The CMS Office of Minority Health Issue Briefs offer insight and examination into a variety of health and health disparity topics. The briefs are a concise summary of a particular issue and examine policies that impact the quality of and access to health care for minority and disadvantaged populations. Issue Briefs evaluate CMS programs, including Medicare and Medicaid, to include recommendations and suggestions relating to the issue at hand.
Adults with disabilities are almost twice as likely as other adults to report unmet health care needs due to problems with the accessibility of a doctor’s office or clinic.9 Structural, financial, and cultural barriers persist for people with disabilities when trying to access care.10 Many individuals with mobility disabilities face difficulties locating or otherwise traveling a burdensome distance to physically accessible services.11 Providing equal access to health care for people with physical disabilities involves many factors including, but not limited to:
Facility access. This includes accessible routes from parking or bus stops into the building, accessible parking, accessible entry doors with the required clearance width, clear floor space, and maneuvering clearance, accessible restrooms, and accessible signage for people who are blind or have low vision.12
Health care services access. This includes accessible scales and exam tables to facilitate a medical exam, accessible treatment and diagnostic equipment (including infusion chairs, mammography machines, and radiology equipment), appropriate resources for individuals with visual and auditory disabilities, and staff trained to assess patient needs and safely help patients move in between and transfer on and off medical equipment.
Protect Our Care – Illinois is a statewide coalition of health care advocates, providers, consumers, and workers, joining together to prevent the repeal of the Affordable Care Act (ACA), prevent disastrous changes to Medicaid, and protect and expand access to quality affordable health care. We know the crusade to undermine the ACA is not over whether there is a repeal vote this week, next week, or next year, so Protect Our Care – Illinois invites you to join Illinoisans across the state to defend access to quality affordable health care for all.
Sunscreen use is on the rise, but so are cases of skin cancer. That’s because a poor-quality sunscreen might keep you from getting a sunburn, but it won’t shield skin from UVA rays that cause melanoma. Recently, scientists with the Environmental Working Group tested almost 1,500 sunscreens, moisturizers, and lip balms that advertise sun protection. They found that 73 percent of those products don’t provide the protection consumers think they’re getting. David Andrews, a senior scientist at the Environmental Working Group, joins Ira to discuss.
During her first year at Washington University School of Medicine in St. Louis, Hilary Gallin studied racial and gender disparities in health care. She learned about various physicians’ approaches to community and global medicine. During overviews of medical specialties — from pediatrics to gerontology — Gallin learned about age-specific patient care.However, she felt one important element was missing in her medical education.
“I kept thinking about people with chronic disabilities, whether physical or cognitive,” said Gallin, who will earn her medical degree in May. “And I kept asking myself if I, as a physician, would have the knowledge and skills to best treat a patient with disabilities.”
Her answer was no.
“I also asked myself if, as a physician, I would have access to specialized exam equipment and other resources,” Gallin said.
She didn’t know the answer to that question. The topic wasn’t formally included in medical school training.
Feeling she’d be unprepared as a physician, Gallin decided to create a multiyear curriculum for the School of Medicine that focused on treating patients with disabilities. According to research published in 2016 in the journal Academic Medicine, most medical schools do not offer formal training in caring for people with disabilities; rather, disability often is viewed as an obstacle to overcome, and health-care providers sometimes discount disability’s social, emotional and cultural contexts.
However, physicians nationwide, including at Washington University, say medical schools have started recognizing the need for training students to effectively and compassionately treat patients with disabilities. Some medical schools have implemented various degrees of disability education or have begun the process of considering or developing a disability curriculum.
Gallin witnessed firsthand the struggles facing people with disabilities. The 29-year-old grew up with a friend who navigated life in a wheelchair due to cerebral palsy, an incurable disorder caused by abnormal brain development, often before birth, that impairs motor function. Also, while a young girl, Gallin spent a lot of time in hospitals in her native New York while shadowing her mother, a pediatric ophthalmologist.
“These experiences inspired me to learn more about what I can do, what we can do, to help people with disabilities,” said Gallin, who also is earning a master of business administration this May from Harvard University and formerly worked as an investment banker at Goldman, Sachs & Co. on Wall Street. She believes business skills will make her a better doctor by guiding her through all aspects of the changing health-care system.
