Despite the high health risks associated with severe mobility impairments, individuals with physical disabilities are less likely to receive the same level of primary care as able-bodied persons. This study explores family physicians' perspectives on primary care for individuals with mobility impairments to identify and better understand the challenges that prevent equitable service delivery to this group of patients. Semi-structured interviews were conducted in the autumn of 2012 with a purposeful sample of 20 family physicians practising in Southwestern Ontario to gather their perspectives of the personal and professional barriers to healthcare delivery for individuals with mobility impairments, including perceptions of challenges, contributing reasons and possible improvements. A thematic analysis was conducted on the transcripts generated from the interviews to identify perceptions of existing barriers and gaps in care, needs and existing opportunities for improving primary care for this patient population. Eight themes emerged from the interviews that contributed to understanding the perceived challenges of providing care to patients with mobility impairments: transportation barriers, knowledge gaps and practice constraints resulting in episodic care rather than preventive care, incongruence between perceived and actual accessibility to care, emergency departments used as centres for primary care, inattention to mobility issues among specialist and community services, lack of easily accessible practice tools, low patient volumes impact decision-making regarding building decreased motivation to expand clinical capacity due to low patient volume, and lastly, remuneration issues. Despite this patient population presenting with high healthcare needs and significant barriers and care gaps in primary care, low prevalence rates negatively impact the acquisition of necessary equipment and knowledge required to optimally care for these patients in typical primary care settings. Novel approaches to address inequitable healthcare practices for this vulnerable group are needed.

Despite having high healthcare needs, individuals with spinal cord injury (SCI) receive suboptimal primary care; they are less likely than able-bodied persons to receive preventive care and more likely to have unmet health care needs. The aim of this mixed quantitative (surveys) and qualitative (interviews) study was to gather primary care health provider and rehabilitation specialists’ perspectives on why these challenges persist despite the increasing body of evidence identifying delivery service gaps. Surveys were completed by 12 family physicians who referred individuals with SCI to an interprofessional primary care mobility clinic. Interviews were completed with eight SCI rehabilitation providers. Questions in both the survey and interviews were asked related to the barriers to the provision of optimal care for SCI, potential solutions, and preferred methods for knowledge dissemination. Skill and attitudinal reasons were offered for the lack of evidence to practice transfer including: the absence of patient self-management, poor access to specialists, lack of education for family practice physicians, fragmentation of community resources and co-ordination upon hospital discharge. Solutions offered included greater patient self-management, better access to specialists, specialized primary care services and provision of SCI guidelines and protocols. Participant explanations and solutions were then analyzed through a social disability lens to see if new understandings could be identified to explain the lack of uptake from research findings to clinical practice for this underserviced vulnerable population.