Authors
of an article
published this month in Annals of
Internal Medicine report that many subspecialists are unable to accommodate
patients who use wheelchairs.
Researchers
enrolled 256 subspecialty medical practices in 5 large US cities (Atlanta;
Dallas; Houston; Portland, Oregon; and Boston) in the study. The practices were
assigned to 1 of 2 groups: those where transfer from a wheelchair to an
examination table is required for adequate care (endocrinology, gynecology,
orthopedic surgery, rheumatology, and urology) and those where transfer might
not be necessary (otolaryngology, ophthalmology, and psychiatry).
The
researchers called practices and tried to make an appointment for a fictional
patient who was obese (99 kg) and was partially paralyzed on 1 side of the
body. The patient used a wheelchair and was unable to self-transfer from the
chair to an examination table. The patient could not bring a family member to
assist with transfer.
More
of the practices that would have to transfer the patient to provide adequate care
were accessible than those that might not have to transfer the patient to
provide adequate care (95% vs 74%). In all, 56 practices (22%) could not
accommodate the patient. Nine of these practices said that their buildings were
inaccessible, and 47 said that they could not transfer the patient to an
examination table. The practices gave different reasons for inability to
transfer the patient, including a lack of staff who could perform the transfer
(37 practices), a concern about liability (5 practices), and that the "patient
was too heavy" (5 practices).
Of
the 160 practices in the group that required transfer for adequate care, 22
(9%) reported using special equipment for transfer, such as height-adjustable
examination tables and mechanical lifts. Another 88 (55%) planned to transfer
the patient from the wheelchair to a high table that was not height-adjustable
without using a lift. Gynecology had the highest rate of inaccessible practices
(44%).
The
authors call for improved awareness about the Americans
with Disabilities Act requirements and the standards of care for patients with
mobility impairment.