Access barriers to primary care for people with mobility disabilities: A mixed methods study of health care administrators

Background: Studies have been conducted to assess the barriers that limit access to health care services for people with disabilities. However, no study to date has been conducted to understand why barriers exist. Do practice administrators lack knowledge of the ADA or is cost to achieve compliance the issue? The purpose of this study was to examine why barriers exist that limit access to primary health care services for people with disabilities. Methods: A convergent parallel mixed methods design was employed. Practice administrators were selected for this study because of their oversight of clinical operations. Primary care practices were selected because they are typically the point of entry into the health care system for patients. Sixty-three primary care practice administrators were surveyed from across the US. Guttman scale, linear regression and MLR were utilized for the data analyses. Results: Access barriers were more prevalent within the medical practices than outside the practices. Administrators' knowledge of the ADA conformed to a valid Guttman scale with a hierarchical ranking pattern. Administrators' Guttman score for knowledge of the ADA was a significant predictor of the number of barriers identified in their clinics using both linear regression (p < 0.01) and MLR (p< 0.01). Other significant predictors of number of barriers were building built before 1993 (p < 0.01) and the age of the administrator (p = 0.03). Conclusion: Improving practice administrators' knowledge of the ADA may be a means to reduce the number of barriers people with disabilities experience when accessing care.