Use of Accessible Examination Tables in the Primary Care Setting: A Survey of Physical Evaluations and Patient Attitudes
Use of Accessible Examination Tables in the Primary Care Setting: A Survey of Physical Evaluations and Patient Attitudes
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DOI：
10.1007/s11606-017-4155-2
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发表时间：
2017-12-01
影响因子：
5.7
通讯作者：
Phelan, Sean
中科院分区：
文献类型：
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作者：
Morris, Megan A.;Maragh-Bass, Allysha C.;Phelan, Sean
方便使用的诊断设备，包括高度可调的检查台，对于容纳残疾患者是必要的。研究表明，只有少数诊所提供无障碍设备。对于有这种设备的诊所，还没有研究检查这种设备在常规临床护理中的使用情况。在有和没有高度可调检查台的初级保健诊所，我们比较了检查台上身体评估的频率和变化以及患者对高质量护理的看法。2015年对明尼苏达州罗切斯特市两家初级保健诊所的患者进行的调查。一家诊所在每个检查室都有高度可调的检查台；另一家诊所没有。共有399名讲英语的成人初级保健患者(61%参与)。参与者被问及在临床接触期间是否在桌子上进行身体评估。此外，他们完成了患者对护理质量感知调查的两个子量表：对提供者床边方式的感知和对提供者工作的感知。总体而言，在患者在检查台上接受检查的可能性或他们对护理质量的感知方面，不同诊所之间没有差异。在两家诊所中，报告残疾的患者接受桌上检查的可能性降低27%，对提供者的床边态度给予好评的可能性(74%对59%)，对提供者的工作持积极看法的可能性(46%对32%)。无障碍医疗设备的存在与向患者提供的护理无关。虽然这对大多数患者可能没有意义，但对残疾患者来说可能会有问题，因为他们不太可能接受检查。因此，仅有可获得的设备可能不足以减少护理体验中的差距。因此，在努力为残疾患者提供公平护理时，必须考虑提供者和组织层面的因素。
Accessible diagnostic equipment, including height-adjustable examination tables, is necessary to accommodate patients with disabilities. Studies demonstrate that only a minority of clinics provide accessible equipment. For clinics with this equipment, no studies have examined the use of such equipment in routine clinical care.In primary care clinics with and without height-adjustable examination tables, we compared the frequency and variation in physical evaluations on examination tables and patients' perceptions of quality care.Survey administered to patients at two primary care clinics in Rochester, MN, in 2015. One clinic had height-adjustable examination tables in every exam room; the other clinic had none.A total of 399 English-speaking adult primary care patients (61% participation).Participants were asked whether they were physically evaluated on a table during their clinical encounter. In addition, they completed two subscales of the Patient Perception of Quality of Care survey: Perceptions of Provider's Bedside Manner and Perceptions of Provider's Work.Overall, there were no differences between clinics in the likelihood of patients being examined on an exam table or in their perceptions of quality of care. Across both clinics, patients who reported a disability were 27% less likely to be examined on a table, were less likely to rate their provider's bedside manner favorably (74% vs. 59%) and to have positive perceptions of their provider's work (46% vs. 32%) than patients without disabilities.The presence of accessible medical equipment was not associated with care delivered to patients. While this might not be meaningful for most patients, it could be problematic for patients with disabilities, who are less likely to be examined. Therefore, accessible equipment alone may not be sufficient to reduce disparities in the care experience. Provider- and organization-level factors must thus be considered in efforts to provide equitable care to patients with disabilities.