“I want to approach medicine from different angles instead of limiting myself to the clinical and research perspective,” said Gallin, whose undergraduate degree in biomedical engineering from Yale University provides an even deeper understanding of the industry as a whole. “A lot of major policy affecting health care is made without a physician in the room.”
Developing a disability curriculum
Academics aside, Gallin values considering patients’ personal backgrounds in evaluation and treatment. For instance, she imagined herself giving a medical exam to her friend with cerebral palsy. She wondered: “How would I weigh her? Would I need a special exam table? What’s it like to go to the doctor when you have a disability?”
So she asked her friend and other people with disabilities. Their insights reflected national findings that people with disabilities often feel that their overall abilities, self-knowledge about their conditions and quality of life are underestimated by health-care providers. Many felt embarrassed to discuss disability-related health concerns such as treating pressure sores or practicing safe sex.
“Physicians may assume the person is not sexually active, and that may not be the case,” said Gallin, who was elected by classmates and faculty to the Gold Humanism Honor Society, which honors those who exhibit compassion in medicine.
“Another example occurred when I was working on cervical cancer screenings, or pap smears, with the National Health Service in the United Kingdom,” Gallin said. “One primary-care physician cited that people with disabilities have lower screening rates, and he admitted that he didn’t feel competent in screening some patients due to lack of training. Physician lack of knowledge increases the risk for negative health outcomes.”
Indeed. “In the medical literature, physician education is cited as a source of health discrepancies in patients with disabilities,” Gallin said. “Formal training in medical school would help to remedy disability as a health disparity.”
A few weeks after Gallin started medical school, she sought guidance on developing a disability curriculum from one of her mentors, Alan I. Glass, MD, assistant vice chancellor for students and director of the Habif Health & Wellness Center, which offers student health services at Washington University.
“Because of her focus, passion and persistence, the project evolved into a mission within the medical school to better care for this large and important population,” Glass said. “Hilary’s work has become an important part of the diversity curriculum for medical students. It serves as a model for other schools.”
For the White House, too. In 2014 and 2015, Gallin presented her curriculum to the director of the National Council on Disability, the agency responsible for devising national policy for people with disabilities.
“In developing the curriculum, I reached out to leaders to learn what they thought was needed in physician education,” Gallin said. “It was around the 25th anniversary of the Americans with Disabilities Act, and the White House director was curious to learn about what medical schools were doing to improve the care of people with disabilities.”
Washington University’s curriculum continues to evolve and improve, Gallin said.
“What is unique about the School of Medicine’s curriculum is that it builds on itself over time,” she said. “Students at other medical schools may receive informal training during their third year or attend isolated curriculum events over the year.
“But with our curriculum, students begin during the first year and continue throughout their studies,” she said. “They must demonstrate mastery of material through exams or standardized patient encounters, which is when an actor plays the role of patient and the student is scored based on performance.”
Gallin said she will continue to advocate for patients with disabilities — as well as all patients — when she begins her post-graduation residency in anesthesiology at the Harvard-affiliated Massachusetts General Hospital.
“One of a physician’s greatest assets is curiosity,” Gallin said. “With each person I treat, I will ask myself, ‘What are the preconceived assumptions that could hinder patient care?’”
Female sterilization accounts for 50% of all contraceptive use in the U.S. The extent to which U.S. women with physical and/or sensory disabilities have undergone female sterilization is unknown.
Our primary objective was to determine the prevalence of sterilization for women with physical/sensory disabilities, and compare this to the prevalence for women without disabilities. We also compared use of long-acting reversible contraceptive (LARC) methods between women with and without disabilities.
We conducted a secondary analysis of data from the National Survey of Family Growth 2011–2013, a population-based survey of U.S. women aged 15–44. Bivariate comparisons between women with and without disabilities by female sterilization and LARC use were conducted using chi-square tests. Using logistic regression, we estimated the odds of female sterilization based upon disability status.
Women with physical/sensory disabilities accounted for 9.3% of the total sample (N = 4966). Among women with disabilities only, 28.2% had undergone female sterilization, representing 1.2 million women nationally. LARC use was lower among women with disabilities than those without disabilities (5.4%, 9.3%, respectively, p < 0.01). After adjusting for age, race/ethnicity, education, insurance, marital status, parity, and self-reported health, women with disabilities had higher odds of sterilization (OR 1.36, 95% CI 1.03, 1.79).
