts (H.S.B.)
| | - Omer A Awan
- Associate Vice Chair of Education, University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201 (O.A.A.).
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Jungels A, Demers L, Ford E, Stevens BK, Sabatello M, Dasgupta S. Project Inclusive Genetics: Protecting reproductive autonomy from bias via prenatal patient-centered counseling. HGG ADVANCES 2023; 4:100228. [PMID: 37646012 PMCID: PMC10461018 DOI: 10.1016/j.xhgg.2023.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/25/2023] [Indexed: 09/01/2023] Open
Abstract
Clinician bias negatively impacts the healthcare received by marginalized communities. In this study, we explored factors that influence clinician and trainee bias against individuals with intellectual disabilities and its impact on clinical judgment in prenatal genetic testing settings. Specifically, we examined bias toward a fetus with a higher chance of developing a disability. We compared genetics specialists with their non-expert counterparts. This web-based study included clinical vignettes, implicit association tests (IATs), and an educational module. 595 participants were recruited via their institution or professional society. We conducted statistical analyses, including regression models controlling for key demographic characteristics, to analyze recommendation patterns and degree of change after the module. Genetics expertise strongly correlated with appropriate testing recommendation when the patient would not consider pregnancy termination (r = 1.784 pre-module, r = 1.502 post-module, p < 0.01). Factors that influenced pre-module recommendation to test include increased age (r = -0.029, p < 0.05), high religiosity (r = 0.525, p < 0.05), and participant personal preference against testing (r = 1.112, p < 0.01). Responses among participants without genetics expertise improved after the educational module (Z = -4.435, p < 0.01). 42% of non-experts who answered inappropriately changed their answer to match guidelines after the module. Individual bias, along with structural and institutional bias, permeates family planning encounters and significantly decreases quality of care. We demonstrate here that anti-bias training is effective, particularly for non-expert providers, and it can improve the care provided to individuals with intellectual disability. Evidence-based training such as this one can help providers make appropriate genetic counseling recommendations.
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Affiliation(s)
- Apolline Jungels
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Lindsay Demers
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston MA, USA
| | - Eric Ford
- Independent Scholar, Brooklyn, NY, USA
| | - Blair K. Stevens
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maya Sabatello
- Center for Precision Medicine and Genomics, Department of Medicine, and Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA
| | - Shoumita Dasgupta
- Department of Medicine, Biomedical Genetics Section, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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23
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Keegan G, Rizzo JR, Joseph KA. Disparities in breast cancer among patients with disabilities: care gaps, accessibility, and best practices. J Natl Cancer Inst 2023; 115:1139-1144. [PMID: 37421404 DOI: 10.1093/jnci/djad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023] Open
Abstract
Pronounced disparities exist in detecting and treating breast cancer in women with disabilities, leading to cancer detection at advanced stages. This paper provides an overview of disparities for women with disabilities related to breast cancer screening and care, primarily focusing on clinically significant mobility disabilities. Current care gaps include screening barriers related to accessibility and inequitable treatment options, with race and ethnicity, socioeconomic status, geographic location, and disability severity factors mediating the disparities for this population. The reasons for these disparities are myriad and stem from both system-level deficiencies and individual-level clinician bias. Although structural changes are warranted, individual healthcare professionals must also be incorporated into the requisite change. Intersectionality is critical to disparities and inequities and should be central to any discussion of strategies for improving care for people with disabilities, many of whom have intersectional identities. Efforts to reduce screening rate disparities for breast cancer in women with mobility-related disabilities should start with improving accessibility through removing structural barriers, establishing comprehensive accessibility standards, and addressing healthcare professional bias. Future interventional studies are needed to implement and assess the value of programs to improve breast cancer screening rates in women with disabilities. Increasing the representation of women with disabilities in clinical trials may provide another avenue for reducing treatment disparities because these trials often provide breakthrough treatment to women with cancer diagnosed at later stages. Ultimately, attention to the specific needs of patients with disabilities should be improved across the United States to promote inclusive and effective cancer screening and treatment.
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Affiliation(s)
- Grace Keegan
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - John-Ross Rizzo
- Department of Physical Medicine and Rehabilitation and Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
- New York University Langone Health Institute of Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
| | - Kathie-Ann Joseph
- New York University Langone Health Institute of Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
- Departments of Surgery and Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Seymour R, Scher C, Frasso R, Truong S, Ziring D, Ankam N. Exposing the disability-related hidden curriculum in case-based learning: A qualitative study. Disabil Health J 2023; 16:101483. [PMID: 37344272 DOI: 10.1016/j.dhjo.2023.101483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND People with disabilities face significant health disparities. Studies show that healthcare professionals harbor negative attitudes towards disability, compromising the quality of care. These attitudes, in unwritten, unofficial, and even unintended ways can be passed from providers to learners in the medical education setting. OBJECTIVE Using a Critical Disability Studies (CDS) paradigm, the authors uncovered the disability-related hidden curriculum within Case-Based Learning (CBL) and proposed guidelines for promoting a disability-conscious medical education that resists ableism. METHODS The study team conducted a qualitative analysis of all CBL cases from the pre-clerkship curriculum (n = 53) at Sidney Kimmel Medical College. The authors employed a directed content analysis approach to develop a codebook based on case examination, literature review, and CDS concepts. Two researchers coded all cases and assessed intercoder reliability. The results informed the development of an explanatory model. RESULTS Only four of 53 cases overtly mentioned disability, none of which defined disability according to CDS. Coding did not identify content challenging stereotypical views of disability. Additionally, two cases included content fueling negative attitudes of disability. CONCLUSION By inadequately addressing disability from a CDS perspective, harmful assumptions of disability may go unchallenged, driving a hidden curriculum within CBL. This phenomenon leaves medical students ill-prepared to care for people with disabilities and creates physicians ill-equipped to teach the next generation. Since many health professions utilize CBL to educate students, these cases provide an untapped opportunity to resist ableism and better prepare students to address the negative attitudes driving health disparities experienced by people with disabilities.
