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BARRIERS TO HEALTH CARE FOR WOMEN WITH DISABILITIES: Education of Health Care Providers. Margaret A. Turk, MD Professor, Physical Medicine & Rehabilitation SUNY Upstate Medical University - Syracuse. Scope of the Problem. 26 million women with disabilities (WWD) in the US

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barriers to health care for women with disabilities education of health care providers

BARRIERS TO HEALTH CARE FOR WOMEN WITH DISABILITIES:Education of Health Care Providers

Margaret A. Turk, MD

Professor, Physical Medicine & Rehabilitation

SUNY Upstate Medical University - Syracuse

scope of the problem
Scope of the Problem
  • 26 million women with disabilities (WWD) in the US
  • Increasing prevalence with improved care
  • WWD among the most disadvantaged (NHISD)
    • Lower socioeconomic
    • Less education
    • Less often married
scope of the problem1
Scope of the Problem
  • Estimated 1 million persons with disabilities have contact with health care providers annually
  • Providers:
    • Physicians and extenders
    • Nurses
    • Therapists: PT, OT, SLP
    • Psychologists
    • Rehabilitation Counselors
    • Social service providers
    • Technicians: phlebotomy,

respiratory, radiology

    • Etc. . .
barriers to health care report from wwd
Barriers to Health CareReport from WWD
  • Difficulty obtaining primary health care, gynecologic services, mental health services, dental care, prescription meds, eyeglasses, fitness
  • Experiences in ED and hospital (PWDD Australia)
    • Required reliance on personal support
    • Negative attitudes of staff
    • Lack of staff skills and knowledge

(Federally funded projects, personal communications, 1996 to present)

(Iacono, 2003)

barriers to health care report from wwd1
Barriers to Health CareReport from WWD
  • Reasons cited:
    • Accessibility - environmental and financial
    • Provider education and training
      • Attitudes
      • Knowledge and skills

(Federally funded projects, personal

communications, 1996 to present)

barriers to health care report from providers
Barriers to Health CareReport from Providers
  • Lack of medical knowledge
    • No formal training undergraduate/graduate
    • PM&R disability and performance focused
    • Education through experience/mentors
  • Time and reimbursement issues
    • Time consuming appointments (2-3X)
    • No compensation for extra time/staff
    • Interpreter cost > reimbursement

(Personal communications

and experience)

barriers to health care report from providers1
Barriers to Health CareReport from Providers
  • Communication with deaf/hearing loss patients in primary care setting (Ralston, 1996)
    • Acknowledge poor communication/understanding
    • Concerns re: patients trusting them
    • Level of comfort not patients in practice
  • Attitudes re: function & back pain (Rainville,1995)
    • Diverse pain attitudes and beliefs
    • Attitudes and beliefs  treatment considerations
health care providers
Physicians and extenders

Nurses

Therapists: PT, OT, SLP

Psychologists

Social service providers

Rehabilitation Counselors

Technicians: phlebotomy, respiratory, radiology

Etc.

No educational requirements re: health care for persons with disabilities

Health Care Providers
education for providers attitudes
Education for ProvidersAttitudes
  • Comparison OT, PT, RN (White, 1998)
    • OT most positive
    • Practice setting, age, education no significance
  • Comparison OT, Med Tech students (Estes, 1991)
    • OT more positive, and most positive last year
  • Comparison OT, business student (Chan 2002)
    • Initial similar attitudes, change after 1st year
education for providers attitudes1
Education for ProvidersAttitudes
  • Medical student attitudes (US and Canada) (Tervo, 2002)
    • Less positive attitudes than norms
    • Males more negative; previous experience positive
  • Rehabilitation Counseling students (Wong, 2004)
    • Preferred disability type physical disability > developmental disability > mental illness
  • OT students in Hong Kong
    • Rank order importance attributes: disability type, history aggressive behaviors, age, employment, gender (Tsang, 2004)
education for providers attitudes2
Education for ProvidersAttitudes
  • RN attitudes more positive with education
    • Comparison NP/RN to general population (Gething, 1992)
    • More positive outpatient, peer encounters (Packer, 2000)
    • More positive attitude post education (Lindgren, Oermann,1993, 1995)
education for providers knowledge
Education for ProvidersKnowledge
  • Existing curricula
    • Fulfill broad requirements
    • Leading edge technology
    • Undergrad/graduate
    • Competencies
  • Curricular reform
    • Competition
    • Test vs education
    • Process
    • Evaluation
education for providers knowledge1
Education for ProvidersKnowledge
  • Disability continuum
  • Disability specific conditions
  • Secondary conditions
  • Aging with a disability
  • Health perceptions & promotion
  • Sexuality and reproductive health
  • Enhancing motor performance
  • Health care access and administration
education for providers skills
Education for ProvidersSkills
  • Communication
    • Cognitive impairment
    • Hearing loss
    • General disability
  • Positioning
  • Transfers
  • General exam
  • Gynecologic exam

Source: Alta Bates,

Comprehensive Breast Center

conclusions
CONCLUSIONS
  • Women with disabilities have reported barriers to health care.
  • Health care providers acknowledge lack of knowledge and skills in providing care to women with disabilities.
  • Attitudes toward persons with disabilities is generally negative, and dependent on disability type, age, and gender.
conclusions1
CONCLUSIONS
  • The literature supports the positive effect of contact, experience, and education on professional attitudes toward persons with disabilities.
  • Curricula for health care providers do not require education about or competencies re: disabilities in general, and about women with disabilities in particular.
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