October 3, 2002
Difficulty with daily living related to dissatisfaction with medical care
Recent research at the University of Washington shows that Medicare patients who have difficulties performing the typical activities of daily living are more likely to also report dissatisfaction with their health care than those without these problems.
The study by senior author Dr. Leighton Chan, associate professor of Rehabilitation Medicine in the UW School of Medicine, and his colleagues shows that as their number of activity restrictions increased, these patients reported an increasing level of dissatisfaction with the health care that they received. The study is featured in the October issue of the Archives of Physical Medicine and Rehabilitation.
About 21,000 Medicare beneficiaries were asked for their responses to an annual survey about several aspects of their health care. For this particular study, Chan and his colleagues examined 10 questions about satisfaction with health care. The Medicare patients rated such things as the overall quality of the care they had received in the past year, the out-of-pocket medical expenses they incurred, availability of medical care to them at nights and on weekends and concern of doctors for the patients’ overall well-being. Additionally, the patients were asked to rate the availability of care by specialists, the ease of getting care and the ability to get questions answered over the phone.
The survey showed that about 3.1 percent of the Medicare recipients without significant problems with activities of daily living (ADL) indicated they were dissatisfied with their health care. However, 7.4 percent of those reporting the highest numbers of difficulties with ADL, or twice as many people, also reported dissatisfaction with their health care.
Disability was determined by using beneficiary responses to questions about whether they had any health-related difficulties performing six separate activities, including bathing, dressing, eating, getting into and out of chairs, walking and using the toilet. The study’s results were adjusted for sociodemographic, behavioral and system characteristics before comparisons were made with Medicare recipients reporting no ADL limitations.
Chan pointed out that the study findings add to the growing evidence that people with disabilities receive qualitatively different care than people without activity limitations.
“Treating individuals with chronic diseases is very challenging because they consume the bulk of the medical resources provided by Medicare,” Chan said. “We’re finding that many of these patients are not receiving preventive and diagnostic care. They are definitely at risk, just as certain racial groups are at risk for high blood pressure or diabetes or certain socioeconomic groups are at risk for health complications.”
The study concluded that efforts should be made to identify people with ADL difficulties and make getting to a doctor easier for them.
Chan adds that health insurance agencies need to think of ways to meet these patients’ needs before they are in a health crisis.
“It may be actually cheaper for an insurance company to make sure that someone with ADL limitations gets to a doctor before they become terribly sick and end up in the hospital. Maybe they can arrange transportation to appropriate clinics or fund more home visits.”
Doctors and nurse practitioners need to identify these patients.
“These patients need to be targeted for things like mammograms and pap smears,” Chan said. “These people need to be identified up front, just as you would identify somebody who needs a flu shot.”
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