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Affiliation(s)
- Rory Seymour
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Carly Scher
- University College Dublin School of Medicine, Dublin, Ireland
| | - Rosemary Frasso
- College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA; Asano-Gonnella Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Susan Truong
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Deborah Ziring
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nethra Ankam
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
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Salinger MR, Feltz B, Chan SH, Gosline A, Davila C, Mitchell S, Iezzoni LI. Impairment and Disability Identity and Perceptions of Trust, Respect, and Fairness. JAMA HEALTH FORUM 2023; 4:e233180. [PMID: 37738065 PMCID: PMC10517379 DOI: 10.1001/jamahealthforum.2023.3180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/27/2023] [Indexed: 09/23/2023] Open
Abstract
Importance Most studies use impaired functioning alone to specify populations with disabilities. However, some people with functional impairments do not identify as disabled. With functional status-based definitions, studies have shown disparate care quality for people with disabilities. Objective To examine whether impairment and disability identity have different associations with perceived health care experiences and explore factors associated with disability identification. Design, Setting, and Participants This cross-sectional study used a nationally representative survey of US adults conducted from April 20 through May 31, 2021, and analyzed between June 1 and August 31, 2022. Survey participants were 1822 English- or Spanish-speaking adults responding either online or via telephone. Exposures Using 8 survey questions, participants were grouped according to presence of impairment and disability identity. Main Outcomes and Measures Likert scale measures of trust, respect, and fairness (henceforth, procedural justice measures) were dichotomized. Sociodemographic characteristics and rates of procedural justice responses were compared across groups. Multivariable logistic regressions adjusting for baseline characteristics were performed to (1) estimate associations of impairment and disability identity with perceptions of procedural justice and (2) explore factors associated with disability identification. Analyses applied survey weights. Results Of 6126 individuals invited to participate, 1854 (30.3%) completed the survey. Thirty-two were excluded due to unreportable gender, for a final analytic sample of 1822 participants. Participants with impairments (n = 816; mean [SD] age, 48.1 [17.0] years; 51.2% women, 48.8% men) had worse perceptions on 7 of 10 procedural justice measures (crude) compared with those without impairments (n = 1006; mean [SD] age, 49.6 [18.1] years, 55.1% female, 44.9% male). Among respondents with impairments, those who did (n = 340) vs did not (n = 476) identify as disabled gave better ratings for clinician communication efforts (a lot of effort, 38.8% vs 31.0%) and having health goals understood (understood very or fairly well, 77.2% vs 70.1%) but gave worse ratings for respect (almost never felt inferior or talked down to, 66.1% vs 59.1%). Disability identification was associated with more reports of unfair treatment (31.0% vs 22.4%; adjusted odds ratio, 1.65; 95% CI, 1.12-2.42) and of being unafraid to ask questions or disagree (50.5% vs 40.1%; adjusted odds ratio, 1.51; 95% CI, 1.04-20.19). Income and employment were associated with disability identification. Conclusions and Relevance In this cross-sectional survey study of US adults, health care perceptions differed between groups defined by impairment status and disability identity. These findings suggest that, alongside functional measures, health systems should capture disability identity to better address disparities for people with impairments.
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Affiliation(s)
- Maggie R. Salinger
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Brian Feltz
- 3D Research Partners LLC, Harvard, Massachusetts
- Flowetik, Boston, Massachusetts
| | - Stephanie H. Chan
- Massachusetts Coalition for Serious Illness Care, Boston, Massachusetts
- Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts
| | - Anna Gosline
- Massachusetts Coalition for Serious Illness Care, Boston, Massachusetts
- Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts
| | - Carine Davila
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Suzanne Mitchell
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lisa I. Iezzoni
- Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Shavelson L, Pope TM, Battin MP, Ouellette A, Kluger B. Neurologic Diseases and Medical Aid in Dying: Aid-in-Dying Laws Create an Underclass of Patients Based on Disability. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:5-15. [PMID: 35972304 PMCID: PMC9931932 DOI: 10.1080/15265161.2022.2105422] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Terminally ill patients in 10 states plus Washington, D.C. have the right to take prescribed medications to end their lives (medical aid in dying). But otherwise-eligible patients with neuromuscular disabilities (ALS and other illnesses) are excluded if they are physically unable to "self-administer" the medications without assistance. This exclusion is incompatible with disability rights laws that mandate assistance to provide equal access to health care. This contradiction between aid-in-dying laws and disability rights laws can force patients and clinicians into violating one or the other, potentially creating an underclass of patients denied medical care that is available to those with other (less physically disabling) terminal illnesses. The immediacy of this issue is demonstrated by a lawsuit in Federal court filed in August 2021, requesting assistance in self-administration for terminally ill patients with neuromuscular diseases. This paper discusses the background of this conflict, the ethical issues at the heart of the dilemma, and recommends potential remedies.
