Accepted Manuscript

Healthcare provider perceptions of accessible exam tables in primary care:

Implementation and benefits to patients with and without disabilities

Allysha C. Maragh-Bass, PhD MPH, Joan M. Griffin, PhD, Sean Phelan, PhD, Lila J.
Finney Rutten, PhD MPH, Megan A. Morris, PhD MPH CCC-SLP

PII: S1936-6574(17)30076-6
DOI: 10.1016/j.dhjo.2017.04.005
Reference: DHJO 604

To appear in: Disability and Health Journal

Received Date: 10 October 2016

Revised Date: 17 March 2017
Accepted Date: 3 April 2017

Please cite this article as: Maragh-Bass AC, Griffin JM, Phelan S, Finney Rutten LJ, Morris MA,
Healthcare provider perceptions of accessible exam tables in primary care: Implementation and
benefits to patients with and without disabilities, Disability and Health Journal (2017), doi: 10.1016/
j.dhjo.2017.04.005.

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to
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RUNNING HEAD: Accessible exam tables

Healthcare Provider Perceptions of Accessible Exam Tables in Primary Care:

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Implementation and Benefits to Patients with and without Disabilities

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Allysha C. Maragh-Bass, PhD MPH1, Joan M. Griffin PhD2, Sean Phelan PhD3, Lila J. Finney

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Rutten PhD MPH3, Megan A. Morris, PhD MPH CCC-SLP1,2

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Affiliations: 1Center for Surgery and Public Health: Harvard Medical School, Harvard T.H.
Chan School of Public Health, and the Department of Surgery, Brigham & Women’s Hospital,
Boston, MA; 2Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care
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Delivery, Rochester, MN, USA; 3Department of Health Sciences Research, Mayo Clinic,
Rochester, MN, USA.
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Corresponding author: Dr. Megan A. Morris, Mayo Clinic, Robert D. and Patricia E. Kern
Center for the Science of Health Care Delivery, Rochester, MN, USA; Department of Health
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Sciences Research, Mayo Clinic, Rochester, MN; 200 First Street SW, Rochester, MN 55905;
morris.megan@mayo.edu
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Disclosures: All of the authors state that they have no financial disclosures or potential conflicts
of interest to report.

Presented at: November 01, 2016 3:10PM - 3:30 PM Oral Session, Annual Meeting of the
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American Public Health Association, Denver, CO.

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Key words: Disability, Examination table, Patient-centered care, Qualitative research, Health
services research

Abstract Word Count: 239

Manuscript Word Count: 2721

Number of References: 26

Number of Figures/Tables: 2
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RUNNING HEAD: Accessible exam tables

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Healthcare Provider Perceptions of Accessible Exam Tables in Primary Care:
Implementation and Benefits to Patients with and without Disabilities

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ABSTRACT

Background. Recent healthcare mandates require availability of accessible medical exam

equipment, which may reduce barriers to care for patients with disabilities (PWD). However,

more research is needed to explore healthcare provider views on implementation and routine use

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of accessible equipment. Objective. This study qualitatively explored healthcare provider

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perceptions of: (1) daily use of accessible medical examination tables with PWD; and (2)

recommendations for addressing challenges to using this equipment. Methods. Qualitative

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interviews and focus groups were conducted with physicians, nurse practitioners and registered

nurses at a clinic where accessible examination tables were recently implemented in all clinic

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rooms. Data were coded and thematically analyzed by two researchers trained in qualitative
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methods. Results. A total of 17 providers participated in focus groups or interviews. Participants

were mostly female (82%; N=14), and registered nurses (47%; N=8), but also included nurse
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practitioners (29.4%; N=5), and physicians (23%; N=4). Common themes were: (1) Ease of use
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and functionality of tables; and (2) Challenges with use and available training. Overall, providers
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reported satisfaction with the tables’ ability to accommodate patients who are PWD, although

they expressed challenges with functionally using the tables with specific populations, such as
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pediatric patients. Conclusions. Healthcare organizations seeking to implement height-adjustable

tables should account for structural requirements of the height-adjustable tables (e.g.
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accommodating clearance needed when planning room sizes). Practical recommendations and
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policies for integrating height-adjustable tables into routine clinical care are needed to ensure

equitable care for PWD.

