Amanda Reichard

Health disparities among adults with physical disabilities or cognitive limitations compared to individuals with no disabilities in the United States

BACKGROUND National survey data indicate the number of individuals reporting a disability is rising. Those with disabilities experience a large number of barriers to health promotion and disease prevention programming. However, only a limited number of studies have used nationally representative data to examine the health status of individuals with disabilities in comparison to those without disabilities. OBJECTIVE/HYPOTHESIS We used the Medical Expenditures Panel Survey (MEPS) to examine whether disability is associated with higher prevalence rates for common chronic diseases, lower use of preventive care and higher health care expenditures. Our research hypothesis was that nationally, adults with either physical disability or cognitive limitations experience significant health disparities in comparison to those with no disability. METHODS We conducted a retrospective analysis comparing the health of adults (18 and over) with physical disabilities or cognitive limitations to individuals with no disability using data from the 2006 full year consolidated data file from the Medical Expenditures Panel Survey (MEPS). We used chi-squared tests, t-tests, and logistic regression to evaluate the association. RESULTS Individuals with physical disabilities or cognitive limitations had significantly higher prevalence rates for 7 chronic diseases than persons with no disabilities. The disability groups were also significantly less likely than the no disability group to receive 3 types of preventive care. CONCLUSIONS These data suggest that adults with disabilities and chronic conditions receive significantly fewer preventive services and have poorer health status than individuals without disabilities who have the same health conditions. This indicates a need for public health interventions that address the unique characteristics of adults with disabilities, many of whom are at risk for high cost, debilitating conditions that may not have as severe an effect on other population segments.

Diabetes among Adults with Cognitive Limitations Compared to Individuals with No Cognitive Disabilities.

Using a retrospective analysis of data from the 2006 Medical Expenditures Panel Survey (MEPS), we assessed the health status of working-age adults with cognitive limitations in comparison to adults with no disability (unweighted N  =  27,116; weighted N  =  240,343,457). Adults with cognitive limitations had a significantly higher prevalence of diabetes than did adults with no disability (19.4% vs. 3.8%, respectively) and a significantly higher prevalence of six other major chronic conditions. In addition, individuals with cognitive limitations and diabetes were significantly more likely to have multiple (four or more) chronic illnesses. The health disparities we found in this study demonstrate the need to improve disease prevention and education efforts for individuals with cognitive limitations and their health care providers.

Perspectives of Dentists, Families, and Case Managers on Dental Care for Individuals with Developmental Disabilities in Kansas.

The status of dental care for individuals with developmental disabilities in Kansas was examined. Dentists, family members, and case managers reported general, but partial, satisfaction with the availability, accessibility, appropriateness, and affordability of such care. Reasons for the results and recommendations for further improvement are discussed.

Quality of diabetes care for adults with developmental disabilities

BACKGROUND Given that individuals with developmental disabilities have a history of difficulty accessing appropriate health care, possess numerous risk factors for diabetes, and frequently have unique needs within the health care setting, it is important to conduct surveillance research to determine the quality of their diabetes care. OBJECTIVE/HYPOTHESIS We assessed the quality of diabetes care for adults with developmental disabilities enrolled in Kansas Medicaid. Developmental disability was defined in accordance with Kansas Medicaid program eligibility and included individuals with intellectual disability, cerebral palsy, autism, and/or seizure disorder. METHODS We identified a retrospective cohort of persons with developmental disabilities who were also diabetic and continuously enrolled in Kansas Medicaid. We tracked their quality of care measures (Hb(A1c)/glucose testing, cholesterol testing, eye examinations, microalbuminaria screening, and primary care visits) across the subsequent 12 months. Quality care measures were evaluated in relation to basic demographic variables and comorbid hypertension using unconditional logistic regression. RESULTS Among 5,960 adults with developmental disability, 666 had diabetes (11.2%). Annual testing rates were Hb(A1c)/glucose testing, 51.7%; cholesterol, 44.3%; eye examinations, 29.3%; and microalbuminaria, 18.5%. Nearly all (93.5%) had contact with a primary care provider during the period. Comorbid hypertension was associated with higher rates of Hb(A1c), cholesterol testing, and primary care visits. Dual eligibility was associated with lower Hb(A1c)/glucose testing and cholesterol testing rates but comparable rates for other measures. Caucasians were more likely to have had an eye examination but less likely to have had their microalbumin checked. CONCLUSIONS Adults with developmental disabilities and diabetes who were enrolled in the Kansas Medicaid Program were screened at lower frequency than published national figures for key quality indicators of diabetes care. These results call for action to find approaches to improve their quality of care. Further work is needed to understand the barriers to appropriate care and incentives that will remedy these gaps. In addition, research is needed to determine the accuracy of diabetes identification, treatment, and monitoring of adults with developmental disabilities.

Access to Health Care for Individuals With Developmental Disabilities From Minority Backgrounds

In this project we examined access to health care by individuals with developmental disabilities in Kansas from low-income populations and from minority backgrounds. Four criteria for determining access were employed: availability, accessibility, affordability, and appropriateness of care. Factors that pose barriers and that facilitate access are described and recommendations are set out, with particular reference to the 2002 Report of the Surgeon General of the United States, related to health status of people with mental retardation.

Perspectives of Physicians, Families, and Case Managers Concerning Access to Health Care by Individuals with Developmental Disabilities.

