title: Healthcare utilization and associated barriers experienced by wheelchair users: A pilot study.
abstract: BACKGROUND
  More than twenty-five years after passage of the ADA, little remains known about the experiences of wheelchair users when attempting to access health care and how accessibility may influence health care utilization.
  
  
  OBJECTIVE
  To describe health care utilization among wheelchair users and characterize barriers encountered when attempting to obtain access to health care.
  
  
  METHODS
  An internet-based survey of wheelchair users was conducted. Measures included demographics, condition, socioeconomic status, health care utilization and receipt of preventive services within the past year, physical barriers encountered at outpatient facilities, and satisfaction with care.
  
  
  RESULTS
  Four hundred thirty-two wheelchair users responded to the survey. Nearly all respondents (97.2%) had a primary care appointment within the past year and most reported 3-5 visits to both primary and specialty care providers. Most encountered physical barriers when accessing care (73.8% primary, 68.5% specialty). Participants received most preventive interventions at rates similar to national averages with the exception of Pap tests. Most participants remained clothed for their primary care evaluation (76.1%), and were examined seated in their wheelchair (69.7%). More than half of participants (54.1%) felt they received incomplete care, and 57% believed their physician had no more than a moderate understanding of their disability-specific medical concerns.
  
  
  CONCLUSIONS
  Wheelchair users face persistent barriers to care, may receive less than thorough physical evaluations, receive fewer screenings for cervical cancer, and largely believe they receive incomplete care.
authors.affiliation: Department of Internal Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA; Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA. Electronic address: michael.stillman1972@gmail.com.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stillman
authors.affiliation: Department of Bioengineering, University of Louisville School of Engineering, 550 S. Preston Street, Rm. 204 Health Sciences Research Tower, Louisville, KY 40202, USA. Electronic address: g.bertocci@louisville.edu.
authors.forename: Gina
authors.initials: G
authors.lastname: Bertocci
authors.affiliation: Department of Bioengineering, University of Louisville School of Engineering, 550 S. Preston Street, Rm. 204 Health Sciences Research Tower, Louisville, KY 40202, USA. Electronic address: c.smalley@louisville.edu.
authors.forename: Craig
authors.initials: C
authors.lastname: Smalley
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA. Electronic address: swboston@hotmail.com.
authors.forename: Steve
authors.initials: S
authors.lastname: Williams
authors.affiliation: Department of Bioengineering, University of Louisville School of Engineering, 550 S. Preston Street, Rm. 204 Health Sciences Research Tower, Louisville, KY 40202, USA. Electronic address: k.bertocci@louisville.edu.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Frost
mesh_terms: D000328:Adult; D000368:Aged; D001107:Architectural Accessibility; D001290:Attitude; D006233:Persons with Disabilities; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010342:Patient Acceptance of Health Care; D010808:Physical Examination; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011320:Primary Health Care; D012923:Social Class; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014910:Wheelchairs; D055815:Young Adult
keywords: Access to health care; Disability; Health care utilization; Primary care; Specialty care; Wheelchairs