Word count: 239

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INTRODUCTION

In 2010, approximately 56 million individuals in the United States were living with a

disability.1 Over 30 million reported a mobility disability.1 Multiple studies show that patients

with disabilities (PWD) experience disparities in access to high-quality healthcare services

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compared to patients without disabilities.2-4 Lack of adequate accessible equipment can result in

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fewer preventive screenings and routine visits, delay care, and worsen health outcomes for PWD

compared to persons without disability.5-9 Story and colleagues found that when PWD access

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care, difficulties such as lack of physical support to transfer onto tables can negatively impact

healthcare encounters.10 These barriers are often compounded for certain disabled populations,

including those with obesity.11-15

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Titles II and III of the Americans with Disabilities Act include administrative
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requirements for healthcare providers and organizations to ensure full and equal access to

PWD.16 Title III, for example, requires hospitals and doctors’ offices to install accessible
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wheelchair ramps, when readily achievable.16 Section 4203 of the Patient Protection and
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Affordable Care Act (ACA) recently mandated standards for accessible medical diagnostic

equipment.17, 18 Nonetheless, a study of over two thousand California primary care facilities
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found only eight percent of clinics had height-adjustable exam tables available to accommodate

PWD.4
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Extant research has assessed implementation of accessible examination equipment in

healthcare settings.10-15 To date, however, few of these studies have explored the potential

barriers to utilization of accessible medical equipment. 10-15 More research is needed to

understand the feasibility issues associated with utilization of accessible exam tables from the

vantage point of healthcare providers. Therefore, the present research qualitatively explored
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provider-reported views on: (1) daily use of accessible medical examination tables with PWD;

and (2) recommendations for addressing challenges to using this equipment.

METHODS

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Setting and participants

The present research was part of an exploratory, concurrent, merged mixed-methods

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study, First, data collection consisted of qualitative formative research (exploratory).

Quantitative surveys, were also conducted with a larger sample of participants (concurrent).

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Qualitative findings guided analyses and contextualized the quantitative arm (connected).

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The study took place at two community-based primary care clinics affiliated with the Mayo
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Clinic in Rochester, MN. The clinics differed in three ways: location within Rochester, MN; age

(existing community clinic versus a new clinic established January 2015); and accessibility of
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equipment (existing clinic had no height-adjustable examination tables versus new clinic which
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had only height-adjustable examination tables).

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The exam tables were purchased in bulk from a large international manufacturer which is

headquartered in the United States. The tables were 75 inches in length with the footrests
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extended. The adjustable base, had a “home position” height of 18 inches. Unlike standard tables

which are completely flat and/or not height adjustable, these tables had curved headrests, a
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padded seat, and an indentation at the hinge were the back rest met the base of the table. Other
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features included a 650-pound weight capacity, a drawer heater, and an optional scale integrated

into the table for weight patients with limited mobility.

Quantitative surveys were conducted with adult patients at both clinics. Qualitative

interviews and focus groups were conducted with physicians, nurse practitioners and nurses at
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the new clinic. Inclusion criteria for providers were: (a) being 18 years or older; (b) being

employed at the newly open clinic; and (c) consenting to participate. All data were collected

concurrently; only qualitative data were utilized in the present study.

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Data collection and analyses

Focus groups and interviews were conducted in May and June 2015 at the clinic with

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height-adjustable tables. All providers were invited to participate in a focus group. To

accommodate varying schedules, telephone interviews were conducted with providers unable to

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attend focus groups. Focus groups and interviews were semi-structured and elicited experiences

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of using the accessible examination tables, and views on the training providers received to use
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the new tables. Focus groups and interviews lasted between thirty and sixty minutes and were

audio-recorded. Recordings were then transcribed verbatim. Two researchers (AMB and MAM)
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inductively coded the transcripts, and reviewed codes iteratively throughout analyses.

