Access to Subspecialty Care for Patients With Mobility Impairment A Survey

Background: Adults who use wheelchairs have difficulty accessing physicians and receive less preventive care than their able-bodied counterparts. Objective: To learn about the accessibility of medical and surgical subspecialist practices for patients with mobility impairment. Design: A telephone survey was used to try to make an appointment for a fictional patient who was obese and hemiparetic, used a wheelchair, and could not self-transfer from chair to examination table. Setting: 256 endocrinology, gynecology, orthopedic surgery, rheumatology, urology, ophthalmology, otolaryngology, and psychiatry practices in 4 U.S. cities. Patients: None. Measurements: Accessibility of the practice, reasons for lack of accessibility, and planned method of transfer of the patient to an examination table. Results: Of 256 practices, 56 (22%) reported that they could not accommodate the patient, 9 (4%) reported that the building was inaccessible, 47 (18%) reported inability to transfer a patient from a wheelchair to an examination table, and 22 (9%) reported use of height-adjustable tables or a lift for transfer. Gynecology was the subspecialty with the highest rate of inaccessible practices (44%). Limitation: Small numbers of practices in 8 subspecialties in 4 cities and use of a fictional patient with obesity and hemiparesis limit generalizability. Conclusion: Many subspecialists could not accommodate a patient with mobility impairment because they could not transfer the patient to an examination table. Better awareness among providers about the requirements of the Americans with Disabilities Act and the standards of care for patients in wheelchairs is needed.