Presence of Accessible Equipment and Interior Elements in Primary Care Offices

Purpose: To describe the disability accessibility level of primary care office interiors and the presence of accessible examination equipment. Methods: Data from on-site audits of 3993 primary care offices in California for 2013–2016 are descriptively analyzed. Architectural access is assessed using an instrument based on ADA Accessibility guidelines (ADAAG), along with noting accessibility of examination equipment. Results: Compliance across architectural elements was *85%. Accessible examination tables and scales were observed in 19.1% and 10.9% of offices, respectively. Conclusions: Proactive accessibility auditing makes visible the infrequent presence of accessible examination equipment. It offers data for tracking progress to increase medical office disability acces

Accessibility of Primary Health Care Settings for People with Disabilities

People with disabilities report physical barriers in doctors’ offices that affect the quality of care. The analysis seeks to describe overall primary care office physical accessibility and identify (1) in which areas offices meet access criteria, (2) which accessibility criteria are most often not met, and (3) whether there are urban/non-urban differences

An assessment of the structural & equipment accessibility of primary care offices

The purpose of this research is to assess the overall structural and equipment barriers encountered by persons with functional limitations when attempting to access medical care. Using data about the physical accessibility of 3991 primary care offices in California, offices were ranked on a scale of accessibility. Results overall show that primary care offices are meeting most, or between 63-87%, of federal accessibility guidelines. It appears that major problematic areas for accessibility are Exam Rooms and Toilet Rooms. Possibilities for this outcome include higher costs for equipment (as opposed to structural/architectural changes), difficulty accommodating interior room layouts, and the office’s perception of need

What Works: Patient-Physician Relationships or Electronic Health Record Information in Planning Healthcare Delivery for Patients with Disabilities?

While much research has examined physician and patient satisfaction with the use of Electronic Health Records (EHR), little research has examined how EHRs can be used to prepare for delivering healthcare to patients with disabilities, nor these patients’ satisfaction regarding how their accommodation needs are met. A federally qualified health clinic in California added disability accommodation questions to their electronic patient database. This study reports an analysis of their utilization of this information. The data were collected from 4 focus groups with 28 doctors, nurses, physician assistants, and front office staff, and from phone interviews with 12 patients with disabilities. Qualitative analysis of the focus groups and interviews using NVivo indicates that despite healthcare staff having advanced documentation of patients’ disability-related needs, lack of systemization remains regarding how to handle complex accommodations, many of which are done “on the fly”. Staff and patient interviews indicate that meeting patient needs was a more efficient and comfortable process when a staff-patient relationship existed. Additionally, patients’ expectations regarding disability accommodations were rooted in their perception that their physician and clinic staff knew them, not because accommodation information was documented technologically. Patients’ satisfaction with healthcare experiences seemed to be more strongly related to their perception that their needs were known and understood by the clinic staff, rather than presence of specialized equipment or accommodations. These findings indicate that despite the potential for advanced planning that EHRs may offer, human relationships remain vital in facilitating safe and satisfactory healthcare experiences for people with disabilities

Considering Endpoints for Comparative Tolerability of Cancer Treatments Using Patient Report in the Context of the Estimand Framework

Regulatory agencies are advancing the use of systematic approaches to collect patient experience data, including patient-reported outcomes (PROs), in cancer clinical trials to inform regulatory decision-making. Due in part to clinician under-reporting of symptomatic adverse events, there is a growing recognition that evaluation of cancer treatment tolerability should include the patient experience, both in terms of the overall side effect impact and symptomatic adverse events. Methodologies around implementation, analysis, and interpretation of patent-reported tolerability are under development, and current approaches are largely descriptive. There is robust guidance for use of PROs as efficacy endpoints to compare cancer treatments, but it is unclear to what extent this can be relied-upon to develop tolerability endpoints. An important consideration when developing endpoints to compare tolerability between treatments is the linkage of trial design, objectives, and statistical analysis. Despite interest in and frequent collection of PRO data in oncology trials, heterogeneity in analyses and unclear PRO objectives mean that design, objectives, and analysis may not be aligned, posing substantial challenges for the interpretation of results. The recent ICH E9 (R1) estimand framework represents an opportunity to help address these challenges. Efforts to apply the estimand framework in the context of PROs have primarily focused on efficacy outcomes. In this paper, we discuss considerations for comparing the patient-reported tolerability of different treatments in an oncology trial context.<br/