Medical Instrumentation

Accessibility and Usability Considerations

Jack M. Winters, Molly Follette Story

• Publisher: CRC Press
• Year: 2006
• eBook ISBN: 9781000654172
• Topic: Médecine
• Subtopic: Biotechnologie en médecine

Two of the most important yet often overlooked aspects of a medical device are its usability and accessibility. This is important not only for health care providers, but also for older patients and users with disabilities or activity limitations. Medical Instrumentation: Accessibility and Usability Considerations focuses on how lack of usabi

Part I

Background: The Problem, Existing Infrastructure, and Possible Solutions

1	The Patient’s Perspective on Access to Medical Equipment June Isaacson Kailes

CONTENTS

1.1 Introduction

1.1.1 Health Care Access

1.2 Who Are People with Disabilities?

1.2.1 Functional Limitations Increase with Age

1.2.2 Taking the Broad View of Disability

1.3 The Health Care Hassle Factor

1.4 Healthcare Barriers for People with Activity Limitations

1.4.1 Health Care Compliance with Americans with Disabilities Act

1.4.2 Attitudinal Barriers

1.5 Medical Equipment Access

1.5.1 Examination Tables

1.5.2 Medical Chairs

1.5.3 Weight Scales

1.5.4 Exercise Equipment

1.5.5 Communication Between Healthcare Provider and Patient

1.6 Summary

Acknowledgment

References

1.1 INTRODUCTION

It takes a village to get me on and off an exam table, which means I don’t go to preventive care appointments [1].

This chapter describes common access barriers to health care for people with disabilities, with specific focus on medical equipment access. It overlays a “human face” on the barriers by providing examples from the reality of individuals who regularly deal with healthcare systems. These experiences often go undocumented and, thus, underreported.

1.1.1 HEALTH CARE ACCESS

The term “access” refers to the ability of individuals or groups to receive needed services from the health care system. This may include availability of a particular service, awareness by individuals that the service exists and how to obtain it, and ability to get the service in a reasonable amount of time. Health care access for people with disabilities and activity limitations includes additional layers of equipment, physical, communication, and program access necessary to benefit from quality health care.

For people with disabilities, equipment access represents one of the fundamental barriers to receiving health care and health-promoting services. Many people have vivid memories of medical procedures and the instructions they received, such as, “Just hop up, look here, read this, listen up, don’t breathe, and stay still!” These directions can be amusing or uncomfortable for many, but they can be difficult to impossible for people with a variety of functional activity limitations.

In addition to barriers resulting from facility design, attitudinal, and competency barriers, many people experience lack of access because of inaccessible diagnostic, therapeutic, procedural, rehabilitation, and exercise equipment, such as examination and treatment tables and chairs, weight scales, x-ray equipment, glucometers, blood pressure cuffs, treadmills, and exercise machines.

1.2 WHO ARE PEOPLE WITH DISABILITIES?

The 2000 U.S. Census found that people with disabilities represented 19.3% of the 257.2 million people aged 5 and older in the civilian noninstitutionalized population, or nearly 1 person in 5 [2]. In addition, the Government Accountability Office has estimated that at least 1.8 million individuals with disabilities are being served in institutional settings, including 1.6 million in nursing facilities [3].

1.2.1 FUNCTIONAL LIMITATIONS INCREASE WITH AGE

The 2000 Census showed that disability rates rise significantly with age. The data showed that 54% of people over the age of 65 reported having a disability compared to 19% of people under the age of 65. The Census Bureau predicts that if current trends continue, Americans 65 years and older will constitute 20% of the total population by the year 2030, compared with about 12% in 1997 [4].

Most people, if they live long enough, will age into disability. As time alters our bodies, activity and functional limitations become natural occurrences. Arthritis, the leading cause of disability among adults, affected 70 million people in 2001, including 60% of people age 65 and older [5]. If current rates of arthritis prevalence remain unchanged, the number of persons over age 65 living with arthritis will double by 2030. Obesity among adult Americans is also increasing [6]. In addition to often being disabling itself, obesity contributes to other potentially debilitating conditions, including diabetes, arthritis, high blood pressure, and asthma [2].

Preparing to accommodate people with disabilities often translates into being better equipped to serve all people. Medical, technology, legal, and social advances keep more people with disabilities, chronic conditions, and activity limitations alive, healthy, productive, and functioning independently in their communities. If the age-specific prevalence of major chronic conditions remains unchanged, the absolute number of people in the U.S. with functional limitations will rise by more than 300% by 2049 [2]. Increasing numbers of people will live with multiple coexisting, chronic, and disabling conditions. This trend will continue to increase the number of people who will benefit from and require equipment access. Given the arriving age wave of the “baby boom” generation, people who live with disabilities today are truly “canaries in the [health care] mine,” who are more sensitive to barriers in the system.

