Accessibility of Primary Health Care Settings for People with Disabilities

Background and Purpose: A large and growing literature documents that physical and programmatic barriers prevent people with disabilities from obtaining primary care of equal quality to the care others receive. Patients report difficulties getting into and maneuvering around doctors' offices and receiving necessary examinations and tests because of inaccessible offices and equipment. Some patients have experienced severe harm as a consequence. While qualitative studies have gathered patient reports of barriers, there are no national estimates of the proportion of providers prepared to serve patients with disabilities. Sample surveys sent to providers in different cities have had extremely poor response rates, often producing n's below 100. This study presents the best data to date on the physical accessibility of medical offices. The aim is to identify which aspects of access are generally available and which are rarely present so as to inform policies for improving the health care received by people with disabilities.

Method: This study uses a unique dataset derived from facility site reviews conducted by two health plans in Southern California. Since 2006, the health plans have conducted disability accessibility surveys at the same time that they administer the state-required Facility Site Review (FSR). Using a 55-item survey, “ADA Seniors and Persons with Disabilities (SPD) Facility Site Review Assessment Tool,” trained nurses collect the data during their site visits to provider buildings and offices for the FSR. The dataset has 1,206 providers and is the largest sample to date of providers' facilities and their access characteristics. We present a descriptive analysis that reports the distribution of the different access elements among providers representing different primary care specialties, augmented by the qualitative comments noted by the surveyors.

Results: Among the findings, accessibility rates are highest for architectural elements, such as accessible parking (90.6%), path of travel in the office (98.8%), and examination room size (84.5%); however, two-thirds of the elevators fail the ADA standard for size. Only a small percentage of providers' offices have height-adjustable exam tables (7.1%) or accessible scales (4.2%), both important to a basic medical exam. The qualitative comments indicate that in many instances of architectural non-compliance, the problems are not difficult to remedy. There is little variation by primary care specialty, perhaps because many of the providers' offices are group practices.

Conclusions and Implications: The findings offer a quantitative estimate of the presence of accessibility in medical practices, addressing important aspects of physical accessibility. They document the low rate of accessible scales and exam tables, statistics not previously known, even though the prevalence of these items has been the focus of litigation and policy discussion. The profile of medical office accessibility provided by this study can assist policy decisions aimed at reducing the documented disparities in health care access that disabled Medicaid and other patients with disabilities face and increasing the quality of health care they receive.