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Hartsgrove C, DeLauter G, Kirshblum S. Sustained Impact of a Virtual Disability Education Curriculum With Fourth-Year Medical Students in a Mandatory Physical Medicine and Rehabilitation Clerkship. Am J Phys Med Rehabil 2023; 102:780-786. [PMID: 36753447 DOI: 10.1097/phm.0000000000002201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The aim of the study was to measure the short- and long-term impact of a virtual disability education curriculum associated with a 2-wk mandatory physical medicine and rehabilitation clerkship for fourth-year medical students. DESIGN A prospective pre-post intervention survey-based study measuring the impact of a virtual disability education series at 1-wk and 6-mo time points after a mandatory physical medicine and rehabilitation clerkship including 8 hrs of virtual didactics with an emphasis on physical disabilities. The surveys assessed the overall virtual curriculum, perceived benefit of a virtual encounter, and the long-term applicability of the information learned from the clerkship. RESULTS The physical medicine and rehabilitation clerkship was effective in improving medical students' perceived comfort and clinical knowledge regarding treatment of persons with disabilities ( P < 0.01). There were no statistical differences at the 6-mo time point, indicating sustained benefit and integration of knowledge in the long term ( P > 0.05). In addition, 84% of students reported using the information in clinical experiences at 6 mos. CONCLUSIONS The physical medicine and rehabilitation clerkship including a virtual disability education curriculum improved long-term perceived medical student comfort and knowledge of treating persons with disabilities, with a focus on those with physical disabilities. Virtual encounters with persons with disabilities are viable and impactful avenues to provide this education.
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Affiliation(s)
- Caitlin Hartsgrove
- From the Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey (CH, SK); Rutgers New Jersey Medical School, Newark, New Jersey (CH, SK); Kessler Institute for Rehabilitation, West Orange, New Jersey (CH, SK); and Select Medical, Mechanicsburg, Pennsylvania (GD)
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Otero DK, James TG, Stone AE. Evaluation of a Student-Led Community-Based Veterinary Clinic for Disabled Low-Income Clients: A Case Study of the University of Florida PAWS Program. JOURNAL OF VETERINARY MEDICAL EDUCATION 2023:e20230032. [PMID: 37257147 DOI: 10.3138/jvme-2023-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
People with disabilities experiencing low socioeconomic position are priority populations when considering access to veterinary care. In this population, intersectional inequities lead to adverse health outcomes for both those individuals and the companion animals they care for. Community-based veterinary clinics provide an opportunity to target these inequities from a culturally sensitive lens, intending to improve human and animal outcomes. We conducted a process evaluation of a student-led community-based clinic for this population to better understand client satisfaction, assess learning outcomes among veterinary students, and improve program delivery and services. During academic year 2020-2021, the monthly clinics had 162 appointments in total with a median 15 DVM candidates volunteering at each clinic. Clients and volunteers responded to survey questionnaires designed to elicit information about their experiences with the clinic, including open-ended questions for further elucidation of measurable indicators of client-, patient-, and student-level impact. Clients attributed enrollment in the clinic with improved quality-of-life and reduction of financial burden; the program saved clients approximately $2,050 per pet during the evaluation year. Furthermore, the clinic widely facilitated completion of the college's core Primary Care and Dentistry learning outcomes. Beyond curriculum-standard learning objectives, students also reported positive attitude changes and increased readiness to provide care to people with disabilities and people experiencing low socioeconomic position. The results of this evaluation have significant implications for both veterinary and public health pedagogy. Especially, they highlight the significance of community health practice in veterinary trainee education.
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Affiliation(s)
| | - Tyler G James
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI USA
| | - Amy E Stone
- UFCVM's Small Animal Hospital, Clinical Associate Professor, Small Animal Clinical Sciences, Primary Care and Dentistry Service, Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, FL USA
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Knowlton Marcus V. After the Deluge: Leveraging Lessons from the COVID-19 Pandemic to Build the Trust of North Carolina's Disability Community. N C Med J 2023; 84:169-171. [PMID: 39302280 DOI: 10.18043/001c.74501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
North Carolina's disability services infrastructure is biased toward institutional care, with inadequate funding and supply of home- and community-based services. The COVID-19 pandemic revealed dangers with this imbalance and provided the roadmap and motivation to fix it.
