Research has shown patients with disabilities can face challenges to receiving the same level of care as those without disabilities. One way that health care organizations and policymakers attempt to address this issue is by providing accessibility equipment.
But new research led by Mayo Clinic finds simply having this equipment, like height-adjustable exam tables, may not be enough to increase quality of care overall or even ensure their use.
“It is often assumed that if we had more disability-friendly equipment and exam rooms, we would ‘fix’ the disparities,” says Megan Morris, Ph.D., who led the research while she was with the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. “But it looks like simply having the tables is not enough to provide equitable care.”
The researchers, who published their findings recently in the Journal of General Internal Medicine, surveyed 399 adults who received care at Mayo Clinic. Half of those surveyed were at a clinic with adjustable exam tables, and half were at one without them. When comparing the two clinics, the researchers didn’t find a difference in the percentage of patients evaluated on an exam table; but they did find age and disability status were determining factors as to whether patients were examined on a table. Patients 65 and older and those with a disability were 20 and 27 percent less likely, respectively, to be examined on a table.
Also across both clinics, patients without disabilities reported positive perceptions of their clinicians’ bedside manner 74 percent of the time, compared with just 59 percent of patients with disabilities. And patients — with and without disabilities — who received an exam on a table were significantly more likely to rate their visit positively.
“This tells us that there is a portion of our patients who are less satisfied with their care, and that further efforts to improve these patients’ care experiences are needed,” says the study’s senior author, Sean Phelan, Ph.D., a researcher in the Mayo Clinic Robert D. and Patria E. Kern Center for the Science of Health Care Delivery.
The researchers say that while having adjustable tables is a necessary step, clinician education and systematic changes to clinical processes or policies may be needed. They say regardless of whether an exam room has an adjustable table, clinicians may not have time to transfer patients to the table, or they may not have the training or resources to do so. Knowing what accommodations a patient needs before the visit also would help clinicians meet those needs, the researchers say.
“Training clinicians on strategies to improve patient-centered, empathetic communication with patients with disabilities may also help,” Dr. Phelan suggests. “This could include reducing the likelihood that conscious or unconscious negative attitudes about certain patient groups affects care.”
The research was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. Dr. Morris is now an assistant professor at the Adult and Child Consortium for Health Outcomes Research and Delivery Science at the University of Colorado Anschutz Medical Campus.