Impact of COVID-19 on people with physical disabilities: A rapid review

BackgroundThe COVID-19 pandemic caused drastic changes in the lives of the general population. People with physical disabilities, who commonly encounter daily challenges such as barriers to community mobility, reduced access to healthcare services and higher risk of suffering from depression, may face additional challenges in the context of the pandemic.ObjectiveThis study aims to review the impact of the COVID-19 pandemic, and associated isolation and protective measures, among people with physical disabilities.MethodsA rapid review of the published literature was conducted on August 10, 2020 through a search in six online databases to synthesize results from original studies regarding the impact of the COVID-19 pandemic on people with physical disabilities. The International Classification of Functioning, Disability and Health was used to describe the population and the personal and environmental factors with a unified and standard health language.ResultsEleven records were extracted from 1621 individual papers retrieved from the search strategy. Various impacts on daily functioning such as a decrease in access to healthcare have been noted during the pandemic. Changes in social and lifestyle habits, mood changes and decreased levels of physical activity were also noted.ConclusionsOur results highlighted the lack of early research about the impacts of COVID-19 experienced by people with physical disabilities. Future studies should focus on specific consequences and needs of this vulnerable population to ensure their inclusion in public health recommendations and consideration by policy makers.     

Telemedicine is an important aspect of healthcare services amid COVID‐19 outbreak: Its barriers in Bangladesh and strategies to overcome

The current pandemic of coronavirus disease 19 (COVID‐19) has been a global concern since early 2020, where the number of COVID‐19 cases is also on a rapid surge in Bangladesh with the report of a total of 276,549 cases after the detection of the first three cases in this country on 8 March 2020. The COVID‐19 pandemic has made a seismic shift in the healthcare delivery system, where physician offices have accelerated digital health solutions at record speed, putting telemedicine (i.e., telehealth) at centre stage. Amid the severely contagious COVID‐19, telemedicine has moved from being an optional service to an essential one. As the developing country, there are some barriers to get evenly distributed advantages of this approach due to the digital divides and disparities. In this commentary, we have described the importance of telemedicine service amid the outbreak of COVID‐19 in Bangladesh, the barriers and challenges that the country is facing to implement this approach and the strategies to overcome these barriers in this developing country.     

The importance of seasonal influenza vaccination for people with disabilities during the COVID-19 pandemic

A large proportion of Americans have at least one disability and yet people with disabilities face inequities in health and health care access. Factors associated with underlying disability and health, how they perceive and interact with the world, and where they live, or work may increase the risk people with disabilities face for illness or severe outcomes from seasonal influenza. Given the need to reduce the burden of respiratory illness on a healthcare system already overwhelmed by the COVID-19 pandemic, maximizing seasonal influenza vaccination coverage is particularly important in 2020–2021. It is critical this season to ensure equitable access to influenza vaccination for people with disabilities. Providing influenza vaccination services in the unique places where people with disabilities are living, working, or receiving care during the COVID-19 pandemic is crucial, as well as communicating effectively to people with different types of disabilities.     

Does Telemedicine Have a Role to Play in Disease Management?

Telemedicine and disease management are relatively new concepts in healthcare delivery. Disease management focuses on the patient throughout the entire course of the disease, and aims to improve both the clinical outcomes for the patient and the overall cost effectiveness of the treatment regimen by adopting a ‘team approach’ to patient care.Telemedicine enables effective communication, encourages efficient use of resources and ultimately enhances clinical outcomes by permitting access to new information, specialist expertise and knowledge within the continuum of healthcare delivery. The components of a disease management programme are discussed within a telemedicine context. Clearly telemedicine has an important role to play in any disease management programme as it facilitates effective communication throughout the process of healthcare delivery.     

The accessibility of health services to young deaf adolescents in Ghana

Quality health care is a fundamental human right, which is enshrined in several international and domestic legislative instruments. In the Ghanaian context, there are reports that adults with disabilities encounter barriers in their attempts to access health care. However, scholarly attention is yet to explore the perspectives of young people and adolescents with disabilities. Therefore, this quantitative study was conducted from the perspective of critical disability studies, where young deaf adolescents (YDAs) were regarded as right bearers, and where they shared their perspectives on health accessibility decisions, barriers, and needs. Sixty‐seven participants, made up of 44 male and 23 female students, took part in this quantitative study. Although many YDAs who took part in this study indicated that it was not difficult to access health facilities, they claim to have encountered communication barriers. Sign language interpreters in health facilities and introduction of sign language courses in health training institutions to improve communication between health professionals and deaf patients have been suggested as ways of addressing the barriers faced by YDAs in Ghana.     

