Equal Care: Accessibility of Health Care Settings for People with Disabilities across Two Time Periods

Background and Purpose: Physical and programmatic barriers prevent people with disabilities from obtaining primary care of quality equal to that received by others. Access barriers include difficulties maneuvering around doctors’ offices and delay in receiving examinations and tests due to inaccessible equipment. Recognizing this, the ACA required the development of medical diagnostic equipment accessibility standards (issued January 2017) and the collection of information about the number of providers with accessible facilities and equipment (ACA Section 4302). To date, no national databases collect information about provider accessibility. The largest database of provider accessibility comes from audits of primary care offices in California. Earlier, the authors analyzed the California audits for the period 2006-2009; the current study compares these earlier results to recent audit data. A key aim is to determine whether there has been change in physician office accessibility since 2009, and for which elements there has been the greatest change.

 Method:  This study uses data from on-site reviews conducted by Medicaid Managed Care plans in California. Starting in 2006, trained nurses have collected data by visits to primary care offices. Between 2006-2010 they used a 55-item audit tool with elements extracted from the federal ADA Accessibility Guidelines (ADAAG). In 2010, we obtained the data for 2006-2009 for 2,389 sites serving 2.5 million persons, and published this analysis in 2012. In 2011, the audit tool was revised and enlarged to 86 items; the data collection method and many data items remained the same. For the current study, we analyzed data from the revised audit tool, with 3,588 sites for 2013-2016. We present the first findings, focusing on the prevalence of the key access elements in health provider offices, and compare the presence of access elements across the two time periods. We especially focus on exam equipment and bathroom characteristics, the areas of greatest deficit in the prior study. We analyze the data as separate cross-sections, although some primary care doctor sites are present in both survey cohorts.

 Results:  Accessibility rates continue to be highest for such architectural elements as parking and office path of travel. The percent of providers with height-adjustable exam tables and accessible scales remains low (8.4% to 19.0% for tables; 3.6% to 11.5% for scales), but the increase is statistically significant. Tables lack elements to assist transfer (74.7%) and only 6.3% of exam rooms have a lift (new items). Bathroom problem rates appear unchanged (elements re-worded): toilet paper dispensers improperly positioned (37.8%), sink pipes not wrapped (26.7%), and toilet stalls too small for a person in a wheelchair to turn (27.4%).

Conclusions and Implications:  Unequal circumstances for health exams contribute to differential health outcomes for people with disabilities. These findings document that changes in access characteristics are slow, and equipment access is a severe problem. If professionals working in health settings are alert to these access challenges, they may facilitate acquisition of the needed elements. In addition, the audit methodology used to collect these data offers a model for collecting the national data required by the ACA.