Identifying Barriers to Primary Care Access for Adults with Disability in the US between 1999 and 2007- A systematic Literature Review

Barriers to accessing health care are cited as contributors to observed health outcome disparities between people with disabilities and the general population. However, research that identifies barriers to health care access for individuals with disabilities has not been systematically reviewed and summarized previously. The purpose of this study was to identify the barriers and facilitators to primary care access for adults with disabilities in the US. An electronic literature search was conducted in MEDLINE, PsycINFO, and CINAHL for articles published in the English language between 1999 and 2007. Reference lists of included articles (branching) and Table of Contents of key journals were also examined. 4478 potential articles were screened for inclusion at the abstract level and 289 at the full paper level. 34 studies met inclusion criteria and their data were extracted. Of them, about 50% were cross-sectional quantitative studies, about 40% were qualitative and 10% mixed method studies. The majority of quantitative studies had more than 1000 participants, and the qualitative studies had fewer than 50 participants. About 70% of studies targeted both genders. The Andersen Behavioral Model was used as a conceptual framework for summarizing findings. Most frequently cited barriers included the individual's knowledge, clinician's knowledge and attitudes toward patients, lack of accommodation within facilities, lack of care coordination, inadequate time during an appointment, and health care insurance. Few facilitators were identified. The implications of these findings will be discussed.