1.2.2 TAKING THE BROAD VIEW OF DISABILITY

Disability is not a condition that affects the “special” or the “unfortunate few.” Disability is just one variation on the diversity of being human, and it is a common and natural occurrence within the human experience. The notion that people either have a disability or do not have a disability perpetuates misperceptions about the nature of disability and activity limitations. Activity limitations exist along continuums of gradation (partial to total) and duration (temporary to permanent) that affect almost everyone at some point in their lives.

In health care, given these continuums of activity limitation, the number of people who benefit from equipment, physical, communication, and program access is a significant percentage of the patient population. Traditional narrow definitions of disability are not appropriate. If the value that everyone should be accommodated and treated in health care is not infused into planning, then not everyone will be served. By adopting a broad disability definition, one that includes the wide spectrum of people with varying abilities and activity limitations, no one gets left behind [2].

For the remainder of this chapter, this broad group of people is referred to as people with activity limitations.

1.3 THE HEALTH CARE HASSLE FACTOR

For many people with disabilities, maneuvering through the complex health care system is a dense minefield full of access, safety, competency, and attitudinal barriers. A common impact of existing medical equipment, physical, communication, and program access barriers is that people with disabilities feel defeated by the experience of a continual “hassle factor.” This experience often culminates in the “four F” experiences — frustration, fatigue, fear, and failure. For some people, the effort of seeking health care is just too exhausting or degrading. This leads to people postponing or avoiding care, which results in lack of care, delayed diagnosis, and worsening conditions that begin a downward spiral of deteriorating health and that eventually requires more extensive and expensive treatments. These barriers diminish opportunities for longer, healthier productive lives for people with disabilities and compromise the quality of those lives.

The following comments illustrate safety issues and the common “four F” experiences [7]:

My primary physician and several specialists I respect all practice at a major university medical center fairly close to my home. Recently, though, when I requested a gynecology referral there, I was told that I would not be seen unless I could bring my own assistants to help me get on the examining table. This is a huge world-renowned hospital. This is the era of ADA. Still I am treated as though I don’t belong with the other women who seek services in OB/GYN unless I can make my disability issues go away. This news makes me weary. I know it means once again that I can’t simply pursue what I need as an ordinary citizen. I can’t be just a woman who needs a pelvic exam; I must be a trailblazer. I must make the many bits of legal information and persuasive arguments it will take to get me into that clinic.

— Female power wheelchair user with post-polio [8]

I have avoided [gynecology] exams. I’m a 31-year-old woman, and I have not had a pelvic exam — ever — because of all the different complications and fears, for multiple reasons. … Here I am, a woman who’s a researcher in sociology and health, and I’m a real health advocate for others and myself — and this is my secret shame.

— Female power wheelchair user with muscular dystrophy [9]

Shortly after my spinal cord injury, while in a rehab program, I was being transferred to a hospital bed from my wheelchair by an LVN [licensed vocational nurse]. During the transfer, she slipped and I fell, hitting my head on a metal rail of the bed, rebreaking my neck!*

1.4 HEALTHCARE BARRIERS FOR PEOPLE WITH ACTIVITY LIMITATIONS

People with disabilities as a group have a higher need for short- and long-term health services than people without disabilities. In 1989, individuals with no activity limitations reported having approximately four contacts with physicians per year; individuals who had some activity limitation reported twice this amount; individuals unable to perform major life activities (i.e., bathing, dressing, getting around, toileting, eating, walking, climbing stairs) reported five times as many; and for people needing help with instrumental activities of daily living (shopping, transportation, money management, etc), the number was seven times as high [10].

People with disabilities are more likely to have early deaths, chronic conditions, and preventable secondary conditions and to make more emergency room visits, at the same time as they have less health insurance coverage and less overall use of the health care system (as indicated by numbers of pap tests, mammography and oral health exams). One indicator of the health disparities experienced by people with disabilities is that the rate of diabetes among people with disabilities is 300% higher than the general population [11].

Secondary and multiple disabling conditions often cause individuals with disabilities to delay routine care and to seek medical attention only for more serious problems. In addition, lack of access to health care may cause individuals to withdraw and isolate themselves from society and loved ones [12].

There are huge gaps between adequate, equitable, safe, disability-literate, and competent care and the reality of the current health care experience for people with activity limitations. They deal with many more health care barriers than people without activity limitations. Inadequate attention to ensuring Americans with Disabilities ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of Contributors
• Preface
• Acknowledgments
• PART I Background: The Problem, Existing Infrastructure, and Possible Solutions
• PART II Tools for Usability and Accessibility Analysis
• PART III Considerations in Design Guideline Development
• PART IV Considerations in Emerging Trends and Technologies
• PART V Outputs of the Workshop: Key Knowledge Gaps, Barriers, Recommendations
• Glossary of Terms
• Index