IntroductionThe major shift from institutional to community-based carehas placed the responsibility of primary health care of individuals withdisability in the hands of General Practitioners (GPs).
People withintellectual disability demand high quality care and attention as theycompletely rely on their physician for coordination. Therefore, establishing ameaningful relationship while filling the care gaps is crucial for patientswith intellectual disability who often experience health care disparities.Advancement in medical science has increased the life expectancy of adults withintellectual disability. However, these individuals face serious age-relatedhealth problems and often access their primary care through the physician ofthe community in which they reside. As a result, in most cases, patients withintellectual disabilities end up with an inexperienced healthcare provider wholacks the skills and experience to fulfil the healthcare needs of theirpatient.
Previous research studies targeting on exploring the satisfactionlevel of these patients suggest that people with intellectual disabilitiesexpress dissatisfaction with aspects of the care they are given and demand amore understanding healthcare provider who understands their needs andproblems. The patient dissatisfaction discourages them from regular primarycare visits while increasing the chance of hospitalization. Literature studiessuggest that care of patients with disabilities is a weak area for many GPtrainees (Wilkinson, Dreyfus,Cerreto, & Bokhour, 2012).
General Practitioners report a lack of priortraining and education regarding the treatment of people with disabilities andas a result they do not feel comfortable while dealing with special population.Furthermore, it also directly affects the availability of General Practitioners(GPs) for intellectually disabled patients. For instance, in a survey conductedby Peter et al. (2009) shows that lack of training and education in the areasof child-onset conditions was directly linked with lower rate of caring fordisabled individuals. A similar lack of training was also highlighted as themajor problem contributing to gaps in communication among physicians andpatients with intellectual disability in Australia. In addition to this,various other studies conducted in Canada and United Kingdom have also reportedthe negative attitudes and imprecise perceptions about patients with disability(Wilkinson et al.
, 2012). Numerous research studieshave focused on implementing education efforts to train physicians so that theycan provide focused care to intellectually disable individuals. However, therequired educational needs and additional training required was unclear.Therefore, this study has aimed to explore the physicians’ outlook andawareness regarding the present state of healthcare provided for patients withdisability. Furthermore, this study has incorporated the direct words of thephysicians to better understand, analyze and develop interventions to modifycurrent practices and policies.
Results of the current study havehighlighted important themes that give an insight into the problems faced bythe physicians when treating PWD. Some of the physicians have widely focused onthe minimum role played by the education curriculum and universities intraining medical students. Physicians believe that the inadequate exposure tocare for PWD in universities results in barriers faced by the physicians intheir practical life. Physicians believe that education play a vital role inmaking things easy and understandable. Training pre-prepares a physician tohandle any type of patient without any communication gap. The idea of modifyingmedical curriculum and incorporating special training regarding the treatmentof PWD has also been presented in previous research studies.
For instance,disability awareness training has been suggested in the remote areas of NewSouth Wales, Australia. It is difficult to attract more experienced staff forworking in remote and rural areas where the nature of work is different andtough compared to the developed cities. Studies have suggested that GeneralPractitioner’s play a crucial role in delivering targeted healthcare services.However, the attitudes of physicians have never changed with the modifyinglegislation and policies. Evidence states that physicians are strict with theirattitudes and beliefs which keeps them from transition. Patients, on the otherhand, believe that the role of a physician goes beyond treatment and caring.
They are responsible for teaching their patients about the clinical problem andact as a gate-keeper to numerous community-based supports and services. GeneralPractitioner’s are accountable for delivering the best assistance and it istheir responsibility to inform clients about the modern technology and newlyintroduced useful services. The permission of a physician is important for thepatients to have access to community-based services and activities. Physicianshave to play a supportive role for PWD while ensuring that human rights are notviolated during the provision of services. However, current literature surveyshows that physicians are not well informed about the problems faced by PWD andthus they are unable to refer clients to the range of benefits and supportsavailable through community-based services (Bond, Kerr, Dunstan, & Thapar, 1997;Lennox, Diggens, & Ugoni, 1997). Medical model playsan essential role in setting the mindset of the General Practitioners (Gething & Fethney, 1997). According to the medical model physicianshave the duty to restore medical health of the patient. However, this model istoo narrow to accommodate the special health needs of PWD.
Medical modeldefines health as the absence of disease. However, the progressive or permanentnature of disability, physicians consider PWD’s as incurable and believe thatthey cannot be perceived as truly healthy. Research studiesexploring the PWD’s suggest that most of the individuals are healthy, but therestrictions placed by the society depict them as handicaps (Aulagnier et al., 2005; Bond et al., 1997;Lennox et al.
, 1997). Further, whenever PWDs consult a physician, they are looking forassistance rather than treatment or a cure. They seek help of the GeneralPractitioner to gain access to the mainstream life of the community. However,the lack of training, experience and education of physician in handling PWDskeep them from supporting their clients positively. Evidence statesthat PWDs struggle for support and assistance all across the world. Conflictsexists among physicians regarding their role, expectations of government and consumers.These conflicts become more serious in rural and remote areas where theopportunities are limited. Communication is one of the most critical barrierfaced by physicians and PWDs.
