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Is disability exclusion associated with psychological distress? Australian evidence from a national cross-sectional survey.

ABSTRACT: OBJECTIVE:To examine the association between disability exclusion and psychological distress. DESIGN:Cross-sectional study. SETTING:Population-based study of individuals living in households across Australia. PARTICIPANTS:Respondents were persons aged 15 and over living with a disability. PRIMARY OUTCOME MEASURES:Reporting an experience of discrimination or avoidance behaviour due to a respondent's disability. High or very high levels of psychological distress measured using the Kessler K10 instrument. METHODOLOGY:Using the Survey of Disability, Ageing and Carers, we calculated the prevalence of persons with a disability experiencing psychological distress, disaggregated by experiences of disability exclusion, including discrimination and avoidance. Logistic regression models were fitted to examine the association between disability exclusion and psychological distress, once extensive controls and adjustments for survey design and presence of psychosocial disabilities were considered. RESULTS:About 62% of persons citing an experience of disability discrimination were in psychological distress, compared with 27% of those citing no discrimination. Furthermore, 53% of those who actively avoided social, familial or economic activities because of their disability experienced psychological distress, compared with 19% of those who did not avoid these situations. After controlling for demographic characteristics and disabling conditions, reporting an experience of disability discrimination or disability avoidance increased the odds of psychological distress by 2.2 (95% CI 1.74 to 2.26) and 2.6 (95% CI 2.28 to 2.97) times, respectively. Those who experienced both avoidance and discrimination were 3.7 (95% CI 2.95 to 4.72) times more likely to be in psychological distress than those experiencing neither. Avoidance and discrimination in healthcare settings were also found to be strongly associated with experiencing psychological distress. CONCLUSIONS:Given new policy initiatives to improve disability care, coupled with the increasing speed of population ageing, the onus is on governments and its citizenry to address disability exclusion to offset potential mental health impacts.

SUBMITTER: Temple JB

PROVIDER: S-EPMC5988124 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Is disability exclusion associated with psychological distress? Australian evidence from a national cross-sectional survey.

Temple Jeromey B JB Kelaher Margaret M

BMJ open 20180524 5

<h4>Objective</h4>To examine the association between disability exclusion and psychological distress.<h4>Design</h4>Cross-sectional study.<h4>Setting</h4>Population-based study of individuals living in households across Australia.<h4>Participants</h4>Respondents were persons aged 15 and over living with a disability.<h4>Primary outcome measures</h4>Reporting an experience of discrimination or avoidance behaviour due to a respondent's disability. High or very high levels of psychological distress ...[more]

PMID: 29794096

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Project description:ImportanceBilling errors and healthcare fraud have been described by the WHO as 'the last great unreduced health-care cost'. Estimates suggest that 7% of global health expenditure (US$487?billion) is wasted from this phenomenon. Irrespective of different payment models, challenges exist at the interface of medical billing and medical practice across the globe. Medical billing education has been cited as an effective preventative strategy, with targeted education saving $A250?million in Australia in 1?year from an estimated $A1-3?billion of waste.ObjectiveThis study attempts to systematically map all avenues of medical practitioner education on medical billing in Australia and explores the perceptions of medical education stakeholders on this topic.DesignNational cross-sectional survey between April 2014 and June 2015. No patient or public involvement. Data analysis-descriptive statistics via frequency distributions.ParticipantsAll stakeholders who educate medical practitioners regarding clinical practice (n=66). 86% responded.ResultsThere is little medical billing education occurring in Australia. The majority of stakeholders (70%, n=40) did not offer/have never offered a medical billing course. 89% thought medical billing should be taught, including 30% (n=17) who were already teaching it. There was no consensus on when medical billing education should occur.ConclusionsTo our knowledge, this is the first attempt of any country to map the ways doctors learn the complex legal and administrative infrastructure in which they work. Consistent with US findings, Australian doctors may not have expected legal and administrative literacy. Rather than reliance on ad hoc training, development of an Australian medical billing curriculum should be encouraged to improve compliance, expedite judicial processes and reduce waste. In the absence of adequate education, disciplinary bodies in all countries must consider pleas of ignorance by doctors under investigation, where appropriate, for incorrect medical billing.

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Dataset Information

Is disability exclusion associated with psychological distress? Australian evidence from a national cross-sectional survey.

Publications

Is disability exclusion associated with psychological distress? Australian evidence from a national cross-sectional survey.

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