Format

Send to

Choose Destination
Disabil Health J. 2019 Nov 26:100872. doi: 10.1016/j.dhjo.2019.100872. [Epub ahead of print]

Routine identification of patients with disabilities in primary care: A mixed-methods study.

Author information

1
The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada; Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada; University of Toronto Practice-Based Research Network (UTOPIAN), 4001 Leslie Street, Room LE-140, Toronto, Ontario, M2K 1E1, Canada. Electronic address: andrew.pinto@utoronto.ca.
2
Undergraduate Medical Education, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada. Electronic address: e.j.shenfeld@gmail.com.
3
ARCH Disability Law Centre, 55 University Avenue - 15th Floor, Toronto, Ontario, M5J 2H7, Canada. Electronic address: lattanr@lao.on.ca.
4
MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. Electronic address: aratangyt@smh.ca.
5
MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. Electronic address: wangri1@smh.ca.
6
Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada; Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. Electronic address: nisenbaumr@smh.ca.
7
Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada; Health Quality Ontario, 130 Bloor Street West - 10th Floor, Toronto, Ontario, M5S 1N5, Canada. Electronic address: tara.kiran@utoronto.ca.

Abstract

BACKGROUND:

People with disabilities experience barriers to receiving healthcare and often have worse health outcomes, but data on disability is rarely routinely collected in a standardized way.

OBJECTIVE:

This study examined how patients responded to being asked about disabilities as part of a routine, self-administered sociodemographic survey.

METHODS:

We conducted a mixed-methods study in a multi-site primary care organization. We compared the characteristics of people who responded to a question about disabilities to those who did not respond using logistic regression. We also compared survey responses to data available in medical charts. In-depth interviews were conducted with a sample of patients following survey completion.

RESULTS:

Over 28 months, 15,221 patients were offered the survey and 14,247 (93.6%) responded to at least one question. Of these, 11,275 (79.1%) patients answered the question about disabilities. Older patients, patients who rented their home, and non-White patients were less likely to respond to the question. When comparing survey responses to data from medical charts we identified discrepancies. Patients interviewed reported they had difficulty judging what constituted a disability. Stigma related to mental illness and substance use led them to avoid disclosing those conditions.

CONCLUSIONS:

Directly asking patients whether they have a disability may be challenging given confusion about what constitutes a disability and stigma associated with certain disabilities. Future research should examine whether asking about barriers faced in accessing health services could adequately identify patients with disabilities and also be used to identify tangible actions an organization could take to lower barriers to care.

KEYWORDS:

Disability evaluation; Disabled persons; Health services for persons with disabilities; Primary health care; Social determinants of health

PMID:
31941610
DOI:
10.1016/j.dhjo.2019.100872

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center