Communication barriers include lack ofunderstanding and obtaining information from patients. Sometimes the medicalhistories of the patients are unclear which lead to poor comprehension of thecase and affect the quality of care. Apart from communication, the absence ofcompliance with the physician’s management plan also creates difficulties incooperating with the patient and obtaining patient’s loyalty. In addition tothis, barriers such as lack of backup resources, services and difficulties incase management are also reported in literature. Published literature studies have alsodiscussed solutions to barriers which can help improve the treatment andhealthcare quality of PWDs (Aulagnier et al., 2005; Gething , 1997; Wilkinson et al., 2012).
Education and training are the mostfrequently mentioned solution in the past studies. Furthermore, experience andtraining should be delivered to the physicians to help improve thecommunication gaps and case management problems. Another essential solution mentionedby researchers is increasing consultation time and frequency of visits toprovide better assistance to the patients. SummaryPeople withdisability (PWD) face serious problems in accessing healthcare services andbasic living necessities. The health inequity reported for PWDs is widelyassociated with the weak definition of perception of disability. Explaining themeaning of health and disability in the context of PWDs is difficult bymedicine alone.
The attitudes and nature of physicians alleviates healthinequities which raises stigma against PWDs. In most cases, physicians do notconsider PWDs as full human being because their condition is permanent andincurable. However, in order to improve the situation, the Social Model ofDisability (SMD) has been proposed to promote health care equity while changingthe healthcare system (Shakespeare, 2006).
SMD focuses on expanding the healthconstruction while inspecting other elements such as attitudes or accessibilityin the community. It is important to understand the barriers as presented bythe physicians’ daily deal with PWDs. Therefore, the current study focuses onexploring the barriers which affect physician-patient relationship andproposing important interventions that can help improve care for PWD. The fourmain elements or themes which influence the care for PWD identified in thisstudy include training, accessibility, resources, and time remuneration. The results ofstudy show that physicians believe that the teaching methods and curriculumshould be modified with the changing time. Patient-physician interaction shouldbe redefined based on the needs of modern medicine. It is crucial for GeneralPractitioners to have expertise in providing care to different types ofpatients. Multicultural interaction along with modified education curriculum,and training will cover communication gaps between physicians and PWD.
As thetechnology is progressing there is more and more overlap of different culturesand values related to one’s health; global movement has allowed people from allbackgrounds to access medical services across the world. This increase ininteraction with multicultural patients’ needs to become a key focus area ofgrowth and learning for physicians now. The accessibilityto healthcare is a critical barrier identified in this study which creates agap between the actual need of PWDs and what they receive. In various cases,the clinics lack the facilities for providing care to PWDs. Moreover,physicians acknowledge the problems they face while giving treatment orexamining PWDs. In addition to this, it has also been noted that both old andnew clinics do not have advanced technology to support the needs of the peoplewith disabilities.
Furthermore, State policies lack the understanding of PWDneeds which keeps them from improving the condition of the clinics. All thephysicians who were interviewed had varied perspectives regarding accessibilityof healthcare services, however, they believed that improving the condition ofclinics and making them PWD friendly will motivate them to seek medicaltreatment on time. It is a cost-effective intervention which will have apositive impact on healthcare because inaccessible healthcare will result inpoor quality of life, increased readmission and hospitalization rates.
Moreover, it also increases the mortality and morbidity rates making it costlyfor the hospitals to manage. Resources isanother important barrier which has been mentioned by the physicians. They havestated that it takes a lot of time and effort to look for all the optionsavailable. Physicians believe that properly organized resources will help themsave time and focus more on their patients. Some of the important resourcesrequired when treating PWDs include physiotherapist, occupational therapist,and psychiatrist. Treating mental illness cases has been reported to be themost difficult due to the absence of an expert who can deliver CognitiveBehavioral Therapy (CBT) along with other behavioral therapies. Furthermore,specially hiring a psychologist for handling intellectually disabledindividuals is difficult and costly. There is a need to develop a proper protocol which takes some burden offfrom the shoulders of physicians while establishing consistency.
Furthermore,the availability of a written guideline, informational booklets and brochureswill help improve unsystematic healthcare system while eliminating chaos.Previous research studies have shown that incorporating a social worker intothe system divides the responsibility of the physicians while keeping the flowof information intact. This practice has already been implemented in Canadianhealthcare system to improve healthcare quality. Time remunerationis another essential barrier which affect the quality of care delivered to thePWDs. Diagnosing and treating PWDs take more time compared to handling a normalpatient. However, at the same time physician needs to prepare a similar bill inboth cases.
Physicians believe that spending more time with one patient mustinfluence on the bill as they deserve to be paid more in case of PWDs.Furthermore, there exists numerous different barriers in varied cases of PWDsand thus sometimes examination takes double the time of a normal case. Forinstance, a patient suffering from mental illness may not respond well ordemand more attention. Similarly, examining a person in a wheelchair isexhaustive and time taking.
In most cases communication barrier makespatient-physician interaction difficult and challenging. Research studies haveshown that time remuneration is an important factor in PWD cases whichinfluence patient satisfaction and quality of care. Therefore, it is importantto modify the healthcare system in a way that better understands the needs ofPWDs. Billing physicians with different codes will help satisfy the patientsand physicians while enhancing the quality of care.