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Mobility Impairment Reduces Access to Subspecialty Care FREE

[+] Article and Author 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.


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

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