1. How a Persons Disability Can Affect Access to Healthcare Deserae Ishoy Sophia Ortiz Steven Bleak Thanh Nguyen Vanessa Villegas Sonu Gurung

2. Barriers and Facilitators to Health Care Access for Individuals with Psychiatric Disabilities.

3. Problem/Hypothesis ◦ Barriers challenge individuals with severe psychiatric disabilities who also have increased medical co – morbidities and premature mortality. Design ◦ Qualitative study designed to test the effects of receiving service from a NP specialized in psychiatric health v.s a general PCP

4. Data Collection Methods ◦ Key informant interviews of staff regarding access to and delivery of health care. Sample ◦ 3 branches of a behavioral health agency (N=10)

5. Limitations/Bias ◦ Key informants did not include patients of the mental health agency. ◦ Small sample size(N=10) among 3 branches of a large mental health organization Reliability/Validity ◦ Data collection 2004-2009. ◦ Participants consented ◦ Interview questions reviewed by IRB ◦ Analyzed using qualitative data software (NVIVO) ◦ Themes identified by 2 researchers (post doctoral and research graduate coordinator)

6. Nursing Implications People with psychiatric disabilities benefit from having a specialized NP. Psychiatric patients need to be treated with a holistic approach.

7. Use of Emergency Departments among Working Age Adults with Disabilities: A Problem of Access and Service Needs

8. Problem/Hypothesis ◦ ED use higher in individuals with disabilities RT complex medical problems, restrictions to primary care, & frequently use ambulatory and hospital services. Design ◦ Quantitative/Multistage probability  5 rounds of interviews over a 2 year period.  Annualized Medical Expenditure Panel Surveys (MEPS) for 3 years to improve their estimate

9. Data Collection Methods ◦ Individuals were place into one of three group based on self-reported disabilities: (1) no limitations, (2) disabilities not affecting ADLs/IADLs, and (3) disabilities affecting ADLs/IADLs. Sample ◦ Working age adults (18-64)  MEPS of “community-dwelling civilians” throughout the U.S. ◦ N=53,586  represented approximately 185 million adults.

10. Limitations/Bias ◦ Patient self-reported regarding affect of disabilities on their ADLs/IADLs. ◦ Direct ED records are more accurate in actual visits then MEPS. Reliability & Validity ◦ MEPS designed and run by the U.S. Department of Health and Human Services. ◦ Stated to be the most complete source of data on the cost and use of health care and health insurance coverage by said department. ◦ Statistical analysis used a bivariate, multivariate and a t-test for significance.

11. Nursing Implications Coordinate care for the patient with disabilities within different resources versus just using the ED.

12. Barriers to Healthcare Access Among Refugees with Disabilities and Chronic Health Conditions Resettled in the Midwest

13. Problem/Hypothesis ◦ Chronic conditions and related disabilities are prevalent among resettled refugees in the US. There’s a need to identify healthcare access barriers affecting disabled and chronically ill refugees. Design ◦ Qualitative Research ◦ Snowball Sampling

14. Data Collection Methods ◦ Conducted interviews with their key informants and coded their responses. ◦ 3 main themes Sample ◦ Men and women (18 years and older) ◦ Members of refugee communities ◦ N=18

15. Limitations/Bias ◦ Snowball sampling is not randomized ◦ Only selected participants who spoke fluent English Reliability & Validity ◦ Peer reviewed ◦ Small sample not randomized ◦ Disability Act of 1990

16. Nursing Implications Educate and train disabled and chronically ill refugees on the health care system and resources available.

17. Implications of Mobility Impairment on the Diagnosis and Treatment of Breast Cancer

18. Problem/Hypothesis ◦ How does immobility affect the diagnosis and treatment of early-stage breast cancer? Design ◦ Qualitative Research ◦ Snowball sampling

19. Data Collection Methods ◦ Qualitative Analysis ◦ Analyses applied the inductive concepts of grounded theory through in-depth reviews of the interview transcripts. ◦ In depth in-person or telephone interviews Sample ◦ 20 English-speaking interviewees <60y.o. with first stage cancer ◦ Identified interviewees by reviewing patient panels of breast cancer oncologists and through informal networks of women with disabilities

20. Limitations/Bias ◦ Excluded women undergoing initial therapy ◦ Only English- speaking ◦ Women age 60 and younger with early-stage breast cancer Reliability & Validity ◦ Journal of Women’s Health Vol. 20 No. 1 2011 ◦ Conducted by Lisa I. Lezzoni, M.D., M.Sc., Elyse R. Park, Ph.D., and Kerry L. Kilbridge, M.D. ◦ Approved from IRB at Beth Israel Deaconess Medical Center and Massachusetts General Hospital in Boston. ◦ Peer Reviewed

21. Nursing Implications Assess mobility needs and arrange availability of appropriate mobility aids

22. References Mesidor, M., Gidugu, V., Rogers, S. E., Kash- MacDonald, M. V., & Boardman, J. B. (2011). A Qualitative Study: Barriers and Facilitators to Health Care Access for Individuals with Psychiatric Disabilities. Psychiatric Rehabilitation Journal, 34(4), 285–294. doi:10.2975/34.4.2011.285.294 Rasch, E., Gulley, S., & Chan, L. (2013). Use of emergency departments among working age adults with disabilities: a problem of access and service needs. Health Services Research, 48(4), 1334-1358. doi:10.1111/1475-6773.12025

23. References Mirza, M., Luna, R., Mathews, B., Hasnain, R., Hebert, E., Niebauer, A., & Mishra, U. (2013). Barriers to Healthcare Access Among Refugees with Disabilities and Chronic Health Conditions Resettled in the US Midwest.Immigrant Minority Health, 16, 733-742. doi:10.1007/s10903-9906-5 Lezzoni, L. I., Park, E. R., & Kilbridge, K. L. (2011). Implications of Mobility Impairment on the Diagnosis and Treatment of Breast Cancer. Journals of Woman's Health, 20(1), 45-51. doi:10.1089/jwh.2009.1831