This document reports a study on the perception of people with disabilities on health care opportunities. The sample consisted of 135 persons with physical and sensory disabilities from the department of Meta (Colombia). An ad hoc instrument was used, consisting of ten items that inquire about the perception of opportunities for care in general medicine, specialized medicine, and delivery of medicines. The results indicate a moderately favorable perception in relation to the times for the assignment of medical appointments; and an unfavorable perception of the waiting times when attending the consultation and in the delivery of medicines. These results show the importance of the health entities in the department of Meta to improve the care provided to these people to guarantee their right to receive timely care and thus improve their quality of life.

Keywords: health service, patient, quality of life, medical consultation

When referring to disability, in any of its manifestations, health care is an essential and fundamental factor in assessing the quality of life of people with disabilities. In this sense, timeliness is one of the attributes and indicators of quality in health care. In Colombia, since Law 100 of 1993,¹ efforts have been made to guarantee the rights of individuals and communities to a quality of life in accordance with human dignity, by protecting them from the contingencies that affect them, especially those that affect their health, in this case, timely care.

The Ministry of Health and Social Protection defines timeliness in health as the "possibility for the user to obtain the services he/she requires without delays that could put his/her life or health at risk" (Ministry of Health and Social Protection, 2006).² In this regard, Decree 1011 of 2006 establishes that timeliness in health requires the effective organization of the supply of services according to demand, and adequate institutional coordination to manage access to services.³

With Law 1346 of July 31, 2009, the Convention on the Rights of Persons with Disabilities, adopted by the General Assembly of the United Nations, was ratified to guarantee in Colombia the protection of the rights of this population. Likewise, the National Council on Disability - CND, recommends to the national and territorial public entities that integrate the National Disability System, to contribute to the updating of the Registry for the Location and Characterization of Persons with Disabilities - RLCPD, information that allows feeding the National Disability Observatory -OND, for the respective monitoring and decision making. With the implementation of the above standards and strategies, significant progress has been made in health care for people with disabilities, however, there are still failures related to waiting times for care, which in most cases has a negative impact on the health of patients, especially in the case of people with disabilities. In this sense, we wanted to investigate how people with disabilities in the department of Meta perceive the opportunities in health care by their service providers.

This research has a non-experimental, cross-sectional design and is descriptive in scope, in that it seeks to describe how people with disabilities perceive health care opportunities, specifically in general and specialized medical care and the provision of medications.

In Colombia, 1.319.049 persons with disabilities reside, which represents 2.6% of the total population; of these persons, 48.9% are women and 50.1% are men (Registry for the Location and Characterization of Persons with Disabilities - RLCPD, 2020). In the case of the department of Meta, its population is 1.063.454 inhabitants according to the population projection of the National Population and Housing Census - CNPV 2018, of the National Administrative Department of Statistics -DANE-, of this population, 23.031 people report some type of disability, representing 2.2% (RLCPD, 2020).^4,5 The following inclusion criteria were considered for the study: persons with motor and sensory disabilities, over 18 years of age, of both sexes, residents in the department of Meta and who gave their informed consent. Through non-probabilistic sampling, a sample of 135 people with disabilities was obtained. For data collection, an ad hoc questionnaire-type instrument was used, to be applied as an interview. It consisted of 10 items, which inquired about the perception of opportunities for care in general medicine, specialized medicine and delivery of medicines. In addition, 10 items on sociodemographic information.

Sociodemographic characterization

Of the total number of participants, 76 (56%) were women and 59 (44%) were men. At the time of the interview, 21 (16) people reported being 20 years old or younger, 26 (19%) were 21 to 29 years old, 34 (25%) were 30 to 39 years old, 21 (16%) were 40 to 49 years old, 17 (13%) were 50 to 59 years old and 16 (12%) were 60 years old or older. Regarding socioeconomic level, it was found that 69 (51%) people belonged to stratum one, 38 (28%) to stratum two and 28 (21%) to stratum three. Regarding marital status, 58 (43%) were single, 23 (17%) were married, 39 (29%) were in union and 15 (11%) were widowed. One aspect of interest in the study has to do with the type of health system to which people with disabilities are linked. It was found that 90 (67%) belonged to the subsidized regime, 41 (30%) to the contributory regime and 4 (3%) were not insured (Table 1).

