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Original Research |

Access to Subspecialty Care for Patients With Mobility Impairment: A Survey

Tara Lagu, MD, MPH; Nicholas S. Hannon, BS; Michael B. Rothberg, MD, MPH; Annalee S. Wells, DO; K. Laurie Green, MD; McAllister O. Windom, MD, MPH; Katherine R. Dempsey, BA, BS; Penelope S. Pekow, PhD; Jill S. Avrunin, MS; Aaron Chen, BS; and Peter K. Lindenauer, MD, MSc
[+] Article and Author Information

From the Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts; Medicine Institute, Cleveland Clinic, Cleveland, Ohio; Dorchester House, Dorchester, Massachusetts; Duke University School of Medicine, Durham, North Carolina; University of Massachusetts-Amherst, Amherst, Massachusetts; and University of New England College of Osteopathic Medicine, Biddeford, Maine.

Disclaimer: All authors have contributed substantially to the manuscript and have met the criteria for authorship. Dr. Lagu had full access to all of the data in the study and takes responsibility for their integrity and the accuracy of the data analysis.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2815.

Reproducible Research Statement: Study protocol: Available from Dr. Lagu (e-mail, lagutc@gmail.com). Statistical code and data set: Not available.

Requests for Single Reprints: Tara Lagu, MD, MPH, Baystate Medical Center, Center for Quality of Care Research, 280 Chestnut Street, Third Floor, Springfield, MA 01199; e-mail, lagutc@gmail.com.

Current Author Addresses: Dr. Lagu, Mr. Hannon, Ms. Dempsey, Dr. Pekow, Ms. Avrunin, and Dr. Lindenauer: Baystate Medical Center, Center for Quality of Care Research, 280 Chestnut Street, Third Floor, Springfield, MA 01199.

Dr. Rothberg: Department of Internal Medicine, G10, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.

Dr. Wells: 1353 Dorchester Avenue, Dorchester, MA 02122.

Dr. Green: Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199.

Dr. Windom: 5103-202 Copper Ridge Drive, Durham, NC 27707.

Mr. Chen: 15 Lemnos Lane, Springfield, MA 01119.

Author Contributions: Conception and design: T. Lagu, N.S. Hannon, M.B. Rothberg, K.L. Green, M.O. Windom, P.S. Pekow, P.K. Lindenauer.

Analysis and interpretation of the data: T. Lagu, N.S. Hannon, M.B. Rothberg, P.S. Pekow, J.S. Avrunin, A. Chen, P.K. Lindenauer.

Drafting of the article: T. Lagu, N.S. Hannon, J.S. Avrunin.

Critical revision of the article for important intellectual content: T. Lagu, N.S. Hannon, M.B. Rothberg, M.O. Windom, K.L. Green, A. Chen, P.K. Lindenauer.

Final approval of the article: T. Lagu, N.S. Hannon, M.B. Rothberg, K.L. Green, M.O. Windom, K.R. Dempsey, P.S. Pekow, A. Chen, P.K. Lindenauer.

Provision of study materials or patients: T. Lagu.

Statistical expertise: T. Lagu, P.S. Pekow, J.S. Avrunin.

Obtaining of funding: T. Lagu.

Administrative, technical, or logistic support: T. Lagu, N.S. Hannon, K.L. Green, K.R. Dempsey, P.K. Lindenauer.

Collection and assembly of data: T. Lagu, N.S. Hannon, A.S. Wells, K.L. Green, M.O. Windom, K.R. Dempsey, A. Chen.


Ann Intern Med. 2013;158(6):441-446. doi:10.7326/0003-4819-158-6-201303190-00003
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Chinese translation

Background: Adults who use wheelchairs have difficulty accessing physicians and receive less preventive care than their able-bodied counterparts.

Objective: To learn about the accessibility of medical and surgical subspecialist practices for patients with mobility impairment.

Design: A telephone survey was used to try to make an appointment for a fictional patient who was obese and hemiparetic, used a wheelchair, and could not self-transfer from chair to examination table.

Setting: 256 endocrinology, gynecology, orthopedic surgery, rheumatology, urology, ophthalmology, otolaryngology, and psychiatry practices in 4 U.S. cities.

Patients: None.

Measurements: Accessibility of the practice, reasons for lack of accessibility, and planned method of transfer of the patient to an examination table.

Results: Of 256 practices, 56 (22%) reported that they could not accommodate the patient, 9 (4%) reported that the building was inaccessible, 47 (18%) reported inability to transfer a patient from a wheelchair to an examination table, and 22 (9%) reported use of height-adjustable tables or a lift for transfer. Gynecology was the subspecialty with the highest rate of inaccessible practices (44%).

Limitation: Small numbers of practices in 8 subspecialties in 4 cities and use of a fictional patient with obesity and hemiparesis limit generalizability.

Conclusion: Many subspecialists could not accommodate a patient with mobility impairment because they could not transfer the patient to an examination table. Better awareness among providers about the requirements of the Americans with Disabilities Act and the standards of care for patients in wheelchairs is needed.

Primary Funding Source: None.

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Summary for Patients

Mobility Impairment Reduces Access to Subspecialty Care

The full report is titled “Access to Subspecialty Care for Patients With Mobility Impairment. A Survey.” It is in the 19 March 2013 issue of Annals of Internal Medicine (volume 158, pages 441-446). The authors are T. Lagu, N.S. Hannon, M.B. Rothberg, A.S. Wells, K.L. Green, M.O. Windom, K.R. Dempsey, P.S. Pekow, J.S. Avrunin, A. Chen, and P.K. Lindenauer.

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