Impact of COVID-19: Nursing challenges to meeting the care needs of people with developmental disabilities

BackgroundPeople with developmental disabilities (DD) are a population at high-risk for poor outcomes related to COVID-19. COVID-19-specific risks, including greater comorbidities and congregate living situations in persons with DD compound existing health disparities. With their expertise in care of persons with DD and understanding of basic principles of infection control, DD nurses are well-prepared to advocate for the needs of people with DD during the COVID-19 pandemic.ObjectiveTo assess the challenges faced by nurses caring for persons with DD during the COVID-19 pandemic and how the challenges impact people with DD.MethodsWe surveyed 556 DD nurses, from April 6–20, 2020. The 35-item mixed-method survey asked nurses to rate the degree of challenges faced in meeting the care needs of people with DD. We analyzed responses based on presence of COVID-19 in the care setting and geographically. One open-ended question elicited challenges not included in the survey, which we analyzed using manifest content analysis.ResultsStartlingly, nurses reported being excluded from COVID-19 planning, and an absence of public health guidelines specific to persons with DD, despite their high-risk status. Obtaining PPE and sanitizers and meeting social-behavioral care needs were the most highly ranked challenges. COVID-19 impacted nurses’ ability to maintain adequate staffing and perform essential aspects of care. No significant geographic differences were noted.ConclusionsDD nurses must be involved in public health planning and policy development to ensure that basic care needs of persons with DD are met, and the disproportionate burden of COVID-19 in this vulnerable population is reduced.     

Health system access challenges of people with disabilities increased during Covid-19 pandemic

BackgroundPeople with disabilities (PWDs) have unequal access to health services compared with the general population and this disparity is worsening during the Covid-19 pandemic. Evidence supports the importance of policy development and legislation for addressing the unmet health needs of PWDs, but little is known about the impact of these efforts in Ghana.ObjectiveThis study examined health system experiences of PWDs in Ghana within the context of existing disability legislation and related policies prior to and during the Covid-19 pandemic.MethodsNarrative analysis of data from qualitative research approaches of focus group discussions, semi-structured interviews, and participant observations were used to examine the experiences of fifty-five PWDs, four staff of the Department of Social Welfare, and six leaders of disability-focused non-governmental organizations in Ghana.ResultsStructural and system barriers hinder PWDs access to health services. Bureaucratic bottlenecks hinder PWDs access to Ghana's free health insurance policy and health workers' disability stigma impedes accessibility to health services.ConclusionsAccess barriers and disability stigma increased accessibility challenges for PWDs in Ghana's health system during the Covid-19 pandemic. My findings support the need for increased efforts toward making Ghana's health system more accessible to address health disparities experienced by PWDs.     

Worldwide implementation of telemedicine programs in association with research performance and health policy

ObjectivesWe analyzed research performance, international collaboration, corporate contribution, country level economic factors, and legislative frameworks in association with worldwide implementation of telemedicine programs.MethodsWe identified telemedicine scholarly output in EMBASE and SCOPUS and SciVal and combine with Third Global Survey on eHealth available in the World Health Organization Global Observatory for eHealth.ResultsFrom 71245 telemedicine-related publications only 0.8% addressed a policy of tele-healthcare delivery. Scholarly output was positively associated with implementation of telemedicine, with legal framework supporting utilization of telemedicine and with country income and total health expenditure but not total population, physician, nurses or hospital bed density or life expectance. National eHealth policy, capacity building (training of medical students and staff), legislative regulations of electronic health records, and supply chain management information systems supported by information and communication technologies were associated with implementation of all examined telemedicine programs. 43 telecommunication technology or medical devices manufacturing companies contributed to more than 90% of scholarly output and implementation of telemedicine.ConclusionsResearch performance, training of medical students and healthcare professionals and collaboration with technology industry demonstrated the strongest association with implementation of telemedicine. Future efforts should be directed toward consistent collection and routine analysis of patient outcomes after telemedicine interventions. International legislation is needed for telemedicine capacity building, reimbursement policy, and secure data sharing policies.     