Discrepancies were discussed, and consensus coding was achieved on all transcripts. Because
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consensus was reached on all transcripts; inter-coder reliability was not calculated. Finally,
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coded text was then analyzed for recurrent themes, and salient quotes were extracted. Study

procedures were approved by the Mayo Clinic Institutional Review Board.

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RESULTS
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Demographic characteristics
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A total of 17 providers participated in focus groups or interviews (Table 1). Two focus

groups were conducted: the first included registered nurses (n=7). The second included

physicians (n=2) and nurse practitioners (n=4). Four interviews were conducted with a nurse

(n=1), physician (n=2) and a nurse practitioner (n=1). Participants were mostly female (n=14,

82.4%).
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Major themes

Two themes, summarized below, were identified. Table 2 summarizes salient quotes.

Theme 1: Ease of use and functionality of the tables

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Overall, providers’ comments reflected satisfaction with the ease of use and features of

the tables. While the accessible tables had multiple new features (e.g. additional padding for

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patient comfort, arm rests and stirrups built into the table), they most appreciated the ability of

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the tables to be height-adjustable, and that the tables were wider. When discussing these features,

the providers often spoke of them in relation to specific subpopulations, including elderly, gait-

impaired, obese, and pediatric patients.

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Providers thought that elderly patients and those with gait impairments benefited the most
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from the tables. They believed it is easier and safer to examine these patients due to the

adjustable height. As one provider said:

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“There’s just more ease now of getting them to the table and not having that step

up. I think they feel more sure of themselves, so I would say from a safety
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perspective it feels better.” (nurse practitioner, interview)

Several participants reported that with the height-adjustable examination tables, they
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were able to transfer more elderly patients onto the table, allowing for more thorough
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examinations, particularly abdominal and pelvic examinations:

“I’m much more comfortable getting my elderly patients up on the exam table

without the step. I previously would worry or maybe try to do the exam without
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getting them on the table or any patient with a gait difficulty.” (physician, focus

group)

The providers reported that obese patients were more comfortable on the wider tables and

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benefit from the height-adjustable tables as the typical narrow step in most standard examination

tables can be difficult to maneuver. As one nurse commented:

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“For obese patients it’s very nice, because they have a hard time climbing up on

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the wooden tables and then turning around. So they have to climb up facing the

table and then they have to turn around and if they’re pretty large, when they turn

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around their rear end kind of pushes them off the little stool/step thing.” (nurse,
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focus group)
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Finally, several providers reported that the height-adjustable feature for children were

convenient, as the patient was able to independently climb onto the table. One provider stated
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she engaged pediatric patients by allowing them to push the buttons to raise and lower the table.
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Several reported that patients independently commented on the tables, citing them as more

comfortable and easier to get on since they lowered:

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“A patient this morning... was like “these beds are so nice. I don’t have to hop up on the
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step.” Because she was short...She really liked that.” (nurse, focus group)
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Several providers reported that the height-adjustable tables make caring for patients less

physically straining. One nurse reported that it was easier to administer vaccines or examine

pediatric patients since she could raise the table up to her height. Another nurse practitioner

stated:
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“I’m 6 foot 1, so in the past for me doing physical exams I would have to bend in

kind of precarious positions that were not necessarily ergonomically good for my

back, and I do have some back problems too. So I’ve found them very helpful in

the fact that once I get the patient on I bring it almost as high as it can go so I can

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do an exam at eye level.” (nurse practitioner, interview)

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Theme 2: Challenges and available training

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Despite general satisfaction, participants also expressed challenges using the tables.

Providers had mixed feelings about the ease of use of the hand and foot remote control features

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to raise and lower the table:
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“Yeah...the remote button....is designed completely wrong... For us in our clinic
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it tends to be on the side that’s closest to the wall which is harder to get

to.”(nurse, focus group)

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Other mentioned that there was insufficient storage built within the tables and that the arm rests
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sometimes were a barrier to examining patients, particularly pediatric patients. Multiple

providers mentioned that the “home position” of the table was too low, requiring them to raise
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the table for every patient. For at least one provider, constantly raising and lowering the table
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was time-consuming and distracting.

