e7Abstracts / Disability and Health Journal 2 (2009) e1ee15

There is increasing recognition that medication use, specifically

psychotropic medication, can cause significant weight gain. Given that

30-50% of adults with ID are dually diagnosed and receive psychotropic

medication and/or antipsychotic mediation, medication use amongst this

group has become an important factor in the treatment of individuals with ID.

Given the consequences of obesity and being overweight, and the

potential to significantly reverse these consequences by returning to

a normal body weight, the goal of this presentation is two-fold. The first

goal is discuss the results from a study examining the relations between

challenging behaviors, psychiatric care, medical conditions, and obesity

in adults with ID living in a group home setting.

The second goal of this presentation will be to describe the development and

implementation of an obesity center in one of the largest not-for-profit

agencies in the USA, the YAI/National Institute for People with

Disabilities that provides a wide range of services, including health care,

to individuals with ID. The development of a more comprehensive

assessment of an individual’s risk factors for obesity and an improved

method for tracking changes to and the recombination of psychotropic

and/or antipsychotic medication to limit weight gain by medical staff will

be outlined.

Re-assessing physical disability among US medical schools

Demetrius Moutsiakis, MD, MPH, School of Public Health and Health

Professions, University at Buffalo, Buffalo, NY

Thomas Polisoto, MD, Department of Rehabilitation Medicine, Erie

County Medical Center, Buffalo, NY

In 1996, one survey aimed to assess the prevalence of physical

disabilities among medical school graduates in the 1987 through 1990

graduating classes. The study reported 64 graduating medical students

with documented physical disability. This comprised 0.19% of the 33,138

students who graduated from the 67 medical schools.

This study seeks to determine what effects, if any, the passage of the

Americans with Disabilities Act (ADA) of 1991 has had on the admission

rate of individuals with disabilities. A questionnaire is sent to the deans of

student affairs at all accredited medical schools in the United States and

Puerto Rico (n 5 125) in attempts to determine: (1) the prevalence of

medical students with physical disabilities (MSPD) who graduated during

the years 2000-2007, (2) the types of physical disabilities present, (3) the

onset of disabilities, either before or during medical school, and (4) the

academic standing of MSPD.

To date, 10 medical schools have returned their completed surveys. On the

one hand, results appear to be favorable: 0.23% of the graduating medical

students reported having documented disability. On the other hand, only

two schools accounted for 85% of all graduating medical students with

documented physical disability. Half of the medical schools reported

having no graduating medical students with documented physical disability.

These results represent disturbing trends among US medical schools.

Texas disabled Hispanic children: A quest for healthcare access

Katandria L. Johnson, MA, MS, CCC-SLP, Social and Behavioral Sciences

Department, University of North Texas Health Science Center at Fort

Worth, Fort Worth, TX

Julius Larry, MPHc, Health Management and Policy, School of Public

Health, University of North Texas Health Science Center, Fort Worth, TX

Alberto Coustasse, MD,MBA, DrPH, Health Management and Policy,

School of Public Health, University of North Texas Health Science Center,

Fort Worth, TX

This study was designed to identify and describe barriers to and

facilitators of healthcare access for the Hispanic pediatric population with

physical and mental disabilities.

Peer-reviewed journals, books, national reports including: Unequal

treatment and the National Healthcare Disparities Report (NHDR) 2005

were utilized to conduct this research study. An evaluation of the

described incidence of Hispanic children with physical and mental

disabilities in the U.S. less than 18 years, which parents or guardians

reported the quality of health care services provided and their barriers to

access to healthcare was also performed.

Results revealed healthcare access disparities related to race/ethnicity, and

socioeconomic status still persist in the U.S. healthcare system. For patients,

the primary barrier to healthcare access was linked to lack of insurance and

secondary and tertiary barriers were lack of linguistic and cultural

competency of the front end and provider, respectively. Specific statistical

findings from the NHDR illustrated that families reported their child’s

healthcare providers sometimes or never listened carefully; did not explain

facts clearly; respected what they had to say, nor spent enough time with them.

Areas that can facilitate better healthcare access are to increase the cultural

and linguistic competencies of healthcare providers through policy

development. Cultural and linguistic assistance can be initiated at the

university level by recruiting multi-ethnic and linguistic students and by

increasing sociocultural and sociolinguistic content in the coursework,

practicum, or residencies. Such changes are central to effectively addressing

healthcare disparities and promoting positive, long-term healthcare

outcomes among culturally and linguistically diverse populations.

