dr. Biljana Simikic
Recently, a team of researchers, including from the University of Massachusetts Medical School at Worcester, published a study which found that the attitude of many physicians towards patients with disabilities is a significant barrier to care. In the focus groups, nearly all participating physicians said they had little or no training on the Americans with Disabilities Act, and several suggested that providing accommodations under the law was cumbersome or overwhelming. Some have even described how they deny care to patients with disabilities or attempt to get them out of their practice.
As a primary care physician who has dedicated his career to helping adults and children with significant health care needs, including disabilities, I was not surprised by these results. These stigmas contribute to health disparities that have long prevented – and may even discourage – people with disabilities from getting the basic care they need to stay healthy and safe. For example, the Centers for Disease Control and Prevention estimates that one in four adults with disabilities between the ages of 45 and 64 have not had a routine check-up in the past year. As part of our efforts to improve health equity, health care organizations must commit to inclusion and competence in the care of people with disabilities.
Disability-inclusive care practice begins with focusing on accessibility to ensure patients receive the services they need. The use of communication aids and interpreters by providers can minimize delays in diagnosis and treatment for people with vision, hearing or speech impairments. For those who physically travel to a clinical practice, having the right equipment for a productive visit – such as wheelchair scales, patient lifts and adjustable diagnostic equipment – can go a long way to increasing comfort, reduce anxiety and build the necessary trust between patient and provider.
Even something as basic as the lack of proper transportation can prevent a patient from scheduling an office visit. Long overlooked in healthcare, it is now essential that healthcare teams connect patients with safe and reliable ways to get to and from their appointments. Providing care in the home, where patients are most comfortable, is another way to improve access. In Worcester, members of the Commonwealth Care Alliance can receive primary care home visits if needed, as well as home visits from care management teams who can provide the tools and resources to live safely and independently at home.
The delivery of inclusive care does not and should not rest on the shoulders of a single physician. Health care organizations should serve their patients with care teams trained in disability-friendly care. These teams should include physicians, nurses, behavioral health clinicians, social workers, care managers, and occupational and physical therapists, all focused on delivering highly integrated care that meets medical, social, and behavioral health needs. of a patient. In addition, providers should collaborate with external agencies such as the Department of Developmental Services, Department of Mental Health, and other community organizations to ensure that patients and their caregivers receive comprehensive support for health and well-being. – be long-term.
Finally, people with physical, intellectual or behavioral health conditions face unique challenges, and many provider practices are not equipped to handle these needs. Providers need to be trained to better understand the values, preferences, and perspectives of these patients who lead prosperous lives and are not defined by their disabilities.
Through my background in internal medicine and pediatrics, I have seen how young adults with disabilities struggle to find adequate adult care when they outgrow their pediatric care. From recruitment and training to employment and retention, inclusiveness and accessibility must be organizational priorities to ensure patients receive the best care possible. At CCA, we have learned that equipping physicians and other healthcare professionals with the tools, resources, incentives, training and support they need can minimize reluctance and improve their satisfaction with practice of medicine.
Building trust with patients is a central tenet of the medical profession. Healthcare providers and organizations can earn these strong relationships by showing patients how inclusive and responsive they are to their needs, marking a much-needed change in attitude once and for all. This, in turn, will dramatically improve healthcare access and outcomes for our patients with disabilities – in central Massachusetts and beyond.
dr. Biljana Simikic is Senior Medical Director of the Commonwealth Care Alliance and CCA Primary Care, which serves people with significant health care needs in Worcester and throughout Massachusetts.
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