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 Care Report 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 Care Report 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 Care Report 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 Care Report 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. Health Care Providers 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

9. Education for Providers Attitudes 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 Providers Attitudes 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 Providers Attitudes 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 Providers Knowledge Existing curricula –Fulfill broad requirements –Leading edge technology –Undergrad/graduate –Competencies Curricular reform –Competition –Test vs education –Process –Evaluation

13. Education for Providers Knowledge 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 Providers Skills 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.