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The major shift from institutional to community-based care
has placed the responsibility of primary health care of individuals with
disability in the hands of General Practitioners (GPs). People with
intellectual disability demand high quality care and attention as they
completely rely on their physician for coordination. Therefore, establishing a
meaningful relationship while filling the care gaps is crucial for patients
with intellectual disability who often experience health care disparities.

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Advancement in medical science has increased the life expectancy of adults with
intellectual disability. However, these individuals face serious age-related
health problems and often access their primary care through the physician of
the community in which they reside. As a result, in most cases, patients with
intellectual disabilities end up with an inexperienced healthcare provider who
lacks the skills and experience to fulfil the healthcare needs of their
patient. Previous research studies targeting on exploring the satisfaction
level of these patients suggest that people with intellectual disabilities
express dissatisfaction with aspects of the care they are given and demand a
more understanding healthcare provider who understands their needs and
problems. The patient dissatisfaction discourages them from regular primary
care visits while increasing the chance of hospitalization. Literature studies
suggest that care of patients with disabilities is a weak area for many GP
trainees (Wilkinson, Dreyfus,
Cerreto, & Bokhour, 2012). General Practitioners report a lack of prior
training and education regarding the treatment of people with disabilities and
as 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 conducted
by Peter et al. (2009) shows that lack of training and education in the areas
of child-onset conditions was directly linked with lower rate of caring for
disabled individuals. A similar lack of training was also highlighted as the
major problem contributing to gaps in communication among physicians and
patients with intellectual disability in Australia. In addition to this,
various other studies conducted in Canada and United Kingdom have also reported
the negative attitudes and imprecise perceptions about patients with disability
(Wilkinson et al., 2012). Numerous research studies
have focused on implementing education efforts to train physicians so that they
can provide focused care to intellectually disable individuals. However, the
required educational needs and additional training required was unclear.

Therefore, this study has aimed to explore the physicians’ outlook and
awareness regarding the present state of healthcare provided for patients with
disability. Furthermore, this study has incorporated the direct words of the
physicians to better understand, analyze and develop interventions to modify
current practices and policies.

Results of the current study have
highlighted important themes that give an insight into the problems faced by
the physicians when treating PWD. Some of the physicians have widely focused on
the minimum role played by the education curriculum and universities in
training medical students. Physicians believe that the inadequate exposure to
care for PWD in universities results in barriers faced by the physicians in
their practical life. Physicians believe that education play a vital role in
making things easy and understandable. Training pre-prepares a physician to
handle any type of patient without any communication gap. The idea of modifying
medical curriculum and incorporating special training regarding the treatment
of PWD has also been presented in previous research studies. For instance,
disability awareness training has been suggested in the remote areas of New
South Wales, Australia. It is difficult to attract more experienced staff for
working in remote and rural areas where the nature of work is different and
tough compared to the developed cities. Studies have suggested that General
Practitioner’s play a crucial role in delivering targeted healthcare services.

However, the attitudes of physicians have never changed with the modifying
legislation and policies. Evidence states that physicians are strict with their
attitudes and beliefs which keeps them from transition. Patients, on the other
hand, believe that the role of a physician goes beyond treatment and caring.

They are responsible for teaching their patients about the clinical problem and
act as a gate-keeper to numerous community-based supports and services. General
Practitioner’s are accountable for delivering the best assistance and it is
their responsibility to inform clients about the modern technology and newly
introduced useful services. The permission of a physician is important for the
patients to have access to community-based services and activities. Physicians
have to play a supportive role for PWD while ensuring that human rights are not
violated during the provision of services. However, current literature survey
shows that physicians are not well informed about the problems faced by PWD and
thus they are unable to refer clients to the range of benefits and supports
available through community-based services (Bond, Kerr, Dunstan, & Thapar, 1997;
Lennox, Diggens, & Ugoni, 1997).

Medical model plays
an essential role in setting the mindset of the General Practitioners (Gething & Fethney, 1997). According to the medical model physicians
have the duty to restore medical health of the patient. However, this model is
too narrow to accommodate the special health needs of PWD. Medical model
defines health as the absence of disease. However, the progressive or permanent
nature of disability, physicians consider PWD’s as incurable and believe that
they cannot be perceived as truly healthy.

Research studies
exploring the PWD’s suggest that most of the individuals are healthy, but the
restrictions 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 for
assistance rather than treatment or a cure. They seek help of the General
Practitioner to gain access to the mainstream life of the community. However,
the lack of training, experience and education of physician in handling PWDs
keep them from supporting their clients positively.

Evidence states
that PWDs struggle for support and assistance all across the world. Conflicts
exists among physicians regarding their role, expectations of government and consumers.

These conflicts become more serious in rural and remote areas where the
opportunities are limited. Communication is one of the most critical barrier
faced by physicians and PWDs. Communication barriers include lack of
understanding and obtaining information from patients. Sometimes the medical
histories of the patients are unclear which lead to poor comprehension of the
case and affect the quality of care. Apart from communication, the absence of
compliance with the physician’s management plan also creates difficulties in
cooperating with the patient and obtaining patient’s loyalty. In addition to
this, barriers such as lack of backup resources, services and difficulties in
case management are also reported in literature.