The odds of female sterilization is higher among women with physical/sensory disabilities than those without disabilities. Future research is necessary to understand factors contributing to this finding, including possible underutilization of LARC methods.
Research into how people with intellectual disabilities (ID) pursue intimate relationships in care settings presents some contradictory findings; despite increasingly liberal staff views, service users experience significant restrictions. This study attempts to explore this gap within a secure hospital, examining service user’s representations of staff discourses about sexuality and intimate relationships.
Semi-structured interviews with eight service users with intellectual disability were analysed using critical discourse analysis.
Analysis enabled construction of 11 themes falling into three categories. Dominant discourses appeared to maintain the integrity of the institution, enable staff to occupy a position of power and demonstrate service users’ responses to perceived control.
Discourses around sex appear to serve the interests of staff and the hospital, while being restrictive and often incomprehensible to service users. Implications for service development, and future research directions, are considered in the context of “Transforming Care.”
Source: The Week (Excerpted from an article that originally appeared in The Washington Post)
Mary Jordan and Kevin Sullivan
Two hours before sunrise, Dee Matello joined the line outside the Wicomico Civic Center in Salisbury, Maryland, where hundreds of people in hoodies, heavy coats, and wool blankets braced against the wind.
Inside, reclining dental chairs were arrayed in rows across the arena’s vast floor. Days later, the venue would host Disney on Ice. On this Friday morning, dentists arriving from five states were getting ready to fix the teeth of the first 1,000 people in line.
Matello was No. 503. The small-business owner, who supports President Donald Trump, had a cracked molar, no dental insurance, and a nagging soreness that had forced her to chew on the right side of her mouth for years.
Although her toothache wasn’t why she voted for Trump, it was a constant reminder of one reason she did: the feeling that she had been abandoned, left struggling to meet basic needs in a country full of fantastically rich people.
According to Harvard University’s Center on the Developing Child, “The science of child development now helps us to see healthy development as a causal chain— policies and programs across the public and private sectors affect the capacities of caregivers and communities to strengthen three foundations of healthy development: stable, responsive relationships; safe, supportive environments; and appropriate nutrition.” These foundations impact physiological mechanisms that have lifelong impacts on cognitive development, physical growth, and behavioral outcomes.3
It is with this spirit in mind that we will explore opportunities for learning from and leveraging policy development and implementation to continue to create a base of knowledge that can help practitioners from across sectors build bridges to support better health and educational opportunities for vulnerable children and their families. The following policy overview, developed in partnership with the National Farm to School Network and the BUILD Initiative, is intended both to share a broad spectrum of existing information about various experiences in building farm to ECE-supportive policies and begin to point out how forging greater connections between current policies and the work of farm to ECE can benefit early childcare centers, children, and families.
The Good Food, Great Kids* case studies are part of a series developed by pfc Social Impact Advisors for public use and dissemination via the book Good, Evil, Wicked: The Art, Science, and Business of Giving (Stanford University Press 2017), among other publicly accessible media. Information presented was gathered through desk research and 53 interviews with practitioners, policy and issue-area experts, funders, and other local and national stakeholders in the farm to early childcare and education and farm to school sectors. *This report borrows the phrase good food from the W.K. Kellogg Foundation, which defines good food as food that is “healthy, sustainable, fair, and affordable.”
In this study, we investigated intellectual disability support professionals’ knowledge and expectations towards effects of psychotropic drug use on behaviour and drug use in their clients, because shortcomings may lead to misinterpretations of behavioural symptoms and inappropriate drug use.
Two self-designed questionnaires were used to measure the knowledge and expectations of 194 support professionals in 14 residential facilities regarding psychotropic drug use and effects of antipsychotics on behavioural, cognitive and mental functioning of people with intellectual disability. The psychometric properties of both questionnaires were adequate.
A majority of the professionals had unrealistic expectations regarding the positive effects of antipsychotics on cognitive and behavioural functioning, and 94% scored below the cut-off scores regarding knowledge; 60% indicated they needed education and training.
To achieve sufficient collaboration of intellectual disability support professionals in reducing inappropriate psychotropic drug use of clients, vocational educational training is needed.