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Panko TL, Cuculick J, Albert S, Smith LD, Cooley MM, Herschel M, Mitra M, McKee M. Experiences of pregnancy and perinatal healthcare access of women who are deaf: a qualitative study. BJOG 2023; 130:514-521. [PMID: 36156842 PMCID: PMC9992236 DOI: 10.1111/1471-0528.17300] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/07/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Women who are deaf experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared with their peers who can hear. This study explores the pregnancy experiences of women who are deaf to better understand their barriers to and facilitators of optimal pregnancy-related health care. DESIGN Qualitative study using thematic analysis. SETTING Semi-structured, individual, remote or in-person interviews conducted in the USA. SAMPLE Forty-five women who are deaf and communicate using American Sign Language (ASL) and gave birth in the USA within the past 5 years participated in the interviews. METHODS Semi-structured interviews explored how mothers who are deaf experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted. MAIN OUTCOME MEASURES Barriers and facilitators related to a positive experience of perinatal care access among women who are deaf. RESULTS Three major themes emerged: (1) communication accessibility; (2) communication satisfaction; and (3) healthcare provider and team support. Common barriers included choosing healthcare providers, inconsistent communication access and difficulty accessing health information. However, when women who are deaf were able to use ASL interpreters, they had more positive pregnancy and birth experiences. Self-advocacy served as a common facilitator for more positive pregnancy and healthcare experiences. CONCLUSIONS Healthcare providers need to be more aware of the communication and support needs of their patients who are deaf, especially how to communicate effectively. Increased cultural awareness and consistent provision of on-site interpreters can improve pregnancy and birth experiences for women who are deaf.
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Affiliation(s)
- Tiffany L Panko
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, New York, USA
| | - Jess Cuculick
- NTID Department of Liberal Studies, Rochester Institute of Technology, Rochester, New York, USA
| | - Sasha Albert
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts, USA
| | - Lauren D Smith
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts, USA
| | - Margarita M Cooley
- Independent Consultant to Brandeis University, Waltham, Massachusetts, USA
| | - Melanie Herschel
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts, USA
| | - Michael McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Thomas CP, Stewart MT, Ledingham E, Adams RS, Panas L, Reif S. Quality of Opioid Use Disorder Treatment for Persons With and Without Disabling Conditions. JAMA Netw Open 2023; 6:e232052. [PMID: 36884250 PMCID: PMC9996401 DOI: 10.1001/jamanetworkopen.2023.2052] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
IMPORTANCE Adverse outcomes associated with opioid use disorder (OUD) are disproportionately high among people with disabilities (PWD) compared with those without disability. A gap remains in understanding the quality of OUD treatment for people with physical, sensory, cognitive, and developmental disabilities, specifically regarding medications for OUD (MOUD), a foundation of treatment. OBJECTIVE To examine the use and quality of OUD treatment in adults with diagnosed disabling conditions, compared with adults without these diagnoses. DESIGN, SETTING, AND PARTICIPANTS This case-control study used Washington State Medicaid data from 2016 to 2019 (for use) and 2017 to 2018 (for continuity). Data were obtained for outpatient, residential, and inpatient settings with Medicaid claims. Participants included Washington State full-benefit Medicaid enrollees aged 18 to 64 years, continuously eligible for 12 months, with OUD during the study years and not enrolled in Medicare. Data analysis was performed from January to September 2022. EXPOSURES Disability status, including physical (spinal cord injury or mobility impairment), sensory (visual or hearing impairments), developmental (intellectual or developmental disability or autism), and cognitive (traumatic brain injury) disabilities. MAIN OUTCOMES AND MEASURES The main outcomes were National Quality Forum-endorsed quality measures: (1) use of MOUD (buprenorphine, methadone, or naltrexone) during each study year and (2) 6-month continuity of treatment (for those taking MOUD). RESULTS A total of 84 728 Washington Medicaid enrollees had claims evidence of OUD, representing 159 591 person-years (84 762 person-years [53.1%] for female participants, 116 145 person-years [72.8%] for non-Hispanic White participants, and 100 970 person-years [63.3%] for participants aged 18-39 years); 15.5% of the population (24 743 person-years) had evidence of a physical, sensory, developmental, or cognitive disability. PWD were 40% less likely than those without a disability to receive any MOUD (adjusted odds ratio [AOR], 0.60; 95% CI, 0.58-0.61; P < .001). This was true for each disability type, with variations. Individuals with a developmental disability were least likely to use MOUD (AOR, 0.50; 95% CI, 0.46-0.55; P < .001). Of those using MOUD, PWD were 13% less likely than people without disability to continue MOUD for 6 months (adjusted OR, 0.87; 95% CI, 0.82-0.93; P < .001). CONCLUSIONS AND RELEVANCE In this case-control study of a Medicaid population, treatment differences were found between PWD and people without these disabilities; these differences cannot be explained clinically and highlight inequities in treatment. Policies and interventions to increase MOUD access are critical to reducing morbidity and mortality among PWD. Potential solutions include improved enforcement of the Americans with Disabilities Act, workforce best practice training, and addressing stigma, accessibility, and the need for accommodations to improve OUD treatment for PWD.
