Actionable Nuggets for SCI (2nd ed., 2013)
Family physicians acknowledge that patients with disabilities require special considerations in order to receive an appropriate standard of care. The first concern in providing good care to a patient with a spinal cord injury is the accessibility of the office and examining space. In attempting to secure primary care, patients with disabilities may encounter physical barriers (eg., stairs, narrow doorways), attitudinal barriers, limited special expertise about SCI, and administrative procedures that systematically disadvantage them.
Conduct an accessibility audit of your office space using attached Primary Care Accessibility Checklist.
Additional information: Primary Care Accessibility Checklist
Evidence-based Best Practice:
Research shows that only half the doctors who think they have accessible offices actually do – 45% of patients with spinal cord injuries report difficulty accessing their doctor’s office, and 5% can’t access it at all. The most common problem is the inability to transfer onto an examining table or to be properly examined; therefore, routine preventive and acute primary care is often compromised. The addition of an adjustable examining table and ceiling-track lift in one examining room benefits not only SCI but many other patients in the practice as well. There are published guidelines for accessibility of family physician’s offices, based on systematic review of literature and principles of universal design. In some jurisdictions, accessibility is now the law.
Jones, K.E., & Tamari, I.E. (1997). Making our offices universally accessible: Guidelines for physicians. Canadian Medical Association Journal, 156(5): 647-656.
Chan, L., et al. (1999). Do Medicare patients with disabilities receive preventive services? A population-based study. Archives of Physical Medicine & Rehabilitation, 80(6): 642-6.
McColl, M.A., Aiken, A., McColl, A., Sakakibara, B., & Smith, K. (2012). Primary care of people with spinal cord injury. Canadian Family Physician, 58: 1207-16.
McColl, M.A., Forster, D., Shortt, S., Hunter, D., Dorland, J., Benecki, L., Godwin, M. & Rosser, W. (2008). Physician experiences providing primary care to people with disabilities. Healthcare Policy, 4(1):129-147.
McColl, M.A., Shortt, S., Hunter, D., Dorland, J., Godwin, M., Rosser, W. & Shaw, R. (2010). Access and quality of primary care for people with disabilities: A comparison of practice factors. Journal of Disability Policy Studies, 21(3), 131-140.
Nosek, M.A., & Howland, C.A. (1997). Breast and cervical cancer screening among women with physical disabilities. Archives of Physical Medicine & Rehabilitation, 78(12 Suppl 5): S39-44.
Ontario Government (2005). Accessibility for Ontarians with Disabilities Act, 2005 (S.O. 2005).
Rick Hansen Foundation (2011). Planat: Accessibility at your fingertips. Smart phone and web application. http://www.rickhansen.com/language/en-CA/What-We-Do/planat.aspx
Shankardass, K., et al. (2002). Family physicians’ perspectives on access to primary health care for persons with spinal cord injury. American Spinal Injury Association/International Medical Society of Paraplegia, 1st Joint Meeting, Vancouver, BC.