LDN - Health and Fitness

Disabilities tied to worse access to care, poorer health

[October 27, 2017]

By Lisa Rapaport

(Reuters Health) - People with disabilities may have less access to care and worse health outcomes than individuals without physical or mental challenges, two recent studies suggest.

One study found that people with disabilities in the UK have worse access to care largely due to struggles with transportation, costs and long waiting lists for appointments. The other study was done in the U.S. state of Ohio and found people with disabilities were more likely to have unmet medical needs and less likely than others to have a primary care physician.

“We expected to find disparities, but we anticipated that they would not be too wide,” said co-author of the UK study Dr. Dikaios Sakellariou, a researcher at Cardiff University.

“It was also surprising that cost appeared to have such a big impact on people’s access to care, especially in England,” Sakellariou said by email. That’s because the British National Health Service (NHS) generally provides free care, except for medication, he said.

Roughly one in five people in the UK live with a disability, researchers note in BMJ Open.

To see how disability influences access to care, researchers examined survey data on access to care for 12,840 people over the age of 16 who didn’t live in institutional settings like nursing homes. This included 5,236 people with disabilities.

The most common obstacle for all people - whether they had a disability or not - was long waits for treatment, the study found. This was more common, however, for individuals with disabilities and impacted more than one in four people with severe disabilities.

Researchers also found that people with severe disabilities were more than four times as likely to lack treatment for mental health problems as individuals without disabilities.

In addition, women with disabilities were more than seven times more likely to have unmet health needs due to the cost of care or medication than men without disabilities.

This might be due in part to women having lower incomes than men, or more hurdles like the lack of transportation or insufficient time to seek care due to responsibilities caring for kids or other relatives, Sakellariou said.

For the Ohio study, researchers examined survey data on almost 43,000 adults and more than 10,000 children with and without developmental disabilities.

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Overall, they found that 14 percent of children aged 18 and younger with disabilities had problems receiving needed care, compared to 2 percent of kids without disabilities.

Among adults 65 and older, half of people with disabilities and 17 percent of individuals without disabilities reported having one or more unmet healthcare needs, researchers report in the Annals of Family Medicine.

Adults with disabilities were also less likely to have a primary care physician that spends enough time with them or to have clinicians who explained things well.

Neither study was a controlled experiment designed to prove whether or how disabilities may influence access to care.

But previous research has documented significant health disparities for people with disabilities, and the findings suggest that lack of access is one reason why, researchers involved with both studies said.

A lack of training for healthcare providers is another problem, said Susan Havercamp, a co-author of the U.S. study and researcher at The Ohio State University Wexner Medical Center's Nisonger Center in Columbus.

“Healthcare training programs have not changed much in the past 100 years,” Havercamp said by email.

“In contrast, the lives of people with developmental disabilities have changed a great deal,” she said. “A century ago, babies born with developmental disabilities were not expected to survive childhood.”

Now, many of these babies will grow up and require lifelong care that’s tailored to their specific physical and mental health challenges.

“The best way to reduce health and healthcare disparities in people with developmental disabilities is to include disability training in all healthcare training programs,” Havercamp added.

SOURCE: http://bit.ly/2gFXpdo BMJ Open and http://bit.ly/2zSpIha Annals of Family Medicine, online September 11, 2017.

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