Unmet healthcare needs of persons with tetraplegia and their

primary caregivers: Policy implications

Colette Duggan, BSN, MSN, PhD, Research Department, Rehabilitation

Institute of Michigan, Detroit, MI

Virginia Miller, DrPH MS MPH, Department of Family Medicine and

Public Health Sciences, Wayne State University School of Medicine,

Detroit, MI

Persons with tetraplegic (cervical) spinal cord injuries (SCI) have

complex health care needs. They require access to a wide range of goods

and services to maintain their health and prevent/minimize further

functional losses. The severity of SCI impairment puts these individuals at

great risk for incurring serious, costly medical complications over their

lifetime. This 2-year, qualitative/quantitative study, funded by Blue Cross

Blue Shield of Michigan, focuses on the healthcare experiences of the

most needy and vulnerable segment of this population: public insurance

recipients with tetraplegia and their primary caregivers. Qualitative data

comes from in-depth, audiotaped interviews with 20 Medicaid/Medicare

recipients with tetraplegic injuries and their primary caregivers.

Participants also completed survey instruments measuring stress, health/

functioning, and quality of life. Content analysis of coded interviews

transcripts revealed many unmet needs. SCI consumers cited (a)

inadequate supplies, such as catheters and dressings; (b) difficulty

acquiring/repairing durable medical equipment, such as wheelchairs and

lifts; (c) denial of requests for ramps and other environmental

modifications, and (d) untrained, unreliable agency caregivers. SCI

caregivers cited (a) unsatisfactory service by home care agencies; (b) no or

insufficient financial compensation for SCI care provided by the family;

(c) lack of respite care for caregiver; and (d) lack of affordable health

insurance for family caregivers. Participants’ recommendations for

improving access to goods and services were based on an ‘‘insider’’ logic

that stressed long-term savings in hospital/nursing home costs through

prevention of SCI secondary complications and inclusion of health

insurance coverage and respite services for the family caregiver.

Overweight among Children with Attention Deficit Hyperactivity

Disorder

Juhee Kim, ScD, Kinesiology and Community Health, University of Illinois

at Urbana-Champaign, Champaign, IL

e8 Abstracts / Disability and Health Journal 2 (2009) e1ee15

Bo Fernhall, PhD, Kinesiology and Community Health, University of

Illinois at Urbana-Champaign, Champaign, IL

Objectives: To examine the prevalence of overweight among children with

Attention Deficit Hyperactivity Disorder (ADHD) and their difference by

medication.

Method: We conducted a secondary data analysis using the National Survey

of Children’s Health 2003(aged 6-17 years, n 5 62,476). The definition of

ADHD is used from the question of ‘‘Has a doctor or health professional

ever told that [study child] has ADD or ADHD?’’ The odds of overweight

(BMI> 95% percentile) were estimated among children with ADHD who

were or were not taking medication compared with children without

ADHD. Covariates were age, race, education, poverty, family structure,

number of family meals, computer and reading hours, TV viewing hours,

physical activity, sleep, participation of organized activities, and

supportive neighborhood. Further, we adjusted weights and multistage

sampling design effects in multivariate logistic regression models.

Results: Overall 9% of U.S. children had either ADD or ADHD in 2003.

Only girls with ADHD had a higher rate of overweight than that of girls

without ADHD (20% vs. 16%). However, both boys and girls with

ADHD and currently NOT taking medication were more likely to be

overweight than those without ADHD (OR (95% CI) for Boys, 1.44

(1.13-1.84) and Girls, 1.79 (1.20-2.67).

Conclusions: The prevalence of overweight among children with ADHD

is dependent on sex and medication. Children with ADHD who not take

ADHD medication have a higher risk of overweight than those taking

medication and compared to children without ADHD. These data

suggest that medication use should be carefully considered in children

with ADHD.

Age disparities in prescription drug access and utilization within the

Medicare program

Jae Kennedy, Department of Health Policy and Administration,

Washington State University, Spokane, WA

Katie Mackay, MHPA (cand), Department of Health Policy and

Administration, Washington State University, Spokane, WA

Josh Engle, MHPA (cand), Department of Health Policy and

Administration, Washington State University, Spokane, WA

Research Objective: To identify critical differences in prescription drug

access among working age (18-64) and older (65+) Medicare beneficiaries.

Study Design: Secondary analysis of the 2005 Medicare Current

Beneficiary Survey (MCBS) on Access to Care.

