Access to Primary Health Care for Persons with a Disability

18 March 2022

Research shows that “adults with a disability are four times more likely to report their health to be fair or poor than people with no disabilities”1. These proportions are similar in New Brunswick where results from the 2020 edition of the NBHC's Primary Health Survey indicate that only 12.8% of persons with a disability report their perceived health as very good or excellent, in comparison to 48.6% of citizens without a disability. 

Note: "Citizens with a disability" refers to the percentage of citizens who reported being limited sometimes or often in the kinds or amount of activity they can do at home, work or otherwise because of a physical or mental condition, or a health problem. This includes chronic health conditions, developmental, dexterity, flexibility, hearing, learning, memory, mental health-related, mobility, pain-related, and seeing disabilities. 

Persons with a disability have greater health needs, but these are different for each person, depending on  their condition1. Because of these higher needs, persons with a disability generally need to access health care services more than the general population2. However, despite this greater need, it is known that persons with a disability face more difficulties in getting the health care required.1,2

Persons with a disability in New Brunswick: Who are they?

According to the 2020 edition of the NBHC Primary Health Survey, one of four adults (25.1%) in New Brunswick reported having a disability, with variability across the province (see map below). The top three reported disabilities in New Brunswick are:

  • Chronic health conditions: Health problem or long-term condition that has lasted or is expected to last for six months or more
  • Pain-related disabilities: Having pain that is always present, or periods of pain that reoccur from time to time
  • Mobility disabilities: Difficulty walking on a flat surface for 15 minutes, or walking up or down a flight of stairs, about 12 steps, without resting

 

 

The following table shows which demographic groups are more likely to report a disability:

 

 

Despite having complex health needs themselves, 11.3% of persons with a disability are caregivers (providing long term care for a parent, partner, child, other relative or friend who has a disability, is frail, aged or who has a chronic mental or physical illness) versus only 9.1% of the general population.

Persons with a disability have a high prevalence of chronic health conditions, but they don’t necessarily have the tools to manage them 

At least 5 in 10 persons with a disability reported having three or more chronic health conditions. The top reported chronic health conditions by persons with a disability are:

  • Chronic pain (46.6%)
  • Hypertension (44.4%)
  • Arthritis (41.5%)

Despite this high prevalence: 

  • Only 3 in 10  (29.6%) reported that they are very confident in controlling and managing their health condition
  • Only 4 in 10 (42.1%) strongly agree that they know what their prescribed medications do
  • At least 1 in 10 (15.0%) reported that written information about a condition or prescription is always or usually hard to understand 
Persons with a disability have increased mental health needs

Given the higher level of sickness experienced by persons with a disability, it comes with no surprise that their physical health problems or conditions are the leading cause of stress, reported by 57.4% of them, followed by the health of a family member (48.9%) and their financial situation (40.2%). 

 

 

Exposure to higher levels of stress, and the fact they reported being lonelier, having a lower sense of belonging to their community, and a lower life satisfaction (see table above), makes persons with a disability more vulnerable to greater mental health needs. In fact, only 30% of persons with a disability rate their overall mental or emotional health as excellent or very good, compared to 50% of New Brunswickers overall. Moreover, 25% of them reported a perceived need for addiction and mental health services.

Persons with a disability have complex health needs which lead to a greater use of health care services

Persons with a disability in New Brunswick are more likely to have complex health needs that require more social and health services to meet their needs in a coordinated and effective manner. Failing to meet their needs contributes to more vulnerability and deterioration of conditions, which further increases the demand for services. 

In fact, over a year, significantly more persons with a disability (60.9%) required a visit with a specialist than the general population (40.6%), and 37.9% required a diagnostic test in a non-emergency situation compared to 21.4% of New Brunswickers.

 

 

Persons with a disability experience the same wait time for health care services, despite greater needs

Although persons with a disability are more likely to have a primary care provider (family doctor or nurse practitioner; 93.2%), compared to the general population (89.9%), and also tend to see their family doctors most often when they need care (64.9% compared to 57.0% for New Brunswickers overall), that still leaves 12.5% who most often go to after-hours or walk-in clinics as their regular place of care and 10.6% who most often go to a hospital emergency department.

Relying on those settings as a regular place of care compromises the continuity and integration of care, two of the key pillars of an appropriate and effective primary care sector, especially for citizens with complex needs.

