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BARRIERS TO HEALTH CARE FOR WOMEN WITH DISABILITIES: Education of Health Care Providers

BARRIERS TO HEALTH CARE FOR WOMEN WITH DISABILITIES: Education of Health Care Providers. Margaret A. Turk, MD Professor, Physical Medicine & Rehabilitation SUNY Upstate Medical University - Syracuse. Scope of the Problem. 26 million women with disabilities (WWD) in the US

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BARRIERS TO HEALTH CARE FOR WOMEN WITH DISABILITIES: Education of Health Care Providers

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  1. BARRIERS TO HEALTH CARE FOR WOMEN WITH DISABILITIES:Education of Health Care Providers Margaret A. Turk, MD Professor, Physical Medicine & Rehabilitation SUNY Upstate Medical University - Syracuse

  2. Scope of the Problem • 26 million women with disabilities (WWD) in the US • Increasing prevalence with improved care • WWD among the most disadvantaged (NHISD) • Lower socioeconomic • Less education • Less often married

  3. Scope of the Problem • Estimated 1 million persons with disabilities have contact with health care providers annually • Providers: • Physicians and extenders • Nurses • Therapists: PT, OT, SLP • Psychologists • Rehabilitation Counselors • Social service providers • Technicians: phlebotomy, respiratory, radiology • Etc. . .

  4. Barriers to Health CareReport from WWD • Difficulty obtaining primary health care, gynecologic services, mental health services, dental care, prescription meds, eyeglasses, fitness • Experiences in ED and hospital (PWDD Australia) • Required reliance on personal support • Negative attitudes of staff • Lack of staff skills and knowledge (Federally funded projects, personal communications, 1996 to present) (Iacono, 2003)

  5. Barriers to Health CareReport from WWD • Reasons cited: • Accessibility - environmental and financial • Provider education and training • Attitudes • Knowledge and skills (Federally funded projects, personal communications, 1996 to present)

  6. Barriers to Health CareReport from Providers • Lack of medical knowledge • No formal training undergraduate/graduate • PM&R disability and performance focused • Education through experience/mentors • Time and reimbursement issues • Time consuming appointments (2-3X) • No compensation for extra time/staff • Interpreter cost > reimbursement (Personal communications and experience)

  7. Barriers to Health CareReport from Providers • Communication with deaf/hearing loss patients in primary care setting (Ralston, 1996) • Acknowledge poor communication/understanding • Concerns re: patients trusting them • Level of comfort not patients in practice • Attitudes re: function & back pain (Rainville,1995) • Diverse pain attitudes and beliefs • Attitudes and beliefs  treatment considerations

  8. Physicians and extenders Nurses Therapists: PT, OT, SLP Psychologists Social service providers Rehabilitation Counselors Technicians: phlebotomy, respiratory, radiology Etc. No educational requirements re: health care for persons with disabilities Health Care Providers

  9. Education for ProvidersAttitudes • Comparison OT, PT, RN (White, 1998) • OT most positive • Practice setting, age, education no significance • Comparison OT, Med Tech students (Estes, 1991) • OT more positive, and most positive last year • Comparison OT, business student (Chan 2002) • Initial similar attitudes, change after 1st year

  10. Education for ProvidersAttitudes • Medical student attitudes (US and Canada) (Tervo, 2002) • Less positive attitudes than norms • Males more negative; previous experience positive • Rehabilitation Counseling students (Wong, 2004) • Preferred disability type physical disability > developmental disability > mental illness • OT students in Hong Kong • Rank order importance attributes: disability type, history aggressive behaviors, age, employment, gender (Tsang, 2004)

  11. Education for ProvidersAttitudes • RN attitudes more positive with education • Comparison NP/RN to general population (Gething, 1992) • More positive outpatient, peer encounters (Packer, 2000) • More positive attitude post education (Lindgren, Oermann,1993, 1995)

  12. Education for ProvidersKnowledge • Existing curricula • Fulfill broad requirements • Leading edge technology • Undergrad/graduate • Competencies • Curricular reform • Competition • Test vs education • Process • Evaluation

  13. Education for ProvidersKnowledge • Disability continuum • Disability specific conditions • Secondary conditions • Aging with a disability • Health perceptions & promotion • Sexuality and reproductive health • Enhancing motor performance • Health care access and administration

  14. Education for ProvidersSkills • Communication • Cognitive impairment • Hearing loss • General disability • Positioning • Transfers • General exam • Gynecologic exam Source: Alta Bates, Comprehensive Breast Center

  15. CONCLUSIONS • Women with disabilities have reported barriers to health care. • Health care providers acknowledge lack of knowledge and skills in providing care to women with disabilities. • Attitudes toward persons with disabilities is generally negative, and dependent on disability type, age, and gender.

  16. CONCLUSIONS • The literature supports the positive effect of contact, experience, and education on professional attitudes toward persons with disabilities. • Curricula for health care providers do not require education about or competencies re: disabilities in general, and about women with disabilities in particular.

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