Barriers to Healthcare Access Among Refugees with Disabilities and Chronic Health Conditions Resettled in the US Midwest

Chronic conditions and related functional disabilities are highly prevalent among resettled refugees in the United States. There is a need to explore this population’s access to appropriate healthcare services in order to identify service disparities and improve interventions. Using a community-based participatory research approach, semi-structured interviews were conducted with key informants to identify healthcare access barriers affecting disabled and chronically ill refugees. Eighteen participants were interviewed, revealing three main barriers: (1) inadequate health insurance, (2) language and communication barriers, and (3) a complex maze of service systems. These barriers were found to operate at systems, provider, and individual levels. Broad-based policy and practice interventions are required to address barriers including: an expanded pool of medical interpreters, peer navigators, innovative health information technologies, and greater collaboration and information-sharing between service systems. Further research is needed to monitor the impact the Affordable Care Act on service access of refugees with disabilities and chronic conditions.     

Telemedicine,COVID-19, and disparities: Policy implications

While the rapid expansion of telemedicine in response to the COVID-19 pandemic highlights the impressive ability of health systems to adapt quickly to new complexities, it also raises important concerns about how to implement these novel modalities equitably. As the healthcare system becomes increasingly virtual, it risks widening disparities among marginalized populations who have worse health outcomes at baseline and limited access to the resources necessary for the effective use of telemedicine. In this article, we review recent policy changes and outline important recommendations that governments and health care systems can adopt to improve access to telemedicine and to tailor the use of these technologies to best meet the needs of underserved patients. We suggest that by making health equity integral to the implementation of telemedicine now, it will help to ensure that all can benefit from its use going forward and that this will be increasingly integral to care delivery.     

Environmental barriers to health care among persons with disabilities--Los Angeles County, California, 2002-2003

In 2002, an estimated 51.2 million persons in the United States (approximately 18.1% of the population) had a disability. Recent data suggest that substantial disparities in health behaviors and overall health status exist between persons with and without disabilities. Nonetheless, when they have access to adequate health care, persons with disabilities can lead healthy lives. The World Health Organization's International Classification of Functioning, Disability, and Health stresses the importance of environment (e.g., physical environment, attitudes of others, or policies) as either a barrier or facilitator in the daily activities of persons with disabilities. In addition, increasing access to health and wellness treatment programs for persons with disabilities and reducing the proportion of persons with disabilities who report environmental barriers to participation in daily activities are goals of Healthy People 2010 (objectives 6-10 and 6-12). However, few population-based studies have explored how environment affects the lives of those with disabilities. To determine the prevalence of disability among persons in Los Angeles County, California, and assess the effects of environmental barriers on these persons, residents were surveyed during 2002-2003. The results of that survey suggested that persons with physical or sensory disabilities experienced several environmental barriers and that the prevalence of barriers varied by demographic characteristics, household income, and severity of disability. To improve quality of life among persons with disabilities, public and private health agencies should implement measures to remove environmental barriers to health care and other services.     

Health care access and the Americans with Disabilities Act: A mixed methods study

BackgroundThe Americans with Disabilities Act (ADA) requires that health care entities provide full and equal access to people with disabilities. However, results of previous studies have indicated that the ADA has been largely ineffective at creating systemic change in the delivery of health care.ObjectiveThe objective of this study was to examine the current barriers to health care access experienced by people with disabilities under Titles II and III of the ADA.MethodsThis study utilized a mixed methods multiphase design. In phase one, a survey and focus groups were conducted with individuals with disabilities who experienced barriers to health care access. In phase two, key informant interviews were conducted with individuals who had a role in ensuring equal access to health care for people with disabilities.ResultsIn the current context of health care reform, people with disabilities continue to experience multiple barriers to health care access under Titles II and III of the ADA. However, a notable result is that several provisions of the Patient Protection and Affordable Care Act (ACA) have likely bolstered existing directives implementing requirements for health care access under the ADA.ConclusionsThe results of this study provide additional support for a comprehensive examination of both the national standards for accessible health care and the enforcement of laws that prohibit discrimination on the basis of disability.     

State Medicaid and private telemedicine coverage requirements and telemedicine use, 2013–2019

Objective

To examine the association between state Medicaid and private telemedicine coverage requirements and telemedicine use. A secondary objective was to examine whether these policies were associated with health care access.

Data Sources and Study Setting

We used nationally representative survey data from the 2013–2019 Association of American Medical Colleges Consumer Survey of Health Care Access. The sample included Medicaid-enrolled (4492) and privately insured (15,581) adults under age 65.

