Structural barriers to primary care and the impact on patients with physical disabilities: A review

Background: Several qualitative research studies have been conducted with people with disabilities to identify the causes of unmet health care needs. Three main categories of barriers emerged through these studies including: structural, financial and personal/cultural barriers. The purpose of this study was to analyze the prevalence of structural barriers that limit access to health care services for people with physical disabilities in the US through a review of published literature. Methods: PubMed, Scopus, and ScienceDirect were used to electronically search for articles published in English between 1995 and 2010. Search terms included: accessib* or access barriers, disability* or people with disabilities, and primary care. Reference lists of included articles were also evaluated. Inclusion criteria included: studies that primarily measured prevalence of structural barriers, conducted in the US, peer-reviewed articles, focusing on adults with physical disabilities, and quantitative in nature. Article abstracts were reviewed per inclusion criteria. Full text reviews of included abstracts were conducted. Results: The initial search yielded 2,470 articles for review. Five articles met the inclusion criteria for which data were extracted. Physician offices were more likely to meet requirements for external accessibility (parking, unobstructed path of travel, door width, ramps) than for internal accessibility (fully accessible restroom, height adjustable exam tables or wheelchair accessible scales). Conclusion: These findings suggest that structural barriers within the physician's office (exam tables, scales, etc.) may contribute to unmet health care needs more than barriers outside of the physician's office (parking, ramps, doors, etc.).