Office on DisabilityNational Leadership Summit on Eliminating and Ethnic Disparities in Health: Pre-Conference Addressing the Healthcare and Wellness Needs of Women of Color with Disabilities, January 2006Conference Presentation: Optimal Healthcare for Women of Color with Disabilities by Jaye E. Hefner, MDSlide 1 Optimal Healthcare for Women of Color with Disabilities Jaye E. Hefner, MD Slide 2 Healthcare for Women with Physical Disabilities - Recognize the need for healthcare NOT disability care
- Few special primary care needs
- Improve access and eliminate barriers to primary care
- Physical exam issues, transfers, etc
Slide 3 Learning Objectives To describe the barriers and disparities in healthcare that women of color with disabilities face in accessing primary care To identify the availability of healthcare services among women of color with disabilities To discuss interventions for providers to reduce healthcare disparities in their own practice Slide 4 Scope of the Problem - Common: 19.6% of females > age 5 report some type of disability (2000 U.S. Census)
- 30 million women in the US (NIDRR 1999)
- 16 million over the age of 50
- Rates increase with age
- Exact numbers depend on definition
- One minority group anyone can join in a flash
Slide 5 - African Americans have the highest disability rates for those ages 15-54 and for those older than 65.
- Hispanics have the highest rates of disability among 55-64.
Source: (Bradsher, 1996) Slide 6 Routine Screening Persons with major mobility problems: - 70% less likely: asked about contraception (women)
- 40% less likely: Pap smear
- 30% less likely: mammogram
- 20% less likely: asked about smoking history (analyzing smokers only)
Slide 7 The Triple Oppression? Disability, Race and Gender Slide 8 Discrimination on the Basis of Disability - Linked to racial, class and gender dissonance
- Research has indicated that the consequences of disablement are particularly serious for women
Slide 9 Discrimination - Traditionally, women with disabilities are discriminated against on more than one ground: race, gender and disability, and often they have less access to essential services such as health care, education and vocational rehabilitation
Slide 10 Did we really learn everything we needed to know in kindergarten? Slide 11 - Mainstreaming of 5.8 million children with disabilities, notwithstanding, disabilities are still not adequately presented in the two most popular children's magazines: Highlights for Children and Sesame Street Magazine.
- From 1961 to 1990 only sixty-three disability articles were published during a thirty year period of time.
Slide 12 And It Gets Worse? - Only five out of sixty-two disability stories featured an African-American character.
- Asian and Hispanic characters were not represented at all.
Slide 13 - Twenty-five narratives featured a male character.
- Eighteen depicted a female character.
- Nineteen were either mixed, or non-gender specific.
Slide 14 The Triple Oppression? Disability, Race and Gender Slide 15 What is the cultural competence? - Cultural competence is the understanding of those values, beliefs, and needs that are associated with patients' age, gender, racial, ethnic, and/or religious background
- However, the culture of disability has been excluded.
Slide 16 Defining Disability - No single consensus definition
- International Classification of Functioning, Disability and Health:
"disability" = "umbrella term" encompassing medical and social components - Introduces concept of contribution of environment to disability
- Differing conceptions of disability can fundamentally affect patient-clinician communication
Slide 17 Perceptions of Disability 1994-1995 NHIS-D self-respondents "Perceives self as NOT having a disability" - 58 % of blind, very low vision
- 73 % of deaf, very hard of hearing
- 32 % of walker users
- 20 % of manual wheelchair users
- 16 % of power wheelchair users
Slide 18 Perceptions of Disability - Women, racial minorities, and Hispanic respondents are much less likely to say they are disabled than men and white and non-Hispanic respondents
- Low income persons are much more likely to perceive disability than those with high incomes
Source: Iezzoni, 2000 Slide 19 Perceptions of Disability - Complex cultural factors may explain these differences
- If you are disenfranchised because of membership in one minority group, you may be unwilling to identify with yet another group perceived as excluded
- There may be a lack of respect associated with having a disability identity
Slide 20 Why include disability in cultural competency? - It is essential for effective communication and understanding of needs and values
- Recognize there are no hierarchies in culture
- People hold many simultaneous cultural associations, and each have implications for the care process
Slide 21 Slide 22 Access barriers constitute the majority of the limitation to primary healthcare services These include: - Unmet transportation needs
- Lack of provider knowledge regarding disabilities
- Refusal/inability to give medical treatment
- Architectural barriers and negative attitudes of providers
Slide 23 Improve Doctor-Patient Communication Culturally competent communication includes all of the cultures that your patient is a member of (whether or not they self-identify with that culture or not) Slide 24 Disability-Related Screening - Has someone withheld something from you, such as medications or assistance devices?
- Has someone walked out of the room when you needed them, knowing you would be unable to transfer without assistance?
- Has someone prevented you from obtaining a job, finding a house?
Slide 25 What are secondary conditions? Those physical, medical, cognitive, emotional, or psychosocial consequences to which persons with disabilities are more susceptible by virtue of an underlying condition, including adverse outcomes in health, wellness, participation, and quality of life. Slide 26 Examples include: - Depression
- Hypertension
- Chronic pain
- Skin breakdown
- Undetected diseases
- Contractures
- Abuse
- Pulmonary complications
- Unwanted weight gain
- Excessive fatigue
- Social isolation
- Bowel and bladder complications
- Osteoporosis
- Infertility
Slide 27 Welner Exam Table - Lowest level from floor 19 inches
- Hydraulic removable stirrups
Slide 28 Mammography - For those unable to stand
Slide 29 Will I be able to pay my bills? - Schedule appropriately and use Time-Based coding
- Billable time is time spent with the patient and or family for the purposes of determining a diagnosis or an appropriate treatment plan and the counseling is 50% or more of the total patient encounter.
- ALWAYS DOCUMENT TIME SPENT WITH THE PATIENT/FAMILY MEMBERS
Slide 30 Summary There are tremendous unmet needs in clinical care, medical education and training, and clinical research to close the gap and eliminate the health disparities that exist for women, women of color, women with disabilities, women of color with disabilities
|