Study Design

The study design was a quasi-experimental two-way-fixed-effects difference-in-differences analysis that took advantage of state-level changes in telemedicine coverage requirements during the study period. Separate analyses were conducted for the Medicaid and private requirements. The primary outcome was the past-year use of live video communication. Secondary outcomes included same-day appointment, always able to get needed care, and having enough options for where to go to receive care.

Data Collection/Extraction Methods

N/A.

Principal Findings

Medicaid telemedicine coverage requirements were associated with a 6.01 percentage-point increase in the use of live video communication (95% CI, 1.62 to 10.41) and an 11.12 percentage-point increase in always being able to access needed care (95% CI, 3.34 to 18.90). While generally robust to various sensitivity analyses, these findings were somewhat sensitive to included study years. Private coverage requirements were not significantly associated with any of the outcomes considered.

Conclusions

Medicaid telemedicine coverage during 2013–2019 was associated with significant and meaningful increases in telemedicine use and health care access. We did not detect any significant associations for private telemedicine coverage policies. Many states added or expanded telemedicine coverage policies during the COVID-19 pandemic, but states will face decisions about whether to maintain these enhanced policies now that the public health emergency is ending. Understanding the role of state policies in promoting telemedicine use may help inform policymaking efforts going forward.     

Healthcare Communication Barriers and Self-Rated Health in Older Chinese American Immigrants

Older Chinese immigrants are a growing population in the United States who experience multiple healthcare communication barriers such as limited English proficiency and low health literacy. Each of these obstacles has been associated with poor health outcomes but less is known about their effects in combination. This study examined the association between healthcare communication barriers and self-rated health among older Chinese immigrants. Cross-sectional survey data were obtained from 705 Chinese American immigrants ages 50–75 living in San Francisco, California. Communication barriers examined included spoken English proficiency, medical interpreter needs, and health literacy in written health information. The study sample (81 % females, mean age = 62) included 67 % who spoke English poorly or not at all, 34 % who reported needing a medical interpreter, and 37 % who reported “often” or “always” needing assistance to read health information. Two-thirds reported poor self-rated health; many reported having access to racial-concordant (74 %) and language-concordant (86 %) healthcare services. Both poor spoken English proficiency and low health literacy were associated with poor self-rated health, independent of other significant correlates (unemployment, chronic health conditions, and having a primary doctor who was ethnic Chinese). Results revealed that spoken English proficiency and print health literacy are independent communication barriers that are directly associated with health status among elderly Chinese American immigrants. Access to racial- or language-concordant health care services did not appear to resolve these barriers. These findings underscore the importance of addressing both spoken and written healthcare communication needs among older Chinese American immigrants.     

The COVID-19 pandemic and quality of life outcomes of people with intellectual and developmental disabilities

BackgroundPeople with intellectual and developmental disabilities (PWIDD) are contracting and dying of COVID-19 at significantly greater rates than nondisabled people and people with other disabilities. Despite the increased risk of COVID-19 for the IDD community, there has been less attention drawn to the impact of the pandemic on people with IDD, especially beyond their health and safety. Yet, PWIDD also face unique challenges as a result of the pandemic compared to other populations.ObjectiveThe purpose of this study was to explore the impact of the COVID-19 pandemic on the quality of life outcomes of PWIDD.MethodsWe conducted a secondary analysis of Personal Outcome Measures® interviews from 2019 to 2020 (n = 2284).ResultsThere were significant differences in the following quality of life outcomes of PWIDD between 2019 and 2020: continuity and security; interact with other members of the community; participate in the life of the community; intimate relationships; and, choose goals.ConclusionsOur findings suggest the COVID-19 pandemic has negatively hindered the quality of life outcomes of PWIDD in a number of different areas. While the pandemic has been undoubtably hard on the IDD community, in many ways it has simply intensified an underfunded and fractured IDD service system. However the IDD service system evolves during and after the pandemic, it must be done in a way that prioritizes the quality of life of PWIDD and what is most important to them.     

Health care under the ADA: A vision or a mirage?

