Reaching for equitable care: High levels of disability-related knowledge and cultural competence only get us so far |
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| Affiliation: | 1. Coaching and Teaching Studies, College of Physical Activity and Sport Sciences, West Virginia University, 375 Birch Street, P.O. Box 6116, Morgantown, WV 26505, USA;2. Health and Physical Education, Department of Human Movement Sciences, Old Dominion University, VA, USA;3. Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta, GA, USA;4. Community Health Academic Group, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland;1. Ontario Tech University, Faculty of Health Sciences, 2000 Simcoe St N. Oshawa, ON, L1G 0C5, Canada;2. ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada;3. University of Victoria, School of Exercise Science, Physical and Health Education, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada;4. SUNY Cortland, Department of Physical Education, P.O Box 2000, Cortland NY, 13045, USA;5. Centre for Addiction and Mental Health, 1001 Queen St. W., Toronto, ON, M6J 1H4, Canada;1. Department of Physical Therapy, School of Health Professions, The University of Alabama at Birmingham, 360, 1720 2nd Ave S, Birmingham, AL, 35294, USA;2. Department of Kinesiology and Nutrition, The University of Illinois Chicago, 1919 W Taylor St, Chicago, IL, 60612, USA;1. Oregon Health & Science University, Institute on Development and Disability, 707 SW Gaines Street, Portland, OR, 97239, USA;2. OHSU-PSU School of Public Health, 1810 SW 5th Ave, Portland, OR 97201, USA;3. Office of Equity and Inclusion, Oregon Health Authority, 421 SW Oak Street, Suite 750, Portland, OR 97204, USA |
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| Abstract: | BackgroundAchieving equitable medical care for people with disabilities is a complex challenge with emphasis often placed on the need for improved physician knowledge and cultural competence. Physical medicine and rehabilitation (PM&R) is a specialty dedicated to maximizing patient function, where a focus on working with and learning from patients with complex disabilities informs physician training and patient care.ObjectiveThe purpose of this study was to assess barriers to equitable care in PM&R clinics through a structural checklist and semi-structured interviews with clinic staff and physicians.MethodsWe used qualitative analysis with a grounded theory approach to develop a unified explanation of how existing clinic processes and provider attitudes affect equitable access to medical care.ResultsWe found physicians comfortable with and respectful of patient differences who described leveraging unpaid time and creativity to navigate structural, resource, and awareness barriers. Staff and physicians described current barriers as negatively affecting quality of care, clinic efficiency, and, in some cases, patient and staff safety.ConclusionOur results suggest that high levels of physician disability-related knowledge and cultural competence may be insufficient to the challenge of achieving equitable care. |
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| Keywords: | Disability Equitable care Cultural competence Americans with disabilities act ADA Access to care Quality of care Physicians |
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