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Affiliation(s)
- Cindy Parks Thomas
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Maureen T. Stewart
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Emily Ledingham
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Rachel Sayko Adams
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
- Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Health Administration, Aurora, Colorado
| | - Lee Panas
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Sharon Reif
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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COVID-19 Reveals Longstanding Health Inequities and Discrimination Against Americans With Disabilities. Med Care 2023; 61:55-57. [PMID: 36630556 PMCID: PMC9830958 DOI: 10.1097/mlr.0000000000001810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Mintz KT. Disability Bioethics and the "Liabilities" of Personal Experience. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:31-33. [PMID: 36595002 PMCID: PMC9830596 DOI: 10.1080/15265161.2022.2146805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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Singh S, Meeks LM. Disability inclusion in medical education: Towards a quality improvement approach. MEDICAL EDUCATION 2023; 57:102-107. [PMID: 35837829 DOI: 10.1111/medu.14878] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
THE ISSUE The shift to a more diverse workforce that includes physicians with disabilities has gained considerable international traction. Indeed, disability inclusion is experiencing a renaissance in medical education. However, the philosophy of disability inclusion must be adjusted from one where disabled trainees are viewed as problematic and having to 'overcome' disability to one where institutions anticipate and welcome disabled trainees as a normative part of a diverse community. OBSERVATIONS Most trainees with disabilities will enter an unregulated, uninformed system leaving them vulnerable to under-accommodation, systems barriers and lack of informed support. Further, the perception of the super human good doctor creates disincentives for candidates to disclose their disability, creating structural barriers that the system needs to address. A less often discussed contributor to health care inequities is the inadequate training of health professional educators on disability rights and disability competencies. Indeed, the lack of education, coupled with minimal exposure to disability outside of the hierarchical patient-provider relationship, perpetuates to stereotypes and biases that impact clinical care. APPROACH Disability inclusion has not been reviewed through the lens of quality improvement. To close this gap, we examine the state of the science through the lens of disability inclusion and offer considerations for a quality improvement approach in medical education that addresses the global revised trilogy of World Federation for Medical Education standards of quality improvement at all three levels of education, training and practice. CONCLUSION We propose a vision of systems-based disability-inclusive, accessible and equitable medical education using 9 of Deming's 14 points as applicable to medical education.
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Affiliation(s)
- Satendra Singh
- University College of Medical Sciences, University of Delhi, Delhi, India
| | - Lisa M Meeks
- Departments of Learning Health Sciences and Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Creedon TB, Zuvekas SH, Hill SC, Ali MM, McClellan C, Dey JG. Effects of Medicaid expansion on insurance coverage and health services use among adults with disabilities newly eligible for Medicaid. Health Serv Res 2022; 57 Suppl 2:183-194. [PMID: 35811358 PMCID: PMC9660429 DOI: 10.1111/1475-6773.14034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To estimate the effects of Affordable Care Act (ACA) Medicaid expansion on insurance and health services use for adults with disabilities who were newly eligible for Medicaid. DATA SOURCES 2008-2018 Medical Expenditure Panel Survey data. STUDY DESIGN We used the Agency for Healthcare Research and Quality (AHRQ) PUBSIM model to identify adults aged 26-64 years with disabilities who were newly Medicaid-eligible in expansion states or would have been eligible in non-expansion states had those states opted to expand. Outcomes included insurance coverage; access to care; receipt of primary care, outpatient specialty physician services, and preventive services; and out-of-pocket health care spending. To estimate the effects of Medicaid expansion, we used two-way fixed effects models and a triple differences framework to compare pre-post changes in each outcome in expansion and non-expansion states for adults with and without disabilities. EXTRACTION METHODS We simulated Medicaid eligibility with the AHRQ PUBSIM model, which uses state-specific Medicaid rules and MEPS data on family relationships, state of residence, and income. PRINCIPAL FINDINGS Among adults with disabilities who were newly eligible for Medicaid, Medicaid expansion was associated with significant increases in full-year Medicaid coverage (35.9 percentage points [pp], p < 0.001), receipt of primary care (15.5 pp, p < 0.01), and receipt of flu shots (19.2 pp, p < 0.01), and a significant decrease in out-of-pocket spending (-$457, p < 0.01). There were larger improvements for adults with disabilities compared to those without disabilities in full-year Medicaid coverage (11.0 pp, p < 0.01) and receipt of flu shots (18.0 pp, p < 0.05). CONCLUSIONS Medicaid expansion was associated with improvements in full-year insurance coverage, receipt of primary and preventive care, and out-of-pocket spending for adults with disabilities who were newly eligible for Medicaid. For insurance coverage, preventive care, and some primary care measures, there were differentially larger improvements for adults with disabilities than for those without disabilities.
