Rx to cure barriers to care for disabled
Recently, a team of researchers, including from the University of Massachusetts Medical School in Worcester, published a study that reveals many physicians’ attitudes toward patients with disabilities are significant barriers to care. In focus groups, nearly all physician participants said they had little to no training on the Americans with Disabilities Act, and several implied that providing accommodations in accordance with the law was burdensome or overwhelming. Some even described how they deny care to patients with disabilities or attempt to discharge them from their practices.
As a primary care physician who has dedicated her career to helping adults and children with significant health care needs, including disabilities, I was not surprised by these findings. Such biases contribute to health disparities that have long prevented – and can even discourage – individuals with disabilities from getting the basic care they need to stay healthy and safe. For example, the Centers for Disease Control and Prevention estimates that one in four adults with disabilities between ages 45 and 64 did not have a routine checkup in the past year. As part of our efforts to improve health equity, health care organizations must commit themselves to inclusion and competency in caring for individuals with disabilities.
Practicing inclusive care for people with disabilities starts with focusing on accessibility to ensure patients receive the services they need. Use of assistive communication devices and interpreters by providers can minimize delays in diagnosis and treatment for those with vision, hearing or speech impairments. For those who physically come to a clinical office, having the appropriate equipment for a productive visit — such as wheelchair scales, patient lifts and adjustable diagnostic equipment — can go a long a way toward increasing comfort, reducing anxiety and building the trust needed between patient and provider.
Even something as basic as lack of appropriate transportation can prevent a patient from scheduling an office visit. Long overlooked as part of health care, it is now essential that care teams connect patients with safe and reliable ways of getting to and from their appointments. Providing care in the home where patients are most comfortable is another way to improve access. In Worcester, Commonwealth Care Alliance members can receive in-home primary care visits when necessary, as well as in-home visits from care management teams that can provide the tools and resources to live safely and independently at home.
Delivering inclusive care does not, and should not, rest on one physician’s shoulders. Health care organizations should serve their patients with care teams that are trained in disability-competent care. These teams should include physicians, nurses, behavioral health clinicians, social workers, care managers, and occupational and physical therapists — all focused on delivering highly integrated care that addresses a patient’s medical, behavioral health and social needs. Furthermore, providers should collaborate with external agencies such as the Department of Developmental Services, Department of Mental Health and other community-based organizations to ensure patients and their caregivers receive comprehensive support for long-term health and well-being.
Lastly, individuals who have physical, intellectual or behavioral health disabilities face unique challenges, and many provider practices are not equipped to manage these needs. Providers must be trained to better understand the values, preferences and perspectives of these patients who lead prosperous lives and are not defined by their disabilities.
Through my experience in internal medicine and pediatrics, I’ve seen how young adults with disabilities struggle to find adequate adult care when they outgrow their pediatric care. From recruitment and training to employment and retention, inclusivity and accessibility must be organizational priorities to ensure patients are receiving the best possible care. At CCA, we have learned that equipping physicians and other health care professionals with the tools, resources, incentives, training and support they need can minimize reluctance and improve their satisfaction with the practice of medicine.
Building trust with patients is a central tenet of the medical profession. Providers and health care organizations can earn these strong relationships by showing patients how they are inclusive and responsive to their needs, marking a much-needed attitude shift once and for all. In turn, this will drastically improve health care access and outcomes for our patients with disabilities – in Central Massachusetts and beyond.
Dr. Biljana Simikic is senior medical director at Commonwealth Care Alliance and CCA Primary Care, which serves individuals with significant health care needs in Worcester and throughout Massachusetts.
This article originally appeared on Telegram & Gazette: Commonwealth Care Alliance aims to improve health care for disabled