This study of the status of medical care for Kansans with developmental disabilities consists of reports from physicians, service providers, and family members. Overall, these three groups indicated satisfaction with medical care across the four criteria of availability, accessibility, appropriateness, and affordability. The bases for these results are outlined, and suggestions for improving satisfaction with health care are presented.

Disability, health, and multiple chronic conditions among people eligible for both Medicare and Medicaid, 2005-2010.

Introduction People who are eligible for both Medicare and Medicaid (dual eligibles) and who have disabilities and multiple chronic conditions (MCC) present challenges for treatment, preventive services, and cost-effective access to care within the US health system. We sought to better understand dual eligibles and their association with MCC, accounting for sociodemographic factors inclusive of functional disability category. Methods Medical Expenditure Panel Survey (MEPS) data for 2005 through 2010 were stratified by ages 18 to 64 and 65 or older to account for unique subsets of dual eligibles. Prevalence of MCC was calculated for those with physical disabilities, physical plus cognitive disabilities, and all others, accounting for sociodemographic and health-related factors. Adjusted odds for having MCC were calculated by using logistic regression. Results Of dual eligibles aged 18 to 64, 53% had MCC compared with 73.5% of those aged 65 or older. Sixty-five percent of all dual eligibles had 2 or more chronic conditions, and among dual eligibles aged 65 or older with physical disabilities and cognitive limitations, 35% had 4 or more, with hypertension and arthritis the most common conditions. Dual eligibles aged 18 to 64 who had a usual source of medical care had a 127% increased likelihood of having MCC compared with those who did not have a usual source of care. Conclusion Attention to disability can be a component to helping further understand the relationship between health and chronic conditions for dual eligible populations and other segments of our society with complex health and medical needs.

Using population-based data to examine preventive services by disability type among dually eligible (Medicare/Medicaid) adults

BACKGROUND Individuals dually eligible for Medicaid and Medicare constitute a small percentage of these programs populations but account for a disproportionately large percent of their total costs. While much work has examined high expenditures, little is known about their health and details of their health care utilization. OBJECTIVE/HYPOTHESIS Utilize an important public health surveillance tool to better understand preventive service use among the dual eligible population. METHODS This study involved descriptive and regression analyses of dual eligibles in the Medical Expenditure Panel Survey data from pooled alternate years 2000-2008. We classified the sample into 4 mutually exclusive groups: cognitive limitations, physical disabilities, double diagnosis (cognitive limitations and physical disability), or neither cognitive limitations nor physical disability. RESULTS For most groups, age was significantly associated with preventive services, though direction varies. Older age was linked to greater receipt of flu shots while younger age was associated with greater receipt of Pap tests, mammograms and dental services. Black women in all groups (except cognitive limitations) had an increased likelihood of receiving a Pap test and a mammogram. CONCLUSIONS A subset of dual eligibles drives the majority of expenditures. People with physical disabilities, regardless of whether they also have a cognitive limitation, are among the highest costing and sickest of our non-institutionalized dual eligible population. Efforts to understand and address the challenges faced by women with physical disabilities in accessing Pap tests or mammograms may be helpful in improving the overall health status for this disability group, but also for all dual eligibles.

A comparison of two weight management programs for adults with mobility impairments

BACKGROUND Individuals with physical disabilities experience disparities in obesity; yet few interventions have incorporated accommodations necessary for weight loss in this population. OBJECTIVE/HYPOTHESIS This project compared the effectiveness of two weight loss interventions among individuals with physical disabilities. METHODS Adults with physical disabilities who were overweight or obese were randomized across two diet approaches: a modified version of the MyPlate diet (usual care (UC)) and a modified Stoplight Diet (SLDm) supplemented with portion-controlled meals. Project staff met monthly with each participant to measure weight, 24-recalls of diet intake, self-tracking of foods and beverages, and physical activity during the preceding month. RESULTS Of 126 enrollees, 70% completed the initial 6-month diet phase and 60% of these completed a 6-month follow-up phase. Participants in the SLDm group reduced weight and BMI during the 6 month intervention, and maintained or lost more weight during the 6 month maintenance period. Alternately, the UC diet resulted in a reduction in weight and BMI only at 6 months. BMI from baseline was significantly more improved for SLDm than UC and, among those who lost weight, the SLDm group lost more weight at 6 and 12 months. CONCLUSIONS These results demonstrate that interventions with proper design and accommodations can overcome the barriers to weight loss unique to individuals with mobility impairments with low income. Additionally, the results suggest that using portion control may be more effective than teaching portion sizes.

Students Supported by Medical Technology: Making the Transition From School to Adult Life

Transition planning for young adults with disabilities has been identified as a critical element if students are to successfully move from the safety-net of high school into adult life. Focusing on transition has become a priority for two disciplines: education and medicine. Yet, despite the importance these two fields have placed on it, few studies have addressed the transition planning issues specifically related to students with disabilities supported by medical technology. This research employed longitudinal interview techniques to gather information regarding the transition experiences of family members and students supported by medical technology. Three major themes emerged: (a) future expectations of students and parents; (b) implementation of transition planning; and (c) participation and involvement in transition planning. The unexpected factor of a students level of cognitive impairment appeared to impact several of the findings. Overall, results of this study indicated that the majority of students supported by medical technology appeared to be receiving minimal planning during transition. The findings are discussed in terms of implications both for planning for the transition from school to adult life as well as the transition to adult health care systems.