When it comes to getting healthcare, people with disabilities are often treated differently from those without disabilities. Many factors, including the limited time providers can spend with each patient, can contribute to these disparities. There are not much data available about how adults with disabilities feel about their care, and few studies have looked at how providers engage with and treat patients with disabilities.

To gain some insight into these issues, researchers from the University of Pennsylvania and New York University analyzed responses from almost 23,000 participants in the 2017 National Health Interview Survey to see how “culturally competent” — sensitive to their values, beliefs and feelings — their healthcare providers were.

When providers engage directly with the patient, they are less likely to make other small missteps.

People responding to the survey who had disabilities, particularly those with vision, hearing and psychological disabilities, were less likely to say they received care that was understanding and respectful of their needs than those without disabilities, the team found.

These findings set the stage for a conversation about how healthcare providers can do better. “Naming the problem and showing that it exists nationally is the first step towards finding solutions,” Jaya Aysola, corresponding author on the paper, told TheDoctor.

Almost 10,000 people who took the survey had a disability or limitation that affected their participation in any activity. They were more likely than those without disabilities to be older and never or previously married. They were also more likely to be unemployed, have lower incomes and poorer self-reported health.

Perceptions of the cultural competence of their care among people with disabilities were compared to those people without disabilities. Survey responses were also classified according to disability type.

Participants were asked to answer three questions:

  • How often were they treated with respect by their provider?
  • How often did the provider ask for their opinions or beliefs about their care or treatment?
  • How often did the provider give them information about their health and health care that was easy to understand?

They could answer either “Always/most of the time” as a positive response or “Never/some of the time” as a negative response.

Participants with disabilities, especially those with vision, hearing and cognitive disabilities, were less likely to say they received health information that was easy to understand.

Sometimes providers will not talk directly to patients in wheelchairs. They will only address the family members who accompany them to their appointment.

Patients with a hearing disability, for example, may have difficulty understanding a provider who is wearing a mask, because they rely on reading lips. To overcome this issue, their provider may choose to wear a transparent mask. Patients with impaired vision may need medication instructions printed out in a larger font.

People with disabilities, except those with mobility-related disabilities, were also less likely to say their provider treated them with respect. Sometimes providers will not talk directly to patients in wheelchairs. They will only address the family members who accompany them to their appointment, study coauthor Mihir Kakara, an assistant professor of neurology at New York University, told TheDoctor.

Culturally humble care starts with providers acknowledging the patient first, asking them how they would like to be addressed, and using the first-person language, said Aysola, executive director of the Center for Health Equity and Advancement at Penn.

When they engage directly with the patient, healthcare providers are less likely to make other small missteps, such as standing while talking to someone in a chair or bed, instead of sitting down to speak with them at eye level.

“The problem stems from a system that is broken, rather than providers,” said Aysola. Providers want to do the right thing by their patients, but the demands of the health care system often limit providers' ability to accommodate those with disabilities. “We need to reimagine a system where there is sufficient time for providers to engage with patients in a manner that instills trust and fosters a therapeutic relationship.”

The study is published in the Annals of Internal Medicine.