Barriers to health care for women with disabilities education of health care providers
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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.