Physician perspectives on care of individuals with severe mobility impairments in primary care in Southwestern Ontario, Canada

Abstract

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.

“The strategies are the same, the problems may be different”: a qualitative study exploring the experiences of healthcare and service providers with medication therapy management for individuals with spinal cord injury/dysfunction

“…This was especially salient given that some family physicians did not feel it was their role to have specialized medication knowledge relating to common SCI/D secondary conditions. Previous research has identified a similar concern among primary care physicians [28,41]. McMillan and colleagues identified that while physicians acknowledge important knowledge gaps and the need for additional general education about providing care for persons with mobility issues, the lack of time and substantial effort required were barriers [41].…”

“…Previous research has identified a similar concern among primary care physicians [28,41]. McMillan and colleagues identified that while physicians acknowledge important knowledge gaps and the need for additional general education about providing care for persons with mobility issues, the lack of time and substantial effort required were barriers [41]. To address some of these barriers, enhancing interprofessional collaborations between pharmacists and physicians may provide more clinical support for complex MTM.…”

Enhancing primary care for persons with spinal cord injury: More than improving physical accessibility

“…Reasons include lack of transportation, wheelchair ramps, inadequate space for mobility aids, and inability to transfer to an examination table. [1][2][3][4][5] Accessibility is a critical step to ensuring persons with SCI can obtain the care they need. Some government legislation such as the Accessibility for Ontarians with Disabilities Act (2005), mandate that all medical practices be fully accessible in the future.…”

“…While this may ensure that medical practices are physically accessible by wheelchair, patients may still find their care compromised by the lack of appropriate medical equipment such as height-adjustable examination tables, transfer mechanisms such as ceiling lifts, and grab bars. 6 In a recent study we conducted, 3 family physicians reported that without appropriate medical equipment they are unable to properly examine patients resulting in a focus on episodic or acute care rather than preventive care. In some reported cases, patients have been sent to the Emergency Department for care solely due to accessibility and equipment issues.…”

“…Other barriers that might be encountered include provider knowledge gaps and attitudinal bias. 3,8,9 Lack of training on the use of specialized equipment, lack of interprofessional expertise in SCI, lack of easily accessible practice tools, limited remuneration within a publically funded health system for provision of care that is time consuming, low motivation to build clinical capacity due to low patient volumes, and perceptions of persons with SCI as challenging patients can all contribute to less than optimal primary care. 3 For most primary care physicians, management of secondary complications can be challenging and the needs of these patients are not limited to issues that can be met solely by physicians.…”