Timeliness of health care - general medicine

Regarding the timeliness of care in general medicine, the following questions were asked:

How often do you request an appointment at your Health Promoting Entity (EPS) for general medicine in this regard, 41% of respondents answered that every six months, 36% request an appointment every one month, 18% reported that more or less every one year and 1.5% every three to five years. The results indicate that 38.5% of people with disabilities, when requesting an appointment for general medicine, are generally assigned for one to three days, 21.5% reported four to seven days, 20.7% are assigned to be seen in eight to 15 days, 12.6% are seen in 16 to 30 days and 6.7% must wait more than 30 days. Regarding the waiting time for an appointment, from the moment it is assigned, the perception is moderately favorable (ℜ= 2.67, σ= 0.93). Regarding the time they must wait from the time they arrive at the office until the physician sees them, 63.7% reported waiting less than one hour, 29.6% from one to two hours and 6.7% must wait three to four hours. And the perception is unfavorable (ℜ= 2.51, σ= 0.84).

Timeliness of health care- specialty medicine

About the timeliness of care in specialized medicine, we asked:

How often do you request an appointment at your EPS for specialized medicine? In this regard, 48% of those interviewed responded that they request an appointment every one month, 29% more or less every six months, 28% reported that more or less every one year and 30% every three to five years. The results indicate that 17.8% of people with disabilities, when requesting an appointment with a specialist, are generally assigned to be seen in one to seven days, 14.1% reported eight to 15 days, 23.7% are assigned to be seen in 30 days or less, 22.2% are seen in 60 days or less and 22.2% must wait more than 60 days. The perception regarding the waiting time for a consultation with a specialist, from the moment it is assigned, is moderately favorable (ℜ= 2.76, σ= 1.05). They also reported that the waiting time to be seen by the specialist is less than one hour for 46.7%, between one and two hours for 37.8%, and three to four hours for 15.6%. On this issue, they report an unfavorable perception (ℜ= 2.59, σ= 0.76).

Timeliness of health care - delivery of medications

The timely delivery of medicines by health insurers is an aspect that is highly valued by users, especially by people with disabilities, since in many cases their quality of life depends on it. In this regard, it was found that 42.2% of those interviewed generally receive their medications the same day, 22.2% to wait between one and five days, 18.5% between six and 15 days, 10.4% between 16 and 30 days, and 6.7% between 16 and 30 days. The perception regarding the timely delivery of medications is unfavorable (ℜ= 2.51, σ= 0.84).

The timeliness of care in health services is a determining factor of the quality of care and, in general, of the presentation of the service to users, especially when the patient is in a vulnerable condition, as is the case of people with disabilities. The results obtained indicate that the people interviewed had a moderately favorable perception with respect to the time stipulated when appointments are assigned, both for general medicine and for specialists. On the other hand, the perception of waiting time at the doctor's office is unfavorable. Equally unfavorable is the perception regarding delivery times for medicines. The Colombian Ministry of Health and Social Protection, in Resolution 1552 of 2013^6,7 establishes that the maximum term for the assignment of appointments for general medicine is three working days, which applies to the health promoting entities of the contributory and subsidized regimes of the social security health system. In the case of appointments with specialists, the response must be given within five working days from the date of the request. The timeliness of health care facilitates the detection of pathologies and the making of therapeutic decisions or treatments to reduce their consequences or sequels and reduce the time of disability in patients. In the case of people with disabilities, priority should be given to care. However, the standard of the general system of social security in health is not always met, which can generate frustration and dissatisfaction in patients.

None.

The authors declared there are no conflicts of interest.

1. Law 100 of 1993. Whereby the comprehensive social security system is created and other provisions are enacted. 1993.
2. Ministry of Health and Social Protection. National Disability Observatory. 2020.
3. Decree 1011 of 2006. By which the Obligatory System of Quality Assurance of Health Care of the General System of Social Security in Health is established. 2006.
4. National Administrative Department of Statistics (DANE). Directorate of Census and Demographics. 2020.
5. Law 134 of 2009. Whereby the Convention on the Rights of Persons with Disabilities, adopted by the General Assembly of the United Nations. 2009.
6. Resolution No. 1552. Whereby articles 123 and 124 of Decree - Law 019 of 2012 are partially regulated and other provisions are issued. 2013.
7. Republic of Colombia, Ministry of Health and Social Protection. Attributes of Quality in Health Care. 2015.