Problems in health care access are identified using recent studies documenting the health disparities experienced by people with disabilities. Some of these health care access barriers qualify as discrimination prohibited under the Americans with Disabilities Act. Focusing on the past decade of ADA enforcement, issues reported in the U.S. Department of Justice listing of resolved ADA complaints and settlements are compared to the profile of access problems. Key court case outcomes of the past decade also are presented. These sources indicate that the majority of resolved complaints and settlements involved failure to provide effective communication (often sign language interpretation). A smaller percentage of complaints and settlements addressed issues of refusal to provide treatment, physical access, equipment access, and provider procedures. Most of the key settlements involved hospitals and larger provider organizations, while many complaints also focused on individual physicians. Although the record indicates that the ADA can be, and has been, effectively used to increase access in many instances, other types of access problems have been lightly addressed through application of the ADA. This likely stems from enforcement choices made by the Department of Justice and the dynamics of the patient-doctor relationship. The broad challenge for the coming decade is to develop means to achieve effective communication and eliminate physical and programmatic barriers in more health care provider settings more consistently. The ADA can be a vigorous force in this effort as part of a multipronged strategy.     

COVID-19 disproportionately impacts access to basic needs among households with disabled members

BackgroundThe COVID-19 pandemic has disproportionately impacted disabled people, especially those who are members of marginalized communities that were already denied access to the resources and opportunities necessary to ensure health equity before the pandemic.ObjectiveCompare COVID-19 impact on basic needs access among households with and without disabled adults.MethodsAn online survey was distributed to households with children enrolled in one of 30 socially vulnerable elementary or middle schools in San Diego County, California. We measured disability using the single-item Global Activities Limitations Indicator. We measured pandemic impacts on basic needs access using the RADx-UP common data elements toolkit. We then assessed number of impact items reported by household disability using multivariable linear regression, adjusting for household income, household size, education, parent gender, and child's ethnicity.ResultsOf 304 participants, 41% had at least one disabled household member. Participants reporting a disabled household member were more likely to report challenges accessing basic needs, such as food, housing, healthcare, transportation, medication, and stable income during the pandemic (all p < 0.05). Difficulty accessing basic needs was significantly associated with household income and parent gender in the final regression model.ConclusionsHouseholds with a disabled member were significantly more likely to experience difficulty accessing basic needs during the COVID-19 pandemic. This has important implications for the disproportionate impact of COVID-19 on disabled people, especially those from low-income communities that already face barriers to accessing resources. To improve COVID-19 outcomes for disabled people, we must focus on meeting their basic needs.     

Targeting health care improvement for persons with disabilities.

Histories of persons with disabilities only started being widelytold in the last few decades, and often they are not happy.Discrimination, disenfranchisement, and even outright hostilityreach back to Biblical times. The forced isolation of many personswith disabilities over the centuries has obliterated their traces.Leaping forward two millennia, enormous strides have certainlybeen taken, often spurred by people with disabilities themselves.Especially in developed nations, legal, economic, societal,and environmental barriers are falling, allowing persons withdisabilities to participate fully in daily life throughout communities.Nonetheless, persistent hurdles do remain, even in health care. But wait. Barriers to health care for persons with disabilities?After all, as an American presidential advisory committee onhealth care quality wrote, ‘The purpose of the healthcare system must be to continuously reduce the impact and burdenof illness, injury, and disability and to     

Concerns on healthcare access,utilization, and safety due to COVID-19 among American adults with vision loss

BackgroundLimited studies have indicated that Americans with vision loss are differentially impacted by COVID-19.ObjectiveWe examined concerns with healthcare and safety among Americans with vision loss during the early phase of the pandemic (April 2020).MethodsThe Flatten Inaccessibility Survey assessed the impact of COVID-19 on healthcare (pharmacy access, maintenance of eyecare regimen, caregiver access, and resource denial) and safety (social distancing, clean surfaces, and touching public signage) concerns among Americans with low vision or who were blind. Multivariable logistic regression was used to determine associations between respondent characteristics and each concern.ResultsA total of 1921 adults responded to the survey, of whom 65% were blind and 35% had low vision. Most respondents were female (63%) and white (74%). Respondents with additional disabilities/comorbidities were more likely to report healthcare access concerns (pharmacy access, eyecare regimen, caregiver access, and ventilator access) and safety concerns (social distance, clean surfaces, and touching signage) than those with vision loss alone. In addition, females, those identifying as “other” gender, older individuals, and people with adult onset of vision impairment were more likely to experience COVID-19–related concerns and challenges related to healthcare and overall safety.ConclusionThese results suggest that while Americans with vision loss have been differentially impacted by COVID-19, adults with vision loss and additional disabilities/comorbidities are more likely to have concerns with healthcare and safety than those with vision loss alone.