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 1. Home
 2. Evidence Reports
 3. Healthcare Delivery of Clinical Preventive Services for People with
    Disabilities




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HEALTHCARE DELIVERY OF CLINICAL PREVENTIVE SERVICES FOR PEOPLE WITH DISABILITIES


Draft Comments Apr 17, 2024
Open for Comment through May 17, 2024
Download Full Content
Download files for this report here.



 * Full Report (PDF, 1 MB)
 * Appendixes A-H (PDF, 890 KB)
 * Appendixes E & F (XLSX, 101 KB)






PAGE CONTENTS

 * Main Points
 * Structured Abstract




MAIN POINTS

 * Studies on barriers and/or facilitators to the receipt of clinical preventive
   services among people with disabilities are lacking for most preventive
   services and most types of disability.
 * By far, the largest number of studies on barriers/facilitators have been
   related to the receipt of breast cancer screening and/or cervical cancer
   screening.
 * For breast and cervical cancer screening, studies reported on most categories
   of barriers/facilitators and included all types of disability; for other
   preventive services, fewer studies reported fewer categories of
   barrier/facilitator and fewer types of disability.
 * Evidence on interventions to improve the receipt of clinical preventive
   services among people with disabilities is especially limited, with most
   studies also related to breast and cervical cancer screening.
 * Limited evidence from three trials found various educational and health
   advocacy interventions to be associated with increased rates of breast and
   cervical cancer screening among women with physical disabilities,
   cognitive/intellectual/developmental disabilities, and serious mental
   illness.
 * Evidence on interventions to improve the receipt of other preventive services
   is more limited, with no clear effect of the interventions for any preventive
   service.


STRUCTURED ABSTRACT

Objectives: The purpose of this review is to (1) document and summarize barriers
and facilitators to the receipt of clinical preventive services among people
with disabilities; and (2) evaluate the literature on the effectiveness of
interventions to improve the receipt of clinical preventive services among
people with disabilities.

Data Sources: We performed searches in electronic databases (Ovid®, MEDLINE®,
PsycINFO®, Embase®, the Cochrane Central Register of Controlled Trials, and
EBSCO CINAHL Plus) from 1990, the year of passage of the Americans with
Disabilities Act (ADA), through November, 2023; manual review of reference
lists; suggestions from stakeholders; and responses to a Federal Register
Notice.

Review Methods: Following the Agency for Healthcare Research and Quality Methods
Guide (available at: Methods Guide), the review methods were determined a priori
and a protocol was developed through collaboration with Federal partners, Key
Informants, and a Technical Expert Panel. We used predefined criteria for
independent dual review of abstracts and full-text articles to determine
inclusion of studies related to 20 clinical preventive services with Grade A or
Grade B recommendations by the U.S. Preventive Services Task Force. We assessed
individual studies for general quality (studies of barriers/facilitators) or
risk of bias (effectiveness studies) using dual review and criteria specific to
the different study designs. Predefined data from studies were abstracted into
tables by one reviewer and verified by a second reviewer. Barriers and
facilitators were classified into seven general categories (environment-level,
person-level, provider-level, healthcare system-level, accessibility of
healthcare facility, accessible communication, and policy-level).
Barriers/facilitators and interventions were described and presented for each
preventive service according to general types of disability (physical,
cognitive/intellectual/developmental, sensory, and serious psychiatric/mental
illness). Due to high methodological/clinical heterogeneity of the studies and
limited available data, we did not assign strength of evidence ratings or
conduct meta-analyses.

Results: Of 11,010 references, we included 68 studies – 54 reported on
barriers/facilitators and 16 reported on the effectiveness of interventions. For
barriers/facilitators and for the effectiveness of interventions, evidence was
lacking for most preventive services and generally limited to one or two types
of disability for any given preventive service. Studies on barriers/facilitators
were related to 10 of the 20 preventive services included in the review, and
studies on the effectiveness of interventions were related to 8 of the 20
preventive services. Most evidence was for two preventive services – breast
cancer screening and cervical cancer screening. For breast and cervical cancer
screening, studies reported on most categories of barriers/facilitators and
included all types of disability; for other preventive services, fewer studies
reported fewer categories of barrier/facilitator and fewer types of disability.
Limited evidence from three trials found various educational and health advocacy
interventions to be associated with increased rates of breast and cervical
cancer screening among women with physical disabilities,
cognitive/intellectual/developmental disabilities, and serious mental illness.

Conclusions: We found limited evidence on barriers and facilitators to the
receipt of most clinical preventive services among people with disabilities, and
especially limited evidence on interventions to improve the receipt of those
preventive services. Most studies were related to breast and cervical cancer
screening. The lack of studies for most preventive services and types of
disability underscores the need for research to address the substantial gaps in
the evidence.


PROJECT TIMELINE


HEALTHCARE DELIVERY OF PREVENTIVE SERVICES FOR PEOPLE WITH DISABILITIES

Apr 28, 2023

Topic Initiated
Oct 24, 2023

Research Protocol
Apr 17, 2024

Draft Comments
Apr 17, 2024 - May 17, 2024

Draft Comment Period




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Page last reviewed April 2024
Page originally created April 2024

Internet Citation: Draft Comments: Healthcare Delivery of Clinical Preventive
Services for People with Disabilities. Content last reviewed April 2024.
Effective Health Care Program, Agency for Healthcare Research and Quality,
Rockville, MD.
https://effectivehealthcare.ahrq.gov/products/people-with-disabilities/draft-report


 
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