More than 30 years after passage of the landmark Americans with Disabilities Act (ADA), many doctors still don't know how to provide accessible care, a new study finds.
"Despite the fact people with disabilities comprise 25% of the population, they often confront barriers to basic health care services such as physical examinations, weight measurement and effective communication with their physicians," said lead author Dr. Lisa Iezzoni of the Mongan Institute Health Policy Research Center at Massachusetts General Hospital in Boston.
"To achieve more equitable care and social justice for patients with disability, considerable improvements are needed to educate physicians about making health care delivery systems more accessible and accommodating," she said in a hospital news release.
For the study, the researchers surveyed 714 U.S. physicians in outpatient practices. Thirty-six percent knew little or nothing about their legal requirements for patients with disabilities. More than 70% did not know who determines the reasonable accommodations required to provide equitable care.
"The lack of knowledge about who makes accommodation decisions raises troubling questions about health care quality and equity," Iezzoni said.
The survey found that 21% did not know who is obligated to pay for required accommodations and 68% said they believed they were at risk for ADA lawsuits.
Previous studies have found individuals with mobility problems being examined in wheelchairs instead of being transferred to an examination table, resulting in substandard care and delayed diagnoses, Iezzoni said.
Patients who are deaf or hearing impaired have reported that doctors often ignore their preference for effective communication accommodations, such as an in-person sign language interpreter.
"All patients with disabilities should ask their physician's office staff about accommodating their needs and preferences when they schedule an appointment," Iezzoni said. "Physician practices should retain that information in electronic health records and always ask at the time of scheduling if these needs and preferences have changed."
Passed in 1990, the ADA bars discrimination against people with disability, including in health care. It requires doctors and patients to work together to determine what reasonable accommodations are needed to ensure accessible and equitable care.
Researchers called for more training of physicians about the rights of patients with disabilities and their responsibilities under the ADA. They said that training should start in medical school and be part of a physician's continuing medical education.
"Medical schools are currently training students about combating racism, and there should also be training in combating discrimination against people with disability, also known as �ableism,'" said senior author Eric Campbell, a survey scientist at the University of Colorado, who studies access to care for patients with disabilities.
"Every practicing physician can expect to see increasing numbers of people with disability, and they need to know how to accommodate them," Campbell said in the release.
The findings were published Jan. 4 in Health Affairs.
The U.S. Department of Justice has more about the Americans with Disabilities Act.
SOURCE: Massachusetts General Hospital, news release, Jan. 4, 2022