Access to health care for disabled people: a systematic review

The objective of this paper was to systematically review published studies to determine if disability limits access to health care and to attempt to identify what body functions, structures and activities and participation, as well as contextual factors (environmental and personal factors), interact with the health condition to limit this access. The AMED, CINAHL, EMBASE, Medline and psychINFO databases were searched for original study articles in English, dating from 1974 to 2008. Review articles and expert opinion were excluded. Each study had two independent reviews by either a general practitioner or specialist in rehabilitation medicine. Each study was critically appraised according to the National Service Framework for Long-term Conditions (Department of Health, 2005a) methodology and recorded on standardised data extraction sheets. Studies of poor quality were excluded. Sixty studies were included. No randomised controlled trials were identified. Studies broadly fell into the following three main groups: database studies (n=27), quantitative surveys (n=20) and qualitative interviews (n=13). Disabled people are restricted in accessing health care and report less satisfaction with their medical care. Many of the identified studies were from the United States (US) and based on subjective reporting. More objective evidence is needed, especially in the UK, to clarify the true level of access to health care in people with disabilities. The complex, interdependent factors in providing health care to disabled people require complex solutions.