Accommodations for patients with disabilities in primary care: a mixed methods study of practice administrators

Structural barriers that limit access to health care services for people with disabilities have been identified through qualitative studies; however, little is known about how patients with disabilities are accommodated in the clinical setting when a structural barrier is encountered. The purpose of this study was to identify how primary care medical practices in the United States accommodated people with disabilities when a barrier to service is encountered. Primary care practice administrators from the medical management organization were identified through the organization’s website. Sixty-three administrators from across the US participated in this study. Practice administrators reported that patients were examined in their wheelchairs (76%), that parts of the exam were skipped when a barrier was encountered (44%), that patients were asked to bring someone with them (52.4%) or that patients were refused treatment due to an inaccessible clinic (3.2%). These methods of accommodation would not be in compliance with requirements of the Americans with Disabilities Act. There was not a significant difference (p \u3e 0.05) in accommodations for patients with disabilities between administrators who could describe the application of the ADA to their clinic and those who could not. Practice administrators need a comprehensive understanding of the array of challenges encountered by patients with disabilities throughout the healthcare process and of how to best accommodate patients with disabilities in their practice

Practical Measures for Disabled’s Empowerment-Time for Economic Growth!

The objective of this article is to advocate for persons with disabilities’ (PWD) rights, to discuss issues solutions, social awareness and to promote diversity and inclusion. The word ‘Disability’ covers a wide range of irreversible permanent impairments including physical and mobility difficulties, hearing, visual impairment, specific learning disabilities including dyslexia, medical conditions and mental health problems that may hinder their full and effective participation in society on an equal basis with others.1 Handicap is the condition of being unable to perform due to physical or mental unfitness

Telerehabilitation Clinical and Vocational Applications for Assistive Technology: Research, Opportunities, and Challenges

Rehabilitation service providers in rural or underserved areas are often challenged in meeting the needs of their complex patients due to limited resources in their geographical area. Recruitment and retention of the rural clinical workforce are beset by the ongoing problems associated with limited continuing education opportunities, professional isolation, and the challenges inherent in coordinating rural community healthcare. People with disabilities who live in rural communities also face challenges accessing healthcare. Traveling long distances to a specialty clinic for necessary expertise may be troublesome due to inadequate or unavailable transportation, disability specific limitations, and financial limitations. Distance and lack of access are just two threats to quality of care that now being addressed by the use of videoconferencing, information exchange, and other telecommunication technologies that facilitate telerehabilitation. This white paper illustrates and summarizes clinical and vocational applications of telerehabilitation. We provide definitions related to the fields of telemedicine, telehealth, and telerehabilitation, and consider the impetus for telerehabilitation. We review the telerehabilitation literature for assistive technology applications; pressure ulcer prevention; virtual reality applications; speech-language pathology applications; seating and wheeled mobility applications; vocational rehabilitation applications; and cost effectiveness. We then discuss external telerehabilitation influencers, such as the positions of professional organizations. Finally, we summarize clinical and policy issues in a limited context appropriate to the scope of this paper. Keywords: Telerehabilitation, Telehealth, Telemedicine, Telepractic

Renewing the Commitment: An ADA Compliance Guide for Nonprofits

The Americans with Disabilities Act of 1990 has been hailed as one of the most significant civil rights laws since the Civil Rights Act of 1964. Its intent is to ensure that people with physical and mental disabilities have equal access to, and equal opportunity to enjoy, the services and activities of state and local governments, as well as most private entities including most nonprofit organizations.This guide is just that -- a guide. It does not set standards for grantees of The Chicago Community Trust. It is not intended as legal advice. At times, this guide states the ADA's explicit requirements and identifies them as such. At other times, it makes suggestions that go beyond the minimum requirements of the ADA, providing guidance for improving access and adopting best practices. It is intended to give your organization information about compliance, along with tools that make compliance possible -- tools that you can use and adapt according to your size, activities and resources

Square One Rehabilitation and Wellness: The Effects Architecture Has on Treating TBI