Population Studied: Medicare beneficiaries in the period immediately

preceding implementation of the new Medicare prescription drug

benefit.

Principal Findings: Younger beneficiaries had significantly higher rates of

prescription nonadherance (28.9%) than older beneficiaries (11.6%).

Younger and older beneficiaries had similar rates of prescription drug

coverage (60.2% vs. 61.6%); but younger beneficiaries were more likely

to have coverage through Medicaid (28.3% vs. 6.8%) and less likely to

have private coverage (22.8% vs. 34.6%) or Medicare HMO coverage

(6.4% vs. 12.3%). Younger beneficiaries were more likely to be in poor

health (60.8% vs. 20.2%) and to have ADL limitations (29.8% vs. 15.3%)

than older beneficiaries.

Conclusions: Younger Medicare beneficiaries are at greater risk of

prescription nonadherance. This population is also more likely to

report poor health, low incomes, and multiple impairments or chronic

conditions.

Implications for Policy, Delivery or Practice: Adults under age 65 who

receive Social Security Disability Income (SSDI) become eligible for

Medicare 25 months after they begin to receive SSDI benefits. Younger

beneficiaries are particularly vulnerable to rising drug costs, coverage

gaps, and discontinuities in prescription regimens. The new Medicare

prescription drug benefit should help reduce, but not eliminate, access

barriers to prescribed medicines.

Meeting the occupational safety and health training needs of

workers with developmental disabilities

Robin Dewey, MPH, Labor Occupational Health Program, UC Berkeley,

Berkeley, CA

Approximately 4.5 million individuals in the US have developmental

disabilities. An estimated 30% of working-age adults with developmental

disabilities are employed either in segregated ‘‘workshops’’ or

mainstream settings. The results from recent needs assessments indicate

there are very few examples of health and safety training being provided

to workers with developmental disabilities. When safety training does

occur, it is usually limited to task-specific instructions provided on an as

needed basis. This lack of real health and safety training leaves these

workers unprepared to be able to identify hazards in a variety of settings,

know what to do when something unexpected happens, and advocate for

themselves when a problem arises. This presentation will describe

a unique effort to bridge this gap by creating an occupational safety and

health education training program that meets the cognitive needs of

workers with developmental disabilities. The training program has been

pilot-tested with several adults with developmental disabilities, including

employees participating in Walgreens Company’s initiative to hire a third

of its warehouse employees from this population. Attendees will be

introduced to the learning activities that are part of this basic curriculum

and discuss strategies for integrating health and safety training into the

activities of the agencies and organizations that serve this population.

Use of Post-Hospital Care to Disabled Stroke Patients in Taiwan: A

National Health Insurance Experience

Guey-Ing Day, PhD, Bureau of Planning, Department of Health, The

Executive Yuan, Taiwan, Taipei, Taiwan

Shwu-Chong Wu, PhD, Institute of Health Policy and Management,

College of Public Health, National Taiwan Unerversity, Taipei, Taiwan

Shin-Chung Huang, Bureau of National Health Insurance, Taiwan., Taipei,

Taiwan

The study examines factors associated with the utilization of post-

hospital care of disabled stroke patients within 6 months after hospital

discharge and the varied costs to the national health insurance (NHI)

system. A sample of 1,534 disabled stroke individuals 50 and order who

were hospitalized in the past year was extracted from a nation-wide

random sample. The first hospitalization in that year was designated as

their index hospitalization. Six months of NHI claim data together with

matched survey results were analyzed. Multiple regression and ANOVA

identified factors associated with the use of post-hospital care.

Results: The hospital readmission rate within 6 months after index

hospitalization was 46.5%. Utilization of outpatient service was 98.1%,

emergency service 38.0%, home nursing service 12.2%, and rehabilitation

rate 32.3%. Results revealed that co-payment, long-term care arrangement,

living in cities, co-morbidities, functional dependency were significant

variables. Patients who are waived of NHI co-payments, cared in

institutions, living in municipalities, completely dependent, or have

suffered from three and more chronic diseases consume more health care

and higher cost to the NHI.

Implication & Conclusion: In allocating NHI resources and policy design,

these factors should be taken into consideration for better resource

management and efficiency. While an diagnosis related groups system in

the NHI being started, issues concerning post-hospital care in terms of

insurance benefits and co-payment need to be re-examined. The

integration of acute care with post-hospital care is critical to assure the

continuity and comprehensiveness of services.