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Affiliation(s)
- Timothy B. Creedon
- Office of the Assistant Secretary for Planning and EvaluationUS Department of Health and Human ServicesWashingtonDistrict of ColumbiaUSA
| | - Samuel H. Zuvekas
- Agency for Healthcare Research and QualityUS Department of Health and Human ServicesRockvilleMarylandUSA
| | - Steven C. Hill
- Agency for Healthcare Research and QualityUS Department of Health and Human ServicesRockvilleMarylandUSA
| | - Mir M. Ali
- Office of the Assistant Secretary for Planning and EvaluationUS Department of Health and Human ServicesWashingtonDistrict of ColumbiaUSA
| | - Chandler McClellan
- Agency for Healthcare Research and QualityUS Department of Health and Human ServicesRockvilleMarylandUSA
| | - Judith G. Dey
- Office of the Assistant Secretary for Planning and EvaluationUS Department of Health and Human ServicesWashingtonDistrict of ColumbiaUSA
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Zurn P, Stramondo J, Reynolds JM, Bassett DS. Expanding Diversity, Equity, and Inclusion to Disability: Opportunities for Biological Psychiatry. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1280-1288. [PMID: 36038045 DOI: 10.1016/j.bpsc.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/28/2022] [Accepted: 08/22/2022] [Indexed: 12/13/2022]
Abstract
Given its subject matter, biological psychiatry is uniquely poised to lead STEM (science, technology, engineering, and mathematics) DEI (diversity, equity, and inclusion) initiatives related to disability. Drawing on literatures in science, philosophy, psychiatry, and disability studies, we outline how that leadership might be undertaken. We first review existing opportunities for the advancement of DEI in biological psychiatry around axes of gender and race. We then explore the expansion of biological psychiatry's DEI efforts to disability, especially along the lines of representation and access, community accountability, first-person testimony, and revised theoretical frameworks for pathology. We close with concrete recommendations for scholarship and practice going forward. By tackling head-on the challenge of disability inclusion, biological psychiatry has the opportunity to be a force of transformation in the biological sciences and beyond.
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Affiliation(s)
- Perry Zurn
- Department of Philosophy and Religion, American University, Washington, DC; Department of Critical Race, Gender and Culture Studies, American University, Washington, DC.
| | - Joseph Stramondo
- Department of Philosophy, San Diego State University, San Diego, California
| | - Joel Michael Reynolds
- Department of Philosophy, Kennedy Institute of Ethics, Georgetown University, Washington, DC; Hastings Center, Garrison, New York; Greenwall Foundation, New York, New York
| | - Dani S Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Santa Fe Institute, Santa Fe, New Mexico
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McKee M, James TG, Helm KVT, Marzolf B, Chung DH, Williams J, Zazove P. Reframing Our Health Care System for Patients With Hearing Loss. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3633-3645. [PMID: 35969852 PMCID: PMC9802570 DOI: 10.1044/2022_jslhr-22-00052] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 06/04/2023]
Abstract
PURPOSE Nearly 20% of U.S. Americans report a hearing loss, yet our current health care system is poorly designed and equipped to effectively care for these individuals. Individuals with hearing loss report communication breakdowns, inaccessible health information, reduced awareness and training by health care providers, and decreased satisfaction while struggling with inadequate health literacy. These all contribute to health inequities and increased health care expenditures and inefficiencies. It is time to reframe the health care system for these individuals using existing models of best practices and accessibility to mitigate inequities and improve quality of care. METHOD A review of system-, clinic-, provider-, and patient-level barriers, along with existing and suggested efforts to improve care for individuals with hearing loss, are presented. RESULTS These strategies include improving screening and identification of hearing loss, adopting universal design and inclusion principles, implementing effective communication approaches, leveraging assistive technologies and training, and diversifying a team to better care for patients with hearing loss. Patients should also be encouraged to seek social support and resources from hearing loss organizations while leveraging technologies to help facilitate communication. CONCLUSIONS The strategies described introduce actionable steps that can be made at the system, clinic, provider, and patient levels. With implementation of these steps, significant progress can be made to more proactively meet the needs of patients with hearing loss. Presentation Video: https://doi.org/10.23641/asha.21215843.
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Affiliation(s)
- Michael McKee
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Tyler G. James
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Kaila V. T. Helm
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Brianna Marzolf
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Dana H. Chung
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - John Williams
- Department of Population Health Science, University of Mississippi Medical Center, Jackson
| | - Philip Zazove
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
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Binkley CE, Reynolds JM, Shuman A. From the Eyeball Test to the Algorithm - Quality of Life, Disability Status, and Clinical Decision Making in Surgery. N Engl J Med 2022; 387:1325-1328. [PMID: 36198184 DOI: 10.1056/nejmms2207408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Charles E Binkley
- From the Department of Bioethics, Hackensack Meridian Health, Edison, and the Department of Surgery, Hackensack Meridian School of Medicine, Nutley - both in NJ (C.E.B.), and Markkula Center for Applied Ethics at Santa Clara University, Santa Clara, CA (C.E.B.); the Department of Philosophy and the Kennedy Institute of Ethics, Georgetown University, Washington, DC (J.M.R.); the Hastings Center, Garrison, and the Greenwall Foundation - both in New York (J.M.R.); and the Center for Bioethics and Social Sciences in Medicine and the Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor (A.S.)
| | - Joel Michael Reynolds
- From the Department of Bioethics, Hackensack Meridian Health, Edison, and the Department of Surgery, Hackensack Meridian School of Medicine, Nutley - both in NJ (C.E.B.), and Markkula Center for Applied Ethics at Santa Clara University, Santa Clara, CA (C.E.B.); the Department of Philosophy and the Kennedy Institute of Ethics, Georgetown University, Washington, DC (J.M.R.); the Hastings Center, Garrison, and the Greenwall Foundation - both in New York (J.M.R.); and the Center for Bioethics and Social Sciences in Medicine and the Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor (A.S.)