Despite these more complex needs that require timely access, persons with a disability still wait on average the same time as their fellow New Brunswickers to access certain services:

  • Only 51.3% can get an appointment within five days with their family doctor
  • Only 65.8% wait less than four hours at the emergency department
  • Only 38.4% wait less than one month for a first visit with a specialist
  • Only 51.0% are able to obtain a diagnostic test within a month in a non-emergency situation
Persons with a disability face more barriers to access health services, financial reasons in particular

Difficulties in getting the health care needed disproportionately affect persons with a disability, which can result in delays in seeking care and consequently, of treatment1. Below are the top five barriers experienced by persons with a disability in getting the health care needed in New Brunswick. 

General financial barriers are the top reported difficulty faced by persons with a disability in getting the health care they need. This can include skipping a recommended medical test or treatment because of the cost or not filling a prescription or skipping a dose because of the cost, for example. This leads to insufficient treatment and monitoring compliance for their condition, which leads to inferior health outcomes3. This is consistent with the fact that “financial situation” is among the leading reported contributor of stress among persons with a disability. 

 

 

Besides the general barriers to health services, some persons with a disability also experience difficulties directly related to their disability, where 9.0% have trouble getting medical or rehabilitation equipment or supplies and 10.9% have trouble physically accessing a health care setting.  

Around 25.0% of persons with a disability have a perceived mental health need, however 24.4% of those did not see someone in this regard. The top reported reasons for that perceived unmet mental health need are: the wait time for the services was too long, or they could not afford the cost/insurance did not cover enough. 

Concerning home care services, the 2020 edition of the NBHC's Primary Health Survey demonstrates a considerable need for home care services among persons with a disability. In fact, 9.5% of persons with a disability report needing home care services, but not receiving any, compared to only 3.0% of New Brunswickers in general. 

The services provided to persons with a disability don’t meet their needs and they are less satisfied

Meeting the needs of persons with a disability does not only involve removing barriers and providing timely access to services, it also involves making sure the services provided are relevant to their needs and based on established standards.

If we look at the experience of persons with a disability with their family doctor, they seem to be at disadvantage compared to New Brunswickers overall. Only 61.7% reported that their family doctor always gives them enough time to discuss (NB average: 66.9%), and 27.5% reported that their family doctor limits the number of problems that can be discussed in a visit (NB average: 24.2%). Persons with disability are also at lower odds of reporting adequate communication with their family doctors : 70.3% reported that their family doctor always explains things in a way that they can understand (NB average: 75.7%) and 65.2% reported that their family doctor always involves them in decisions about their care (NB average: 71.8%). Coordination of care is instrumental for citizens with complex health needs; however, persons with disabilities are less likely to report  that their family doctor always helps them coordinate the care from other providers (65.6% vs. 68.7% for New Brunswickers in general).

Overall, persons with disability have a  lower favourable rating of the services they received from their family doctor (76.9%) compared to the general population (81.5%).

In brief

One of four adults in New Brunswick has a reported disability. People with a disability are more likely to have complex health needs, which leads to an increase in demand for different types of services. However, in New Brunswick, people with a disability are more likely to face barriers in accessing the health care they need, notably financial barriers. This leads to unmet health needs for this population. When people with a disability access health care services, these are not necessarily adapted to their needs. “New Brunswickers with disabilities need support to reach a level playing field where they can demonstrate their full potential as contributing citizens”.4

A full data table on access to primary health care by persons with a disability can be found here.

 

References
  1. Krahn, G. L., Walker, D. K., & Correa-De-Araujo, R. (2015). Persons With Disabilities as an Unrecognized Health Disparity Population. American Journal of Public Health, 2(105), 198-206.
  2. Sakellariou, D., & and Rotarou, E. S. (2017). Access to healthcare for men and women with disabilities in the UK: secondary analysis of cross-sectional data. BMJ Open, 1-9.
  3. Parikh, P.B., Yang, J., Leigh, S., Dorjee, K., Parikh, R., Sakellarios, N., Meng, H., & Brown, D. L. (2014). The Impact of Financial Barriers on Access to Care, Quality of Care and Vascular Morbidity Among Patients with Diabetes and Coronary Heart Disease. J Gen Internal Med, 29(1), 76-81.
  4. New Brunswick’s Disability Action Plan for Persons with a Disability. (2020, July). Retrieved from DAP-APFEO-2020.pdf (gnb.ca), p.7
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