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The tables also presented space challenges. The participants reported that the tables were

larger than the previous non-height-adjustable tables they were accustomed to. Additionally, they

noted that raising the table interfered with items hanging on the wall (e.g. basket to hold the

blood pressure cuff). Finally, providers stated concerns about using the tables with pediatric

populations as the tables have more curves and contours:

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“It makes me worried because there is not a nice flat surface anywhere for

putting newborns and young infants on the table.”(nurse practitioner, focus

group)

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Several providers reported hesitation with universal implementation in a healthcare

system. One participant reported that while the features of the accessible tables are advantageous

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for subpopulations, the majority of her patients did not need the features, but conceded that it

would be logistically challenging to have dedicated rooms designated for the subpopulations.

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Providers were uncertain whether the new tables affected patient care delivery, and some stated

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that it was still sometimes easier to examine a patient sitting in a chair.
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“I think ... the care, really comes down to the providers... not every person that

comes into the clinic gets that physical exam... some patients may have expected a
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physical exam, but their symptom doesn’t necessarily warrant a physical exam on
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the bed, even though they may have the mobility issues, they may think that’s why
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they weren’t fully examined.”(physician, interview)

The providers reported that a one-time training, approximately fifteen minutes in length, was
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available when the clinic first opened, although not all were able to attend. Of those who
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attended the training, the participants had mixed reviews as to its usefulness. Several reported
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that they wished the training focused more on “tips and tricks” for how to use the tables and

expressed concern that the trainers did not have extensive experience using the tables.

Nonetheless, most providers stated that the tables were user-friendly, and that the best training

was using the tables during actual patient care.

DISCUSSION
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The purpose of the present research was to explore the views of primary care providers

on implementation and use of height-adjustable examination tables. While these

accommodations are recommended by leading organizations, including the National Academy of

Medicine (formerly the Institute of Medicine), as a means to provide equal access to care for

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PWD,10,16-18 existing research has not evaluated their implementation. Our results suggest that,

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overall, providers were satisfied with the new tables and recognized benefits to their use.

Nonetheless, providers also reported challenges with daily use and described considerations for

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other organizations seeking to implement height-adjustable tables.

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Providers identified benefits of using the tables for patients with mobility disabilities.
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Regular use of height-adjustable tables with this population could mitigate some of these

environmental barriers to care faced by PWD.2-9 Additionally, multiple providers noted that
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elderly patients appreciated how the tables could be adjusted. Similarly, providers noted that the

width of the tables was conducive to examining obese patients. These findings align with
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previous research which suggests that accessible examination tables are beneficial to patient care
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across many patient populations other than just PWD.19-21

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Despite the benefits, providers discussed several relevant challenges to routine use of the

height-adjustable tables. First, multiple providers noted that unless the patient’s chief complaint
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necessitates evaluation on a table, the provider will not use it. However, as one provider noted,
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patients often expected an evaluation on the table, irrespective of chief complaint. This is in

keeping with existing literature, which suggests that physical examination is often viewed by

patients as an indicator of quality of care.22-25

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The present research identifies the importance of practical considerations for using

height-adjustable tables. Healthcare organizations that wish to introduce this equipment should

consider the limitations of the tables for special populations such as pediatric patients, as well as

the physical dimensions of examination rooms. A potential solution for both of these

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considerations, therefore, might be having both accessible and non-accessible tables, depending

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on the optimal usage for various patient populations and/or room size. Additionally, the results

highlight the need for ongoing exploration into factors associated with perceived need for

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accessible tables, particularly as they impact care for persons without disability. Future research

should explore the views of patients on accessible examination equipment, particularly those

who are obese, and/or older patients.

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Limitations
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Several limitations of our study merit discussion. First, the study addressed caring for

patients with disabilities and obese patients, which could be perceived as a sensitive topic. While
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we ensured confidentiality, it is possible that social desirability prevented participants from

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disclosing more information. Second, providers were predominantly White females, highly

trained, and only represented one primary care site within Mayo Clinic. It is possible that
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contextual factors would differ among other providers, other care settings, and/or areas of the
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country. Finally, interviews and focus groups were conducted only four to five months after the
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opening of the clinic; it is possible that their perceptions might have changed with more

experience using the height-adjustable tables. Furthermore, additional times with the tables prior

to the study might have resulted in more patient encounters with varying accessibility needs, and

therefore more robust experiences for providers to share.

