Would you be surprised to discover that…

• Doctors’ offices are not required to be accessible to people with disabilities?

• There is no additional compensation for doctors who take extra time with disabled patients with complex problems?

• Doctors can decline to take on a patient with a disability if he or she appears to require too much of the doctor’s time?

• Disabled patients often don’t receive the screening or prevention measures recommended for someone their age?

• Disabled patients are less likely to actually be examined when they come to the doctor’s office with a problem?

• People with disabilities feel that their doctors don’t understand their disability or what they need as a result of it?

• The quality of care received by people with disabilities differs depending on how the doctor gets paid?

• Despite recent emphasis on primary care reform, to date policy-makers are not paying attention to issues like these pertaining to people with disabilities?

 

What can you or your organization do to improve primary care for disabled people in Ontario?

• Recognize that this is exactly the right time to do something about this, when government is highlighting primary care as one of its top priorities.

• Work together with other individuals and organizations to attract the attention of policy-makers in the Ministry of Health and Long Term Care to the issues of people with disabilities in primary care.

• Contact the new Minister Responsible for Disability Issues to let her know that primary care should be a priority in implementing the new Accessibility for Ontarians with Disabilities Act.

• Talk to your family doctor about how you can work together to ensure that you are receiving the best possible primary care within the context of his or her practice. Remember that medical practitioners are motivated by a genuine desire to do good, and in all likelihood, your family doctor is as anxious as you are to ensure excellent care.

• Whenever possible, collaborate with researchers to produce a better understanding of the issues of disabled people’s access to primary care.

Over the past four years, researchers at Queen’s Centre for Health Services & Policy Research and Queen’s Centre for Studies in Primary Care have worked together to better understand the issues involved in providing primary care to people with disabilities. As a result of eight different studies, we have been able to show the following results:

• In a national survey of health services utilization, we found that people with disabilities see their family doctors three times as often as their non-disabled counterparts, and yet they report that they experience three times as many unmet needs.

• In a review of more than 30 federal, provincial and regional health policy documents pertaining to primary care, very little was said about people with disabilities. Despite recent legislation on accessibility in Ontario (ODA, 2004; AODA, 2005), there is as yet no requirement for doctors’ offices to be made accessible.

• We interviewed family doctors about their experiences with disabled patients in their practices, and they stated unequivocally that disabled patients take more time and present more complex issues than most non-disabled patients. Family doctors are not compensated for any extra time they might wish to take with disabled patients.

• Family doctors also told us that they often neglected to provide preventive care to disabled patients or to perform a proper examination because of the volume of other health issues, or because of beliefs about the life expectancy or sexuality of disabled patients.

• We interviewed 40 people with a variety of physical and cognitive disabilities from across the country, and repeatedly heard from them that they expected more from their family doctors than the average patient. They expected their doctor to know about:

• disability in general
• their particular disabling condition
• resources and programs pertaining to disability in the community and from government.

• In an international study of people who have had a spinal cord injury for at least 20 years, we found that participants often used their rehabilitation specialists to meet primary care needs, and that people were relatively uncertain as to what issues to take to what doctor.

• In a recent study of differences in access and quality of primary care for people with disabilities, we found that doctors who are paid by salary tend to operate out of more accessible premises and to provide more complete and appropriate care to their disabled patients than do doctors paid by fee for service or capitation.

• We have been exploring options for providing better service to people with disabilities in primary care by examining models from other provinces and other countries. We have determined that there are six ways in which disability services can be incorporated into primary care settings. Over the next three years, we will be trying out three of these models in pilot sites in Ontario, and evaluating them for broader distribution.

 

Primary care refers to medical services provided at the first point of contact with the health care system.

Access to health services is defined as the ability to receive services in a timely and satisfactory fashion. People with disabilities typically encounter four types of barriers when attempting to access health services:

• physical barriers
• inadequate expertise about disability
• attitudinal barriers
• systemic inequities

Fast facts

The Canadian Health Services Access survey estimates that 12-14% of Canadians do not have access to a family doctor, and a recent national poll suggests that access is declining.

Access problems in the general population (such as wait times and geographical distribution) result in delays and inconvenience in obtaining primary care. Access problems associated with disability actually prevent people with disabilities from receiving service.

Additional reason for access problems among people with disabilities include:

• office and examining tables that are not suitable for someone with a wheelchair or other mobility device
• transportation problems
• policies about appointment times, home visits, and office assistance that systematically disadvantage disabled patients
• providers who are not sufficiently aware of disability information or issues.

Text from Brochure

The Canadian Health Services Access survey estimates that 12-14% of Canadians do not have access to a family doctor, and a recent national poll suggests that access is declining.

Where problems like this exist in the general population, they are sure to be more acute and more serious in disadvantaged populations.

Access problems in the general population (such as wait times and geographical distribution) result in delays and inconvenience in obtaining primary care.

Access problems associated with disability actually prevent people with disabilities from receiving service.

Additional reason for access problems among people with disabilities include:

• office and examining tables that are not suitable for someone with a wheelchair or other mobility device

• transportation problems

• practice-level policies about appointment times, home visits and office assistance that fail to address the needs of disabled patients

• health care providers who are not sufficiently aware of disability information or issues.

Here are some suggestions if you want to take action and make your voice heard:

• Recognize that this is exactly the right time to do something about this issue, when government is highlighting primary care as one of its top priorities.

• Work together with other individuals and organizations to attract the attention of policy makers in the Ministry of Health & Long Term Care to issues of people with disabilities in primary care.

• Contact the new Minister Responsible for Disability Issues to let her know that you believe that primary care should be a priority in implementing the new Accessibility for Ontarians with Disabilities

Take Action

More suggestions if you want to take action and make your voice heard:

• Talk to your family doctor about how you can work together to ensure that you are receiving the best possible primary care within the context of his or her practice.

• Remember that medical practitioners are motivated by a genuine desire to do good, and, in all likelihood, your family doctor is as anxious as you are to ensure that you receive excellent care.

• Collaborate with researchers whenever possible to produce a better understanding of the issues of disabled people access in primary

Addressing the Primary Care Needs of People with Disabilities

Would you be surprised to discover that…

• disabled patients are less likely to be examined when they come to the doctor’s office with a problem?

• family doctors can decline to take on disabled patients because their care takes too much time?

• doctors’ offices don’t have to be accessible to people in wheelchairs

• the kind of care a disabled person gets differs depending on how the doctor is paid?

• primary care reform is not currently addressing issues of people with disabilities?

For More Information

Over the past four years, researchers at Queen’s Centre for Health Services & Policy Research and Queen’s Centre for Studies in Primary Care have worked together to better understand issues involved in providing primary care to people with disabilities.

If you would like more information about their research, visit their website at: http://chspr.queensu.ca

or contact:

Mary Ann McColl, PhD
Centre for Health Services & Policy Research
Queen’s University
Kingston, ON K7L 3N6
Phone (613) 533-6353
Fax (613) 533-6387
mccollm@post.queensu.ca

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