Summaries for Patients |

Mobility Impairment Reduces Access to Subspecialty Care FREE

[+] Article, Author, and Disclosure Information

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.

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.

Ann Intern Med. 2013;158(6):I-17. doi:10.7326/0003-4819-158-6-201303190-00001
Text Size: A A A

What is the problem and what is known about it so far?

The Americans with Disabilities Act of 1990 requires that all medical practitioners be prepared to provide all patients “full and equal access to their health care services and facilities.” Yet, many practices cannot accommodate patients with mobility impairment; therefore, adults who require a wheelchair for mobility may be denied the care that they need.

Why did the researchers do this particular study?

To learn how many subspecialist practices were accessible to patients with mobility impairment and why they could or could not accommodate these patients.

Who was studied?

256 subspecialty medical practices in 5 large U.S. cities in 4 states (Atlanta, Georgia; Dallas and Houston, Texas; Portland, Oregon; and Boston, Massachusetts). The study included 2 groups of subspecialties: those where transfer from a wheelchair to an examination table is required for adequate care (endocrinology, gynecology, orthopedic surgery, rheumatology, and urology) and those where transfer might not be necessary (otolaryngology, ophthalmology, and psychiatry).

How was the study done?

The researchers called practices and tried to make an appointment for a fictional patient who was obese (99 kg) and was partially paralyzed on 1 side of the body. The patient used a wheelchair and was unable to self-transfer from the chair to an examination table. The patient could not bring a family member to assist with transfer.

What did the researchers find?

More of the practices that would have to transfer the patient to provide adequate care were accessible than those that might not have to transfer the patient to provide adequate care (95% vs. 74%). In all, 56 practices (22%) could not accommodate the patient. Nine of these practices said that their buildings were inaccessible, and 47 said that they could not transfer the patient to an examination table. The practices gave different reasons for inability to transfer the patient, including a lack of staff who could perform the transfer (37 practices), a concern about liability (5 practices), and that the “patient was too heavy” (5 practices). Of the 160 practices in the group that required transfer for adequate care, 22 (9%) reported using special equipment for transfer, such as height-adjustable examination tables and mechanical lifts. Another 88 (55%) planned to transfer the patient from the wheelchair to a high table that was not height-adjustable without using a lift. Gynecology had the highest rate of inaccessible practices (44%).

What were the limitations of the study?

The practices that were called may not be representative of all subspecialists or the United States as a whole. The fictional patient—who was both obese and partially paralyzed—had characteristics that may be representative of only some patients with mobility impairment.

What are the implications of the study?

Many subspecialists reported inability to accommodate a patient in a wheelchair. Improved awareness is needed about the Americans with Disabilities Act requirements and the standards of care for patients with mobility impairment.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Want to Subscribe?

Learn more about subscription options

Related Articles
Journal Club
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.