Conclusions
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Despite limitations, the present research is one of few studies to explore healthcare

providers’ perceptions of implementation of accessible, height-adjustable examination tables in a

primary care setting. Findings have several important implications for larger scale

implementation of accessible exam tables. First, results suggest that short of hands-on

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experience, training providers in use of the tables should consider the demanding schedules of

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providers. The training offered in the present study was 15 minutes, which providers generally

found acceptable. Second, healthcare organizations seeking to implement accessible tables

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should consider the clinic room size as the height-adjustable examination tables might be wider

and require more height clearance than static tables. Finally, healthcare organizations should

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consider the implications of having all height-adjustable exam tables or only select clinic rooms
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with height-adjustable exam tables. Since some patients may not require height-adjustable exam

tables, it could be logistically challenging to schedule patients who would benefit from the tables
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in the appropriate clinic room.

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The US Access Board, which sets accessibility standards, was created by Section 502 of
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the 1973 Rehabilitation Act.18 The guidelines set forth by the Access Board are used by federal

entities to set enforceable standards; for example, the Department of Transportation has
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standards for meeting width and material requirements for sidewalk curb cuts.18, 26 Section 4203
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of the ACA added Section 510 to the Rehabilitation Act, which created accessibility standards
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specifically for diagnostic equipment.18,27 Our findings about the practical limitations of

accessible examination tables are in keeping with some of these standards, which were created

by an advisory committee appointed by the US Access Board. For example, in the present study,

we found that the home position of the tables was lower than previous tables, which caused

issues with baskets that hang off the side of the apparatus. To address such issues, Section 4203
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guidelines recommend using an examination table height measurement method which takes into

account the porous materials used for seating which compress when patients are seated and also

home; most current manufacturers do not use such corrections.18

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The discrepancy between manufacturer specifications, and those set forth by the Access

Board’s advisory committee illustrates our finding that in a primary care setting, implementation

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of accessible tables which met ADA guidelines resulted in unforeseen challenges. Some of these

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challenges may impact the quality of care patients receive, which suggests that further

improvements to the design of medical examination tables, and evaluation of their impact on

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patient care, is needed. Finally, our results highlight the need for practical recommendations for
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clinical care in the real-world setting, to supplement and expand upon healthcare mandates and

policy which call for improvements to care for patients with disabilities.
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ACKNOWLEDGMENTS

This work was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the

Sciences of Healthcare Delivery.

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REFERENCES

1. United States Census Bureau. Americans with Disabilities: 2010. Household Economic
Studies. 2010. http://www.census.gov/prod/2012pubs/p70-131.pdf. Accessed 15 June
2016.
2. Van Rooy G, Amadhila EM, Mufune P, et al. Perceived barriers to accessing health

PT
services among people with disabilities in rural northern Namibia. Disabil Society. 2012;
27(6): 761-75.
3. Henning-Smith C, McAlpine D, Shippee T, et al. Delayed and unmet need for medical
care among publicly insured adults with disabilities. Medical Care. 2013; 51(11): 1015-9.

RI
4. Yee S. Health and Health Care Disparities Among People with Disabilities - Disability
Rights Education and Defense Fund. http://dredf.org/healthcare/Health-and-Health-Care-

SC
Disparities-Among-People-with-Disabilities.pdf. Accessed 15 June 2016.
5. Institute of Medicine (IOM). The Future of Disability in America. Washington, DC: The
National Academies: 2007.

