More Than Ramps: A Guide to Improving Health Care Quality and Access for People With Disabilities.

More Than Ramps: A Guide to Improving Health Care Quality and Access for People With Disabilities

Iezzoni LI, O'Day BL. New York, NY 10157, Oxford University Press Inc, 2006, hardcover, 366 pp, illus, ISBN: 0-19-517276-0, $65.

This book describes experiences and issues that adults with physical and sensory disabilities may encounter when seeking primary health care and suggests ways that these individuals and health care practitioners can circumvent common barriers in order to ensure high-quality care. The authors--one has a physical disability, the other has a visual disability--skillfully combine both quantitative and qualitative information that offers recommendations and ideas to help the health care practitioner and manager deliver the highest quality care possible to people with disabilities. The authors discuss barriers such as the "built environment," medical equipment, institutional policies and procedures, and clinicians' technical knowledge and interpersonal communication, among many others. Some of these barriers are more commonly written about than others, and the authors adeptly explore these additional obstacles to quality care.

The book has 3 parts. Part I explores overall social and health insurance policies that affect people with disabilities. The authors establish the basis of the book by providing a very thorough review of the historical roots of disability definitions, from those of governmental agencies that result in legal rulings, to the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF). The many challenges to obtaining health insurance coverage, and the ability or inability to access health care when needed by a person with a disability, are fully described. The authors challenge the reader, especially policy makers, to rethink fundamental coverage and policies related to chronic conditions and disability.

Part II describes challenges people with disabilities will experience when trying to access health care, from the initial need to the identification of the most appropriate and receptive primary health care physician to the physical access to and navigation in health care settings. The importance of good communication in all encounters with clinical staff, from the scheduling person to the receptionist to the physician, is highlighted. Some very poignant real-life examples of the need for sensitivity and etiquette during physical examinations for people with disabilities--particularly for those with visual and hearing disabilities--are provided. Assistive technology, personal assistance services, public transportation, and accessible housing are all discussed.

Part III makes specific suggestions to overcome barriers to high-quality health care, and discusses resources that are available to do so. This part discusses the need for universal designs so that people with visual, heating/speech, and physical disabilities can be comfortably accommodated. It encourages a paradigm shift in the patient's thinking, so that the person with a disability is his or her own primary caregiver, and the practitioners in primary and specialty health care serve as resources or consultants to assist the person in this role. The importance and need for improved patient-clinician communication, as well as for accessible communication and information, are highlighted. Use of contemporary information technologies, such as the Internet, is encouraged.

The book has 4 appendixes: the first 2 list Internet resources for general disability and health care topics as well as resources for specific disabilities, diseases, and disorders. Appendix 3 provides concrete suggestions for improving accessibility of health care services beyond that of the physical environment. The final appendix provides the questions, wording, and responses used to define disability categories in the various surveys used in the authors' work. A concluding section, "Notes," offers more background information and clarification on content included in some of the chapters.

Overall, this is an excellent resource. It encourages the reader to think beyond physical barriers for people with disabilities and to consider the many other barriers that these individuals may encounter. The style of the book is a combination of literature review and personal accounts of people with disabilities through the real-life stories they shared with the authors. This mixed approach of both quantitative, factual material with the qualitative, first-person accounts and experiences of people with disabilities makes for a very readable and concrete text. The authors' suggestions and challenges to address some of the issues take the work beyond the "we have problems" realm to a "let's do something about it" outcome. This book is important reading for any person working in a health care environment, from the primary care practitioner to all of those who interact with people with disabilities. [DOI: 10.2522/ptj.2006.86.9.1309]

Paulette Cebulski, PT, PhD

University of Michigan-Flint 

Flint, Mich

Cebulski is Director of the Physical Therapy Department, Retiring. Her teaching has been in the areas of physical therapist practice management, professional orientation, and current issues in physical therapist practice.