Traumatic Brain Injury, TBI, is an injury that affects how the brain works. These injuries may impact individuals? behavior, mobility, memory, language, problem solving and empathy. TBI patients also tend to feel isolated because cognitive, physical, and social disabilities prevent them from engaging in their pre-injury activities in a normalized way. Depending on how severe one?s injuries may be, one may recover from a traumatic brain injury. However, most will live with permanent effects from their injuries. Recovery at any level may involve years of relearning how to do daily tasks. Throughout a TBI survivor?s recovery process, they will need substantial support to learn, live and work with their disability. Healthcare professionals along with community, family and friends can help the survivor regain confidence when returning to the outside world to live and work with their disability. Through design, innovative rehabilitation methods are combined with connections to nature and community to create a holistic and supportive atmosphere for patients to recover from their traumas in this facility. A focus on overall community health and wellness is also provided to benefit a wider population and create space for interaction between TBI patients and the community to assist in breaking stigmas. TBI survivors, family, friends and the broader community will be able to interact and learn in an environment that encompasses whole body wellness

Why Access Barriers to Primary Care Exist for People with Mobility Disabilities: A Mixed Methods Study of Health Care Administrators

Previous studies have been conducted to assess the barriers that limit access to health care services for people with disabilities. However, no study has been conducted to understand why barriers exist. Do practice administrators lack knowledge of the Americans with Disabilities Act (ADA) or is cost the issue? The purpose of this study was to examine why structural and equipment barriers exist that limit access to primary health care for people with disabilities. A convergent parallel mixed methods design was employed. Practice administrators were selected for this study because of their oversight of the budget, equipment purchasing, facility operations and patient flow. Primary care practices were selected for this study as they are typically the point of entry into the health care system for patients. Participants in this study were Southern Nevada primary care practice administrators or primary care practice administrators who were members of the Medical Group Management Association (MGMA). The survey was constructed using ADA construction guidelines, the ADA\u27s Access to Medical Care for Individuals with Mobility Disabilities, the Adaptive Environment Center\u27s Checklist for Existing Facilities, and published literature. Eighty-one practice administrators completed the survey. Mann-Whitney U, chi square, Guttman scale, and linear regression were utilized for the data analyses. The total number of barriers for each practice was calculated. The mean number of barriers were calculated for the total sample and each group of administrators. Southern Nevada practice administrators reported significantly fewer barriers than MGMA administrators. There was no significant difference in total ADA knowledge scores between groups and the proportions of affirmative answers did not show significant differences between groups. Total ADA knowledge scores for practice administrators conformed to a valid Guttman Scale and summed knowledge scores were found to be a significant predictor of the total number of barriers using linear regression (p = 0.01). Administrators\u27 knowledge of accessible equipment was significantly correlated with the amount of accessible equipment in their practices (p = 0.02). Less than half of the administrators had inquired about the cost of bringing their practice into compliance with the ADA or about the cost of accessible equipment. From this study, it could not be determined if cost was a reason for access barriers reported in the clinics. Multiple linear regression analyses were conducted using characteristics of the administrator and characteristics of the practice. A final model (p \u3c 0.01) was achieved that explained 36% of the variability in the total number of barriers using independent variables: group, ADA knowledge, building built before 1993, age of administrator and number of patients as significant independent variables. Hypotheses concerning knowledge were supported by the findings while hypotheses about cost and responsibility were not supported by the findings of this study. This study revealed that administrators\u27 lack of knowledge about the ADA was significantly related to the total number of barriers in their clinic while knowledge of accessible equipment was significantly related to the amount of accessible equipment in their clinic. Interventions to improve primary care practice administrators\u27 knowledge of the ADA may result in a reduction in access barriers in their clinics and diminish health disparities experienced by people with disabilities

Why Long-Term Marriages Last: A Review

Marriage is a social institution experienced by most adults at least once in their life-time. Like any other type of institution marriage has its own set of norms and roles that are culturally specific to the area where it is being practiced. Marriage has existed in some form in almost every culture throughout time. There are four major types of marriages practiced in the world today. They are polygynous (one husband and many wives), polyandrous (one wife and several husbands), multilateral (several people of both sexes existing as a part of one marriage) and monogamous (two partners usually one male and one female). Currently in the United States, the only socially excepted form of marriage is a monogamous relationship involving one wife and one husband and any children born or adopted into the union living in what is called a nuclear family (Rice, 1993)