U
6. Mele N, Archer J, Burton DP. Access to Breast Cancer Screening Services for Women
With Disabilities. J Obst Gynecol Neonatal Nurs. 2005; 34(4): 453-64.
AN
7. Amy NK, Aalborg A, Lyons P, et al. Barriers to routine gynecological cancer screening
for White and African-American obese women. Int J Obesity. 2006; 30: 147-55.
8. Mitra M, Long-Bellil LM, Iezzone LI, et al. Pregnancy among women with physical
M

disabilities: Unmet needs and recommendations on navigating pregnancy. Disabil Health

J. 2016; 9(3): 457-63.
9. Hall JP. Dually-eligible working-age adults with disabilities: issues and challenges as
D

health reform is implemented. Disabil Health J. 2013; 6(2): 72-4.

10. Story MF, Schwier E, Kailes JI, et al. Perspectives of patients with disabilities on the
TE

accessibility of medical equipment: Examination tables, imaging equipment, medical

chairs, and weight scales. Disabil Health J. 2009; 2(4): 169-79.
11. Lagu T, Hannon NS, Rothberg MB, et al. Access to Subspecialty Care for Patients With
EP

Mobility Impairment: A Survey. Ann Intern Med. 2013; 158(6): 441-6.

12. Mudrick NR, Breslin ML, Liang M, et al. Physical accessibility in primary health care
settings: Results from California on-site reviews. Disabil Health J. 2012; 5(3): 159-67.
C

13. Popplewell NT, Rechel BP, Abel GA. How do adults with physical disability experience
primary care? A nationwide cross-sectional survey of access among patients in England.
AC

BMJ Open. 2014; 4(8): e004714.

14. Iezzoni LI, Wint AJ, Smeltzer SC, et al. Physical accessibility of routine prenatal care for
women with mobility disability. J Women’s Health. 2015; 24(12): 1006-12.
15. McColl MA, Aiken A, Schaub M. Do People with Disabilities Have Difficulty Finding a
Family Physician? Int J Environ Res Public Health. 2015; 12(5): 4638-51.
16. Americans with Disabilities Act. Revised ADA Regulations Implementing Title II and
Title III. 2012. https://www.ada.gov/regs2010/ADAregs2010.htm. Accessed 17 June
2016.
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17. The ADA National Network. Fact Sheet: Accessible Medical Examination Tables and
Chairs. https://adata.org/factsheet/accessible-medical-examination-tables-and-chairs.
Accessed 17 June 2016.
18. United States Access Board. Rehabilitation Act of 1973. https://www.access-
board.gov/the-board/laws/rehabilitation-act-of-1973. Accessed 15 March 2017.
19. National Task Force on the Prevention and Treatment of Obesity. Medical Care for

PT
Obese Patients: Advice for Health Care Professionals. Am Fam Physician.
2002;65(1):81-8.
20. National Institute of Diabetes and Digestive and Kidney Disease. Medical Care for

RI
Patients with Obesity. http://www.niddk.nih.gov/health-information/health-topics/weight-
control/medical/Pages/medical-care-for-patients-with-obesity.aspx#optimal. Accessed 20
June 2016.

SC
21. Ganz DA, Fung CH, Sinsky CA, et al. Key Elements of High-Quality Primary Care for
Vulnerable Elders. J Gen Intern Med. 2008; 23(12): 2018–23.
22. Solomon DH, Schaffer JL, Katz JN, et al. Can history and physical examination be used

U
as markers of quality? An analysis of the initial visit note in musculoskeletal care. Med
AN
Care. 2000;38(4):383-91.
23. Oboler SK, Prochazka AV, Gonzales R, Xu S, Anderson RJ. Public expectations and
attitudes for annual physical examinations and testing. Ann Intern Med. 2002;136:652-9.
24. Kadakia KC, Hui D, Chisholm GB, et al. Cancer patients' perceptions regarding the value
M

of the physical examination: A survey study. Cancer. 2014; 120(14): 2215-21.

25. Hunt DP. Do patients with advanced cancer value the physical examination? Cancer.
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2014; 120(14): 2077-9.