    Published literature studies have also
discussed solutions to barriers which can help improve the treatment and
healthcare quality of PWDs (Aulagnier et al., 2005; Gething &
Fethney, 1997; Wilkinson et al., 2012). Education and training are the most
frequently mentioned solution in the past studies. Furthermore, experience and
training should be delivered to the physicians to help improve the
communication gaps and case management problems. Another essential solution mentioned
by researchers is increasing consultation time and frequency of visits to
provide better assistance to the patients. 



People with
disability (PWD) face serious problems in accessing healthcare services and
basic living necessities. The health inequity reported for PWDs is widely
associated with the weak definition of perception of disability. Explaining the
meaning of health and disability in the context of PWDs is difficult by
medicine alone. The attitudes and nature of physicians alleviates health
inequities which raises stigma against PWDs. In most cases, physicians do not
consider PWDs as full human being because their condition is permanent and
incurable. However, in order to improve the situation, the Social Model of
Disability (SMD) has been proposed to promote health care equity while changing
the healthcare system (Shakespeare, 2006). SMD focuses on expanding the health
construction while inspecting other elements such as attitudes or accessibility
in the community. It is important to understand the barriers as presented by
the physicians’ daily deal with PWDs. Therefore, the current study focuses on
exploring the barriers which affect physician-patient relationship and
proposing important interventions that can help improve care for PWD. The four
main elements or themes which influence the care for PWD identified in this
study include training, accessibility, resources, and time remuneration.

The results of
study show that physicians believe that the teaching methods and curriculum
should be modified with the changing time. Patient-physician interaction should
be redefined based on the needs of modern medicine. It is crucial for General
Practitioners to have expertise in providing care to different types of
patients. Multicultural interaction along with modified education curriculum,
and training will cover communication gaps between physicians and PWD. As the
technology is progressing there is more and more overlap of different cultures
and values related to one’s health; global movement has allowed people from all
backgrounds to access medical services across the world. This increase in
interaction with multicultural patients’ needs to become a key focus area of
growth and learning for physicians now.

The accessibility
to healthcare is a critical barrier identified in this study which creates a
gap 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 or
examining PWDs. In addition to this, it has also been noted that both old and
new clinics do not have advanced technology to support the needs of the people
with disabilities. Furthermore, State policies lack the understanding of PWD
needs which keeps them from improving the condition of the clinics. All the
physicians who were interviewed had varied perspectives regarding accessibility
of healthcare services, however, they believed that improving the condition of
clinics and making them PWD friendly will motivate them to seek medical
treatment on time. It is a cost-effective intervention which will have a
positive impact on healthcare because inaccessible healthcare will result in
poor quality of life, increased readmission and hospitalization rates.

Moreover, it also increases the mortality and morbidity rates making it costly
for the hospitals to manage.

Resources is
another important barrier which has been mentioned by the physicians. They have
stated that it takes a lot of time and effort to look for all the options
available. Physicians believe that properly organized resources will help them
save time and focus more on their patients. Some of the important resources
required when treating PWDs include physiotherapist, occupational therapist,
and psychiatrist. Treating mental illness cases has been reported to be the
most difficult due to the absence of an expert who can deliver Cognitive
Behavioral Therapy (CBT) along with other behavioral therapies. Furthermore,
specially hiring a psychologist for handling intellectually disabled
individuals is difficult and costly. 
There is a need to develop a proper protocol which takes some burden off
from the shoulders of physicians while establishing consistency. Furthermore,
the availability of a written guideline, informational booklets and brochures
will help improve unsystematic healthcare system while eliminating chaos.

Previous research studies have shown that incorporating a social worker into
the system divides the responsibility of the physicians while keeping the flow
of information intact. This practice has already been implemented in Canadian
healthcare system to improve healthcare quality.

Time remuneration
is another essential barrier which affect the quality of care delivered to the
PWDs. Diagnosing and treating PWDs take more time compared to handling a normal
patient. However, at the same time physician needs to prepare a similar bill in
both cases. Physicians believe that spending more time with one patient must
influence on the bill as they deserve to be paid more in case of PWDs.

Furthermore, there exists numerous different barriers in varied cases of PWDs
and thus sometimes examination takes double the time of a normal case. For
instance, a patient suffering from mental illness may not respond well or
demand more attention. Similarly, examining a person in a wheelchair is
exhaustive and time taking. In most cases communication barrier makes
patient-physician interaction difficult and challenging. Research studies have
shown that time remuneration is an important factor in PWD cases which
influence patient satisfaction and quality of care. Therefore, it is important
to modify the healthcare system in a way that better understands the needs of
PWDs. Billing physicians with different codes will help satisfy the patients
and physicians while enhancing the quality of care.  






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