| | - Andrew Shuman
- From the Department of Bioethics, Hackensack Meridian Health, Edison, and the Department of Surgery, Hackensack Meridian School of Medicine, Nutley - both in NJ (C.E.B.), and Markkula Center for Applied Ethics at Santa Clara University, Santa Clara, CA (C.E.B.); the Department of Philosophy and the Kennedy Institute of Ethics, Georgetown University, Washington, DC (J.M.R.); the Hastings Center, Garrison, and the Greenwall Foundation - both in New York (J.M.R.); and the Center for Bioethics and Social Sciences in Medicine and the Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor (A.S.)
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Iezzoni LI, McKee MM, Meade MA, Morris MA, Pendo E. Have Almost Fifty Years Of Disability Civil Rights Laws Achieved Equitable Care? Health Aff (Millwood) 2022; 41:1371-1378. [PMID: 36190880 PMCID: PMC10359967 DOI: 10.1377/hlthaff.2022.00413] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
For almost fifty years, federal civil rights laws such as Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act (ADA) of 1990 and the ADA Amendments Act of 2008, and Section 1557 and other provisions of the 2010 Patient Protection and Affordable Care Act have prohibited discrimination against Americans with disabilities, including in health care. Despite these laws, disabled Americans continue to experience disparities in health and health care, from preventive care to home and community-based services. In its 2022 Health Equity Framework for People with Disabilities, the National Council on Disability highlighted some of these disparities and recommended remedies. To explore these concerns, this article examines disability inequities and potential solutions within six areas. It concludes by recommending the ratification of the 2006 United Nations Convention on the Rights of Persons with Disabilities to reinvigorate US efforts to maximize the health and dignity of disabled Americans and support their full participation in the community.
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Affiliation(s)
- Lisa I. Iezzoni
- Lisa I. Iezzoni , Harvard University and Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Elizabeth Pendo
- Elizabeth Pendo, Saint Louis University, St. Louis, Missouri
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Lagu T, Haywood C, Reimold K, DeJong C, Sterling RW, Iezzoni LI. 'I Am Not The Doctor For You': Physicians' Attitudes About Caring For People With Disabilities. Health Aff (Millwood) 2022; 41:1387-1395. [PMID: 36190896 PMCID: PMC9984238 DOI: 10.1377/hlthaff.2022.00475] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
People with disabilities face barriers when attempting to gain access to health care settings. Using qualitative analysis of three physician focus groups, we identified physical, communication, knowledge, structural, and attitudinal barriers to care for people with disabilities. Physicians reported feeling overwhelmed by the demands of practicing medicine in general and the requirements of the Americans with Disabilities Act of 1990 specifically; in particular, they felt that they were inadequately reimbursed for accommodations. Some physicians reported that because of these concerns, they attempted to discharge people with disabilities from their practices. Increasing health care access for people with disabilities will require increasing the accessibility of space and the availability of proper equipment, improving the education of clinicians about the care of people with disabilities, and removing structural barriers in the health care delivery system. Our findings also suggest that physicians' bias and general reluctance to care for people with disabilities play a role in perpetuating the health care disparities they experience.
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Affiliation(s)
- Tara Lagu
- Tara Lagu , Northwestern University, Chicago, Illinois
| | | | | | | | | | - Lisa I. Iezzoni
- Harvard University and Massachusetts General Hospital, Boston, Massachusetts
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DeCormier Plosky W, Ne’eman A, Silverman BC, Strauss DH, Francis LP, Stein MA, Bierer BE. Excluding People With Disabilities From Clinical Research: Eligibility Criteria Lack Clarity And Justification. Health Aff (Millwood) 2022; 41:1423-1432. [DOI: 10.1377/hlthaff.2022.00520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Ari Ne’eman
- Ari Ne’eman, Harvard University, Cambridge, Massachusetts
| | | | | | | | | | - Barbara E. Bierer
- Barbara E. Bierer , Brigham and Women’s Hospital and Harvard University
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James TG, Argenyi MS, Guardino DL, McKee MM, Wilson JAB, Sullivan MK, Griest Schwartzman E, Anderson ML. Communication Access In Mental Health And Substance Use Treatment Facilities For Deaf American Sign Language Users. Health Aff (Millwood) 2022; 41:1413-1422. [DOI: 10.1377/hlthaff.2022.00408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tyler G. James
- Tyler G. James , University of Michigan, Ann Arbor, Michigan
| | - Michael S. Argenyi
- Michael S. Argenyi, Wake Forest University, Winston-Salem, North Carolina
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Hall JP, Kurth NK, Ipsen C, Myers A, Goddard K. Comparing Measures Of Functional Difficulty With Self-Identified Disability: Implications For Health Policy. Health Aff (Millwood) 2022; 41:1433-1441. [DOI: 10.1377/hlthaff.2022.00395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jean P. Hall
- Jean P. Hall , University of Kansas, Lawrence, Kansas
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Nicholson J, Valentine A, Ledingham E, Reif S. Peer Support at the Intersection of Disability and Opioid (Mis)Use: Key Stakeholders Provide Essential Considerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9664. [PMID: 35955019 PMCID: PMC9368223 DOI: 10.3390/ijerph19159664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/27/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Individuals with disabilities may experience higher rates of opioid/substance use disorders (OUD/SUD) than other individuals and are likely vulnerable to unmet treatment needs. Peer support may be beneficial to these individuals, given the evidence of benefits in target populations with similar needs and the potential for overcoming barriers to treatment suggested in the available literature. The objective of this exploratory study was to specify essential considerations in adapting peer support for this population. Diverse key stakeholders (n = 16) were interviewed to explore the experiences, needs, and available supports for individuals with disabilities and OUD/SUD. A Peer Support Work Group including members with lived experience advised each component of the study. Semi-structured interview data were content analyzed and memos generated to summarize themes related to the research question. Participants reported extensive professional and personal experience in human services, disability, and recovery. Emergent themes included the importance of accessibility and model fit, the notion of "peerness" and peer match, and essential aspects of peer recruitment, training, and support. An accessible, acceptable, effective model of peer support requires particular attention to the needs of this diverse and varied population, and the contexts in which they are identified, referred, and engaged in services.