26. National Council on Disability. Implementing the Affordable Care Act (ACA): A
TE

Roadmap for People with Disabilities. https://www.ncd.gov/publications/2016/

implementing-affordable-care-act-aca-roadmap-people-disabilities. Accessed 23 June
2016.
EP

27. United States Access Board. Health Care. https://www.access-board.gov/guidelines-and-

standards/health-care/about-this-rulemaking/background/rehbilitation-act-section-510.
Accessed 15 March 2017.
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Table 1. Demographic characteristics of participants (N=17)

Characteristic Total
N(%)

Role on Healthcare Team

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Physician 4 (23.5)
Nurse Practitioner 5 (29.4)

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Registered Nurse 8 (47.1)

Gender

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Male 3 (17.6)
Female 14 (82.4)

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Table 2. Qualitative themes and exemplary quotes

Theme Quote
Ease of use and “I think, especially our elderly patients who maybe don’t get around
functionality of quite as well have really appreciated them because they can be in
the tables such a low position.” (nurse practitioner, interview)

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“I tend to use the remote all of the time with my school-aged kids, so
I get them up and then I let them work themselves down. So I pull the
button and tell them to push the home so they feel like they enjoy that

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tremendously; they can’t wait. And I can get some younger pre-
schoolers on the table because [...] it seems less intimidating.”
(physician/nurse practitioner, focus group)

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“I had a [..] an adolescent who had osteosarcoma and I’ve never been able to
do the exam on the table without a double-person lift transfer [...], and I
thought coming here, oh my gosh, [...] she could get herself in a minute from

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that chair to that table [...] so I was thinking like the benefit for specifically
her would have been huge.” (physician/nurse practitioner, focus group)
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“I would say like for paps and stuff when I have women on the table who are
a little bit larger that it does seem a bit more comfortable.” (nurse
practitioner, interview)
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“I feel like you know instead of you know trying to position my body
and hunch down and you know be uncomfortable, I feel like I’m more
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comfortable; I can be more at the eye level of the patient and it’s a
much more comfortable experience and I feel like the tools—otoscope
and that can be positioned at a better angle” (nurse practitioner,
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interview)
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Challenges and “My biggest thing is the foot pedal I think. Sometimes it’s a little hard to get
available training my foot just in the right place to make it go up or make it go down. I always
blame it on the fact that I have big feet.”(nurse practitioner, interview)
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“... the room is so small. It has to be right up against the [wall] .. it is hooked
on the little basket for the blood pressure and it has I think ripped [a spot]...
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because I put it up too high...that’s not the table though.” (nurse practitioner,
interview)
“To get a wheelchair in is tough; you have to squeeze and squeeze to try to
get over and then get in front of them.....I think the leg room is
smaller...totally a space problem. Not a bed problem.” (nurse, focus group)
“also there is an issue with the height and what we have attached to the wall
and how close the tables are to the wall. Um as you lift them up, um, the
blood pressure cuff basket catches” (physician, interview)
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“they’re just time-consuming I think because of the fact that you have to wait
for them to raise or wait for them to go down, which is not a bad thing; it’s
just more time-consuming.” (nurse, focus group)

“I find for my patients who are at risk; my elderly, my gait unstable, it is a

huge advantage, but then for the majority of my patients who are able-bodied,

PT
[...] they sit down and they’re two feet lower than they need to be so I raise
them up and you know it takes a little time and then you raise it down so they
get off or they jump off and so I think for about 80% of the patients it is a

RI
little bit of a hassle; but a huge hassle, no, but it is palpable in the room. Um
but it certainly may be off-set by the safety and convenience for those at risk.
I don’t know you otherwise target that you know unless you have elderly

SC
unstable rooms where you have those and you know that gets just too
logistically difficult.” (physician/nurse practitioner, focus group)

“ [training] was brief but our two kind of dry-run days before the clinic

U
opened they had a people come out; they were ergonomic people who kind of
taught us how to use the bed, but it was brief and it didn’t encompass the
AN
whole thing. We maybe could have had more time learning features and
actually practicing. I feel like they are pretty easy to figure out, though.”
(nurse, focus group)
M

“we’re so used to the other [tables] that getting used to these and the
transition isn’t great ever. The transition is never good but um just learning
how do it and what to prepare for beforehand; whereas we knew before. So
D

to really give a truthful answer, yeah, there’s a lot of pros and cons but just
because we’re used to something else.”(nurse, focus group)
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