Research Paper
Healthcare utilization and associated barriers experienced by wheelchair users: A pilot study

https://doi.org/10.1016/j.dhjo.2017.02.003Get rights and content

Abstract

Background

More than twenty-five years after passage of the ADA, little remains known about the experiences of wheelchair users when attempting to access health care and how accessibility may influence health care utilization.

Objective/Hypothesis

To describe health care utilization among wheelchair users and characterize barriers encountered when attempting to obtain access to health care.

Methods

An internet-based survey of wheelchair users was conducted. Measures included demographics, condition, socioeconomic status, health care utilization and receipt of preventive services within the past year, physical barriers encountered at outpatient facilities, and satisfaction with care.

Results

Four hundred thirty-two wheelchair users responded to the survey. Nearly all respondents (97.2%) had a primary care appointment within the past year and most reported 3–5 visits to both primary and specialty care providers. Most encountered physical barriers when accessing care (73.8% primary, 68.5% specialty). Participants received most preventive interventions at rates similar to national averages with the exception of Pap tests. Most participants remained clothed for their primary care evaluation (76.1%), and were examined seated in their wheelchair (69.7%). More than half of participants (54.1%) felt they received incomplete care, and 57% believed their physician had no more than a moderate understanding of their disability-specific medical concerns.

Conclusions

Wheelchair users face persistent barriers to care, may receive less than thorough physical evaluations, receive fewer screenings for cervical cancer, and largely believe they receive incomplete care.

Section snippets

Materials and methods

This was a cross-sectional observational study employing an internet-based survey taken by adult wheelchair users.

Demographic and socioeconomic data

Four hundred thirty two wheelchair users (n = 432) participated in the survey. As shown in Table 1, most respondents used a wheelchair as a result of a neurological condition (67.4%), were female (64.1%), and lived with a spouse, partner, or family member (70.8%). Socioeconomic data revealed most participants were college educated and lived in urban areas (Table 2). The median distance traveled to the most frequently visited clinic was 16 km (28.5 ± 41.7 km).

Health care utilization

Within the previous 12 months,

Discussion

More than twenty-five years after passage of the ADA, individuals with severe mobility disabilities continue to face obstacles when attempting to obtain full and equal access to health care services. Although the findings from this study may not be representative of the experiences of all wheelchair users, they do suggest that obstacles to health care remain. It is reasonable to presume that less affluent, less well-educated and less urban wheelchair users experience the same barriers to health

Conclusion

The primary care setting is the point of entry into the health care system and the gateway to specialty care. This study is the first to document that wheelchair users, despite utilizing health care services more frequently than those without mobility disabilities, face physical barriers to care, tend to feel their care is incomplete, and believe their physicians do not fully understand their medical conditions. Twenty five years after passage of the ADA, a sustained effort is still required to

Author contributions

Drs. Williams & Stillman conceived of the concept. Drs. Stillman, K. Bertocci and G. Bertocci were responsible for study design, analysis of data, interpretation of results, and drafting, editing, and revising the manuscript. Mr. Smalley participated in data collection and analysis, and drafting, editing and revising the manuscript. All five authors have approved this manuscript's submitted version, and none of us has a conflict of interest.

Funding

This work was funded by the University of Louisville, Intramural Research Incentive Grant (IRIG) program.

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