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Affiliation(s)
- Joanne Nicholson
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
| | - Anne Valentine
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
| | - Emily Ledingham
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
| | - Sharon Reif
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
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Mohan A, Roberts JA. Accommodating Developmental Disabilities in the Social Determinants of Health:: A Brief Inquiry into the Applicability of Metrics to the Lives of Individuals with Developmental Disabilities in Delaware. Dela J Public Health 2022; 8:50-55. [PMID: 35692997 PMCID: PMC9162396 DOI: 10.32481/djph.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This commentary outlines the methods and findings of a preliminary study examining the fitness of the Social Determinants of Health in their current conceptualizations for accommodating the specific and general experiences of individuals with developmental disabilities and suggests recommendations for both additional research and policy interventions. The study is based on research conducted with individuals with intellectual and developmental disabilities living in Delaware and other stakeholders working in this community. There is currently extensive literature concerning the validity and importance of including the social determinants of health in healthcare decision-making, but very little research exists around the intersection of developmental disabilities and these determinants. This commentary provides additional detail and added emphasis to calls previously made in this Journal to align social determinants with developmental disabilities and the importance of considering the SDOH in policy measures aimed at supporting this population. The ultimate aim of the work presented here is to explore how the State's interest in putting the SDOH to work generally can be aligned to accommodate the needs and interests of individuals with I/DD and to identify future research and policy interventions in support of these efforts.
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Affiliation(s)
- Ankita Mohan
- Delaware Division of Developmental Disabilities Services
| | - Jody A Roberts
- Delaware Division of Developmental Disabilities Services
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46
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Iezzoni LI. Cancer detection, diagnosis, and treatment for adults with disabilities. Lancet Oncol 2022; 23:e164-e173. [DOI: 10.1016/s1470-2045(22)00018-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 12/20/2022]
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47
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Halkides H, James TG, McKee MM, Meade MA, Moran C, Park S. Spotlighting Disability in a Major Electronic Health Record: Michigan Medicine’s Disability and Accommodations Tab (Preprint). JMIR Form Res 2022; 6:e38003. [DOI: 10.2196/38003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
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Mintz KT, Gammer B, Khan AJ, Shaub G, Levine S, Sisti D. Physical Disability and Psychedelic Therapies: An Agenda for Inclusive Research and Practice. Front Psychiatry 2022; 13:914458. [PMID: 35693959 PMCID: PMC9174510 DOI: 10.3389/fpsyt.2022.914458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 12/02/2022] Open
Abstract
Over the past decade, there has been an increase in the number of clinical trials for psychedelic therapies as treatments for a wide range of psychiatric conditions. We are concerned that research organizations overseeing these trials have neglected the inclusion of individuals with physical and sensory disabilities. We suggest that psychedelic research organizations should prioritize and plan for the inclusion of individuals with physical and sensory disabilities to address the mental health burdens they confront. Not doing so risks reinforcing structural ableism in healthcare: the discriminatory manifestation of lowered expectations toward people with disabilities on the part of medical providers. Drawing on scholarship from disability studies and medical ethics, we offer four recommendations for disability inclusion in research. We recognize particular populations shoulder significant mental health burdens; these populations deserve priority and should be given a range of accommodations. We emphasize the need for extensive disability awareness training for those facilitating psychedelic therapies and encourage psychedelic researchers and therapists to exercise cultural humility toward individuals with physical and sensory disabilities. This article should be the impetus for further scholarship and debate about how psychedelic research and therapies can be made accessible to members of disability communities who might benefit.
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Affiliation(s)
- Kevin T Mintz
- Stanford University, Center for Biomedical Ethics, Stanford, CA, United States
| | - Brinn Gammer
- Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia, PA, United States
| | - Amanda J Khan
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States.,Sage Integrative Health, Berkeley, CA, United States
| | | | | | - Dominic Sisti
- Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia, PA, United States
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