Jones K E, Tamari I E
Department of Family and Community Medicine, Toronto Hospital.
CMAJ. 1997 Mar 1;156(5):647-56.
To develop recommendations for office-based physicians who wish to make their offices accessible to all patients.
Include taking steps to make offices more accessible, or not; offices may be accessible to varying degrees.
Outcomes of accessibility involve patient-care, economic, ethical and legal issues. Stakeholders in these outcomes include patients, physicians, government and society.
Data were obtained from a series of searches of MEDLINE, CINAHL and Healthstar (previously Health) databases for articles on disability and family medicine, primary (health) care and family practice, and on access and offices, and health services accessibility, and from a telephone survey of 50 stakeholders.
A high value was placed on services to persons with disabilities and on stakeholder input. Universal accessibility was valued as an overall goal; improved accessibility was also highly valued.
BENEFITS, HARMS AND COSTS: Benefits to patients include improved access to care as guaranteed by the Canada Health Act and in keeping with provincial Human Rights Codes. Benefits to physicians include contact with a broader patient population and freedom from fear of litigation. Costs of improved accessibility vary depending on individual circumstances and on whether an office is being built or renovated; some improvement costs are minimal.
All physicians should take measures to improve practice accessibility. Improved access should be considered in each of the following areas: transportation and entrance to the facility, entrance to the office, waiting rooms, rest rooms, examination rooms, general building features and other features.
No similar guidelines exist. To assess the content validity of these guidelines, the authors had a draft document reviewed by 18 stakeholders. All specific recommendations met the minimum criterion of adherence to current legislation, including national and provincial building codes. The specific recommendations are endorsed by the Canadian Paraplegic Association (national and Ontario offices), the DisAbled Women's Network (Ontario) and the Centre for Independent Living (Toronto).
Development of these guidelines was supported in part by the Department of Family and Community Medicine, Toronto Hospital, Toronto, Ont.
为希望让其办公室对所有患者均无障碍的门诊医生制定建议。
包括采取措施使办公室更便于出入，或不采取措施；办公室的无障碍程度可能各不相同。
无障碍的结果涉及患者护理、经济、伦理和法律问题。这些结果的利益相关者包括患者、医生、政府和社会。
数据来自对MEDLINE、CINAHL和Healthstar（以前的Health）数据库进行的一系列搜索，以查找有关残疾与家庭医学、初级（保健）护理和家庭医疗，以及关于出入与办公室、卫生服务可及性的文章，并来自对50名利益相关者的电话调查。
高度重视为残疾人提供的服务以及利益相关者的意见。普遍无障碍被视为总体目标；改善无障碍程度也受到高度重视。
益处、危害和成本：对患者的益处包括《加拿大健康法》保障的以及符合省级人权法规的更好的医疗服务可及性。对医生的益处包括接触更广泛的患者群体以及免于诉讼恐惧。改善无障碍程度的成本因具体情况以及办公室是新建还是翻新而异；一些改善成本微不足道。
所有医生都应采取措施改善医疗服务的可及性。应在以下每个领域考虑改善可及性：交通与设施入口、办公室入口、候诊室、洗手间、检查室、一般建筑特征和其他特征。
不存在类似的指南。为评估这些指南的内容效度，作者让18名利益相关者对一份文件草稿进行了审阅。所有具体建议均符合遵守现行立法（包括国家和省级建筑规范）的最低标准。这些具体建议得到了加拿大截瘫协会（国家和安大略省办事处）、残疾妇女网络（安大略省）和独立生活中心（多伦多）的认可。
这些指南的制定部分得到了安大略省多伦多市多伦多医院家庭与社区医学部的支持。
