. "7 RESEARCH ON THE ORGANIZATION, FINANCING, AND DELIVERY OF HEALTH SERVICES." Enabling America: Assessing the Role of Rehabilitation Science and Engineering. Washington, DC: The National Academies Press, 1997.
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mary health care and long-term support needs of people with disabling conditions (Batavia and DeJong, 1990). These services are critical to the prevention of secondary conditions and to the maintenance and improvement of function and well-being over the lifecourse. Yet little attention has been paid to the development of a coherent policy on the provision of these services for people with physical limitations. The committee has identified three broad areas of research that should be given high priority to ensure that people with disabling conditions receive the appropriate primary care and support services they need and are afforded every opportunity to achieve independence, equality, full participation, and economic self-sufficiency. These areas are consistent with the research priorities established at a national consensus conference focused on the primary health care needs of people with physical disabilities (DeJong et al., 1989; Burns et al., 1990).
Primary Health Care Needs and Impediments to Access to Services First, it is important that a better understanding of the primary health care needs of people with disabling conditions and the barriers that impede access to appropriate services be developed. Intrinsic to primary care practice is the promotion of health and the prevention of disease through a sustained partnership between patients and clinicians and within the context of family and community (Institute of Medicine, 1996). In this regard, access to appropriate primary health care is as important to people with disabling conditions as quality medical rehabilitation aimed at restoring function. People with disabling conditions are not only susceptible to acute and chronic health conditions that are typically associated with aging or exposure to environmental hazards or unhealthy lifestyles, but they are also at risk of secondary conditions directly related to their primary condition. It is well known that people with disabling conditions are particularly vulnerable to acute health problems such as decubitus ulcers, urinary tract infections, and contractures. The Centers for Disease Control and Prevention (CDC) through their community based surveillance and prevention programs have fostered the wide recognition of secondary conditions as a significant health problem among persons with disabilities (Graitcer and Maynard, 1990; Toal et al., 1993). These problems not only affect individual quality of life but are also associated with high health care costs, often paid for by public sources. Although a better understanding of the factors related to their incidence is still needed, there is substantial evidence to suggest that many of these problems are avoidable through the promotion of self-care and counseling, screening for early detection, appropriate and timely treatment, and early recognition and reduction of known risk factors (Marge, 1988; Institute of Medicine, 1991; Toal et al., 1993).