title: Predicting barriers to primary care for patients with disabilities: a mixed methods study of practice administrators.
abstract: BACKGROUND
  People with disabilities continue to be identified as a group who experience disparate health/health care. They are less likely to engage in some health care services. Structural barriers are often identified as one of the reasons for the underutilization of some health care services by people with disabilities. However, to date no study has been conducted to understand why structural barriers persist twenty years after the Americans with Disabilities Act (ADA) became law.
  
  
  OBJECTIVE
  We examined the relationship between primary care practice administrators' knowledge of the ADA and the number of accessibility barriers that patients with mobility disabilities might encounter.
  
  
  METHODS
  Primary care practice administrators who were members of a medical management organization were surveyed between December 20, 2011, and January 17, 2012. A mixed methods research design was employed. Data were analyzed using a Guttman scale, linear and multiple linear regression.
  
  
  RESULTS
  ADA knowledge questions conformed to a valid Guttman scale. There was a significant inverse relationship between practice administrators' knowledge of the ADA and the number of barriers reported in their clinics. Age of the administrators and buildings built before 1993 were also significant predictors of the number of barriers.
  
  
  CONCLUSIONS
  This study helps to identify medical practices that are more likely to have access barriers and have the greatest need for ADA compliance interventions. Results from this study highlight practice administrators' need for specific knowledge of the ADA as it applies to their medical practice. Efforts are needed to improve disability training for health professionals.
authors.affiliation: Department of Environmental and Occupational Health, University of Nevada, Las Vegas, School of Community Health Sciences, Las Vegas, NV 89154-3064, USA. pharrj@unlv.nevada.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pharr
authors.forename: Michelle
authors.initials: M
authors.lastname: Chino
mesh_terms: D000288:Administrative Personnel; D000328:Adult; D000367:Age Factors; D006233:Persons with Disabilities / Q000331:legislation & jurisprudence; D004779:Environment Design; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities / Q000331:legislation & jurisprudence; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000331:legislation & jurisprudence; D011361:Professional Competence; D014481:United States