How physicians play a role in reducing healthcare barriers for individuals with disabilities.
By Jenna Hughes
Health equity refers to all individuals having the access to care needed to be as healthy as possible. The healthcare industry plays an important role in ensuring the equitable care of people of all ages with disabilities. As of 2016, an estimated one in four (61 million) adults in the U.S. reported a disability, according to the Centers for Disease Control and Prevention’s Division of Human Development and Disability (DHDD).
There are numerous definitions of a disability; the Americans with Disabilities Act (ADA) defines a person with a disability as someone who “has a physical or mental impairment that substantially limits one or more major life activities, such as walking, hearing, seeing, has a record (or past history) of having such an impairment, or is regarded as having such an impairment.”
People with disabilities often face increased barriers to healthcare access. According to the CDC, studies show that individuals with disabilities are more likely than people without disabilities to report having poorer overall health. CDC data from 2019 also shows that compared to those without disabilities, people with disabilities have less access to health care, increased rates of depression and anxiety, and are more likely to engage in risky health behaviors more often such as smoking, or engaging in less physical activity.
Research further reveals that within healthcare, people with disabilities are less likely to receive comprehensive preventive healthcare, diagnostic imaging, and cancer screenings, according to the Centers for Medicare & Medicaid Services (CMS).
Additionally, secondary conditions such as pain, fatigue, obesity, and depression can occur because of having a disabling condition, according to the CDC, overall decreasing an individual’s overall health and quality of life and making them more susceptible to preventable health problems.
Physicians play a significant role in addressing these barriers to care by creating more accessible hospital and in-office environments.
Physical accessibility barriers
Accessibility within healthcare encompasses both doctor and patient communication and physical ability to access care. Specific patient needs should be addressed by healthcare professionals before a patient visits the doctor’s office or has a telehealth appointment.
Adults with disabilities are almost twice as likely as other adults to report unmet healthcare needs related to the physical accessibility of a doctor’s office or clinic, according to CMS. A survey from CMS of U.S. physicians found that among those seeing patients with significant mobility limitations, only 40% always or usually used accessible exam tables or chairs.
Inaccessible exam tables, weight scales, infusion chairs, mammography machines, and radiology equipment can impact a patient’s treatment outcomes and care quality, according to CMS. Even when an office has accessible medical equipment, patients with disabilities may still experience disparities due to lack of physician awareness about individually required accommodations, varying office rules and procedures, and physician bias.
To ensure physicians’ offices are accessible, according to CMS, considerations for facility modifications include evaluating the entire in-office experience for patients, such as updating public transportation, parking, universally recognized symbols on signage, addressing any specific patient needs at check-in, and installing any needed safety features or office modifications in advance.
Assessing and addressing common barriers to healthcare for patients with disabilities, according to CMS, also requires eliminating any potential physical barriers within the office, discussing a patient’s in-office needs at check-in, and addressing the accessibility of exam rooms with exam tables that can be adjusted to different heights with transfer supports, lift equipment, and clear floor space next to the exam table for ease of access.
Simplifying communication
Proper communication is a key component of accessibility. Reasonable accommodations refer to any changes that a healthcare organization can provide to better serve patients with different communication needs, according to CMS.
Healthcare organizations should conduct a needs assessment to understand the needs specific to their patient population, engage in active planning to more effectively meet patient communication needs, and periodically update these plans. This process helps ensure that organizations have auxiliary aids and services necessary to serve all patient populations.
Healthcare providers themselves play a significant role in the equitable care of all people with disabilities through patient communication. According to the Surgeon General’s report titled, “Call to Action to Improve the Health and Wellness of Persons with Disabilities,” healthcare staff should support the equitable treatment of all patients by giving each individual, including those with disabilities, all of the information needed to live a long and healthy life, listen and respond to each patient’s health concerns, give prevention and treatment advice, communicate clearly and directly to all patients, and take the time needed to meet a patient’s healthcare needs.
Taking action
There are numerous programs currently in place in support of health equity for all patients. Both the CDC and CMS have implemented a variety of programs aimed at making healthcare more accessible for patients with disabilities.
The CDC’s Division of Human Development and Disability (DHDD) monitors recent public health data to reduce the nation’s health disparities. DHDD also promotes healthy living through inclusive programs for those with disabilities and provides information to the public and healthcare providers through the collection of data through the Disability and Health Data System (DHDS), which contains the latest data on U.S. adults with cognitive, mobility, vision, self-care, independent living, and deafness or difficulty hearing, and more. The DHDD additionally provides state-level disability data on 30 health indicators such as smoking, heart disease, receiving the flu vaccine, and more.
Another way the CDC supports individuals with disabilities is by providing funding to the National Centers on Health Promotion for People with Disabilities, also known as the National Centers on Disability, to prevent disease and promote health and wellness for people with disabilities. Through this initiative, the CDC works with state-based disability public health programs to improve the health of populations as a whole and develop and implement public health programs for people with specific conditions. This public health strategy employs prevention efforts to help make the broadest health impact possible on the health of populations, in this case, people with disabilities.
Nineteen of the state-based programs that the CDC assists promote equity in health, prevent chronic disease (such as diabetes, asthma, and high blood pressure), and ultimately strive to increase the quality of life for people with disabilities. Each program customizes its activities to meet its state’s needs. These state programs represent a network of standardized programs committed to helping people with disabilities benefit from public health services. The states serve as communities of practice and play a much-needed role in identifying effective practices, policies, and services for people with disabilities.
The CMS Office of Minority Health (OMH) also offers technical assistance for health care organizations working to advance health equity, and serves as the principal advisor and coordinator to the Agency for the needs of minority and disadvantaged populations. The CMS OMH consults with Human Health and Services (HHS) Federal agencies and other organizations to collaborate on addressing health equity.
CMS additionally offers a resource inventory which provides compiled accessibility topics for physicians such as “Opening Doors to Everyone” , “Accessible Medical Examination Tables and Chairs”, “Access to Medical Care for Individuals with Mobility Disabilities,” and more from the ADA for healthcare professionals to access to better serve all patient populations.