Access barriers to healthcare for people living with disabilities

Journal of Public Health - This study elucidated healthcare access barriers to receiving adequate services among adults with disabilities. In particular, we utilized community focus groups to...     

Satisfaction with healthcare services among Spanish people with disabilities

BackgroundSeveral studies show the relationship between patient satisfaction and quality of health services and also between disabling conditions and healthcare access, but none sufficiently analyze the factors that contribute to satisfaction among patients with disabilities.Objective/hypothesesThe primary aim of this paper is to quantify the impact of social factors, perceived health status and access on satisfaction with healthcare services among Spanish people with disabilities.MethodsThis paper uses data from the European Health Survey 2009 to construct latent variables related to satisfaction, use and health status among Spanish patients with disabilities. Next, partial least squares path modeling is used for quantifying the effects of certain social factors, service use, and health status on patient satisfaction with received healthcare services.ResultsSatisfaction with healthcare services among people with disabilities is correlated (Nagelkerke R² of 0.175) with certain demographic factors (age, gender and town size), assistance support and patient use of these services. Education level and income were not found to have significant effects.ConclusionsPeople with disabilities generally show a high level of satisfaction with healthcare services, influenced by a positive valuation of the differentiated use given their specific care needs. Subjective aspects of care have a notable influence, linked with the perception of the person's own state of health and emotional status, on these positive valuations; patients' individual perceptions can reduce care needs and the use patients make of healthcare services and tend to increase their level of satisfaction with these services when they do seek them.     

Primary healthcare for people with mental health problems or learning disabilities

The physical health inequalities experienced by people with mental health problems or learning disabilities are well established, though comprehensive data for England and Wales have not previously been available. Nor have the reasons for inequalities been examined in detail. The Disability Rights Commission in Great Britain set out to examine such inequalities in relation to primary healthcare and to establish what remedial actions are needed. A range of data-gathering mechanisms was used, including clinical data analysis, qualitative research, structured feedback from service users and professionals, and a high-level inquiry panel which took evidence from government departments and agencies and from national organisations. The data provide detailed evidence about inequalities and this paper sets out key recommendations for change.     

Patterns of healthcare use and employment among people with disabilities

BackgroundEmployment rates among people with disabilities are low. Poor health is often cited as a barrier to work. Disability or a lack of disability-related resources may interfere with the ability to secure and maintain work.ObjectiveThis paper presents an exploratory examination of the association between variation in service use and employment.MethodsThe paper uses data from North Carolina Medicaid recipients age 18–64 who were eligible in fiscal year 2007 due to receipt of Supplemental Security Income (n = 60,190). Logistic regression was used to model employment as a function of variation in healthcare use, with conditional models stratifying by days of service use and unconditional models run by quantile of service use.ResultsPeople with the least service use (<12 days) had the highest employment rate (over 20%); those with the most service use (≥54 days) had the lowest employment rate (7.8%). Those in between displayed remarkably little variation in employment rate by level of service use. The amount of week-to-week variation in service use was positively associated with the probability of employment.ConclusionsAmong Medicaid enrollees with disabilities who use outpatient services, amount of service use is negatively associated with employment and variation in use is positively associated with employment. Future research involving more extensive administrative data, primary data collection, and the use of mixed methods would improve understanding of these findings.     

The effects of community policies to reduce youth access to tobacco.

OBJECTIVES: This study tested the hypothesis that adoption and implementation of local policies regarding youth access to tobacco can affect adolescent smoking. METHODS: A randomized community trial was conducted in 14 Minnesota communities. Seven intervention communities participated in a 32-month community-organizing effort to mobilize citizens and activate the community. The goal was to change ordinances, merchant policies and practices, and enforcement practices to reduce youth access to tobacco. Outcome measures were derived from surveys of students before and after the intervention and from tobacco purchase attempts in all retail outlets in the communities. Data analyses used mixed-model regression to account for the clustering within communities and to adjust for covariates. RESULTS: Each intervention community passed a comprehensive youth access ordinance. Intervention communities showed less pronounced increases in adolescent daily smoking relative to control communities. Tobacco purchase success declined somewhat more in intervention than control communities during the study period, but this difference was not statistically significant. CONCLUSIONS: This study provides compelling evidence that policies designed to reduce youth access to tobacco can have a significant effect on adolescent smoking rates.     

The effect of caregiving on preventive care for people with disabilities

BackgroundOverall, disparities exist in preventive health care services for people with disabilities compared with other Americans. Little is known about the effects of caregiving on preventive services use. This study examines caregiver characteristics and influence on the use of preventive services for people with disabilities.MethodsThe 2000-2001 Behavioral Risk Factor Surveillance System of 25 states included 5486 self-reported respondents with disabilities who were surveyed for preventive care use. Multivariate logistic regression adjusted for demographic and functional status of these respondents.ResultsAmong the subset of the respondents with caregivers, those with paid caregivers were significantly more likely to receive an influenza vaccination (adjusted odds ratio [OR], 1.49; 95% confidence interval [CI], 1.08-1.93). Among those with a caregiver, those with a spouse/partner caregiver were also significantly more likely to receive an influenza vaccination (adjusted OR, 1.33; 95% CI, 1.05-1.69) or PPV (adjusted OR, 1.59; 95% CI, 1.41-2.38) compared with those with “other” as their caregiver. Women with disabilities with a spouse/partner caregiver were significantly more likely to have ever had a Pap test (adjusted OR, 3.13; 95% CI, 1.41-6.67) or mammogram (adjusted OR, 1.85; 95% CI, 1.23-2.70) than those with “other” relative caregiver. Those respondents who reported “rarely adequate” caregiver satisfaction were significantly more likely to have self-reported ever having colon cancer screening compared with those with a usually adequate caregiver. The majority of results did not show consistent evidence of caregiver benefit, and a fair number of the associations were not statistically significant.ConclusionThe findings suggest that having a caregiver is not consistently associated with self-report of ever using preventive services. However, this study suggests that caregiver characteristics are associated with preventive care for people with disabilities. For influenza vaccination, our results showed that paid caregivers were more likely to provide preventive care to individuals with disability than a spouse or partner, which were more likely to provide more preventive care than those with “other” caregiver. Given the number of comparisons, we consider these results to be preliminary and require more confirmation in other population data.     

