Conduct an accessibility audit of your office space and procedures using attached Primary Care Accessibility Checklist.
An essential pre-requisite to good primary care for patients with a spinal cord injuries is accessibility. You may think that your office is accessible, but in fact, only half the doctors who think they have accessible offices, actually do. Recent research shows that 75-95% of disabled patients report encountering barriers in primary care settings. In most jurisdictions, accessibility is now the law, and family physician’s offices are subject to accessibility requirements.
Evidence-based Best Practice
When we think about accessibility, we immediately think of physical barriers, like stairs, narrow doorways, high counters and tight spaces. The most common barriers encountered in primary care are: non-adjustable exam tables, lack of transfer or lifting equipment, and lack of wheelchair accessible weigh scales. The addition of an adjustable examining table and ceiling-track lift in one examining room benefits not only SCI patients, but many other patients and staff in the practice as well.
Less visible barriers to good primary care include:
- Requiring patients to bring someone with them to assist with transfers or dressing/undressing;
- Examining them in their wheelchairs, or fully clothed, to save time;
- Missing out on routine screening and preventive care, including monitoring weight;
- Lack of awareness of disability-specific complications or implications.
Stillman MD, Bertocci G, Smalley C, Williams S & Frost KL (2017). Healthcare utilization and associated barriers experienced by wheelchair users: A pilot study. Disability and Health Journal, 10(4), 502-508.
Actionable Nuggets (4th ed., 2019)
Additional References (since 2016)
Mitra, M., Smith, L. D., Smeltzer, S. C., Long-Bellil, L. M., Sammet Moring, N., & Iezzoni, L. I. (2016;2017;). Barriers to providing maternity care to women with physical disabilities: Perspectives from health care practitioners. Disability and Health Journal, 10(3), 445-450. doi:10.1016/j.dhjo.2016.12.021
Wong, J. L., Alschuler, K. N., Mroz, T. M., Hreha, K. P., & Molton, I. R. (2019). Identification of targets for improving access to care in persons with long term physical disabilities. Disability and Health Journal, 12(3), 366-374. doi:10.1016/j.dhjo.2019.01.002
Pharr, J. R., James, T., & Yeung, Y. (2019). Accessibility and accommodations for patients with mobility disabilities in a large healthcare system: How are we doing? Disability and Health Journal, 12(4), 679-684. doi:10.1016/j.dhjo.2019.03.00
Smeltzer, S. C., Mitra, M., Long-Bellil, L., Iezzoni, L. I., & Smith, L. D. (2018). Obstetric clinicians’ experiences and educational preparation for caring for pregnant women with physical disabilities: A qualitative study. Disability and Health Journal, 11(1), 8-13. doi:10.1016/j.dhjo.2017.07.004
Hamilton, R., Driver, S., Noorani, S., Callender, L., Bennett, M., & Monden, K. (2017). Utilization and access to healthcare services among community-dwelling people living with spinal cord injury. The Journal of Spinal Cord Medicine, 40(3), 321-328. doi:10.1080/10790268.2016.1184828
Ronca, E., Brunkert, T., Koch, H. G., Jordan, X., & Gemperli, A. (2018). Residential location of people with chronic spinal cord injury: The importance of local health care infrastructure.BMC Health Services Research, 18(1), 657-9. doi:10.1186/s12913-018-3449-3
Knox, K., Rohatinsky, N., Rogers, M., Goodridge, D., & Linassi, G. (2014). Access to traumatic spinal cord injury care in Saskatchewan, Canada: A qualitative study on community healthcare provider perspectives. Canadian Journal of Disability Studies, 3 (3). doi: 15353/cjds.v3i3.174
Frost, K. L., Bertocci, G., Stillman, M. D., Smalley, C., & Williams, S. (2015). Accessibility of outpatient healthcare providers for wheelchair users: pilot study. Journal of Rehabilitation Research & Development, 52(6).