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.     

Inequalities in access to health care for people with disabilities in Chile: the limits of universal health coverage

We analysed cross-sectional data collected as part of the National Socioeconomic Characterisation Survey (2013) in Chile, in order to explore if there are differences in access to health care between adult Chileans with and without disability. The study included 7459 Chilean adults with disability and 68,695 people without disability. Logistic regressions were performed in order to determine the adjusted odds ratios for the associated variables. We found that despite universal health coverage, Chileans with disabilities are more likely to report worse access to health care, even when controlling for socio-economic and demographic variables, including age, gender and income. Specifically, they are more likely to face greater difficulty arriving at a health facility, obtaining a doctor’s appointment, being attended to in a health facility, paying for treatment due to cost, and obtaining necessary medicine. Both people with and without disability are more likely to face difficulties in accessing health services if they are affiliated with the public health provider, an indication of the economic factors at play in accessing health care. This study shows that universal health coverage does not always lead to accessibility of health services and underlines the disadvantaged position of disabled people in Chile in accessing health services. While efforts have been made recently to improve equity in health care access, disability in Chile poses an additional burden on people’s access to health care, emphasising the necessity for policy to address this perpetual cycle of disadvantage for disabled people.     

The effects of the COVID-19 pandemic on the psychosocial well-being of people with disabilities

BackgroundBefore the COVID-19 pandemic, people with mobility, vision, hearing, and cognitive disabilities were at a higher risk of lower psychosocial well-being than people without disabilities. It is, therefore, of great importance to investigate whether the pandemic has exacerbated this difference.ObjectiveThis study examines whether people with disabilities (categorized as mobility, vision, hearing, cognitive, and any disabilities) report more COVID-19-related negative effects on psychosocial well-being (loneliness, decreased social contact, decreased hope for the future, concerns about being infected) than people without disabilities.MethodsWe analyzed population-based data from the Finnish Health, Welfare, and Services (FinSote) survey carried out in 2020–2021 (N = 22 165, age 20+). Logistic regression models were applied, controlling for the effects of age, sex, partnership, living alone, and education.ResultsAll disability groups, except those with vision disabilities, reported significantly more often that the pandemic increased loneliness than people without disabilities. There were no significant differences between the disability groups and people without disabilities in decreased social contacts. People with only mobility and cognitive disabilities reported significantly more often that the pandemic decreased their hope for the future than those without disabilities. All disability groups were more often concerned about being infected than people without disabilities, but this effect was not significant among people 75 or older.ConclusionThe psychosocial well-being of people with specific types of disabilities should receive special attention during crises like the COVID-19 pandemic.     

The public health response to the COVID-19 pandemic for people with disabilities

With the rapidly changing landscape of the COVID-19 outbreak, how to best address the needs and continue to protect the health and well-being of people with disabilities (PwDs) is a global public health priority. In this commentary we identify three public health areas of ongoing need and offer possible strategies to address each. These areas include: the types of data that would help clarify risks for PwDs and help assure their safety long term; the prevention, treatment and mitigation measures for PwDs that are needed through the duration of the outbreak; and the issues of equity in access to and quality of medical care for PwDs. Because of the rapid nature of the public health response, it is critical to reassess and readjust our approach to best address the needs of PwDs in the months and years to come and to incorporate these new practices into future emergency preparedness responses.     

Sharing knowledge to advance healthcare policies in Europe for people living with dementia and their carers: the ALCOVE project

Background

Alzheimer’s disease and other related dementias are public health priorities in the European Union due to their prevalence, cost and profound impact on society. Because of these pressing implications, the European Union decided to create a Joint Action to share knowledge about dementia and health policy in order to preserve the health, quality of life, autonomy and dignity of people living with dementia and their carers in Europe.

Methods

ALCOVE is a European Community-funded Joint Action coordinated by the HAS (French National Authority for Health) with a 24-month duration. The project’s life cycle has been divided into the following four steps: (1) collection of existing information, (2) analysis of existing information and making comparisons across Member States, (3) identifying Evidence, Needs, and Priorities, (4) drafting recommendations and disseminating them.

Results

19 countries are participating in the ALCOVE initiative. The project will publish its final findings in 2013. The project’s objectives, participants, method, on-going procedures and work plans are already available on the ALCOVE website: http://www.alcove-project.eu/. Preliminary results show that recommendations will need to focus on clinical and epidemiological data collection, diagnostic system assessment, outstanding approaches for treating behavioural disorders, limiting antipsychotic use, and competence assessment in this vulnerable population.

Conclusions

The European Member States involved are mobilized to share best health policy practices in order to tackle the challenge of dementia’s threat on European health and social systems and to improve the quality of life and care for individuals and their family carers.