Disability & Society, Vol. 18, No. 4, 2003, pp. 443–455 Improving Primary Care for Persons with Disabilities: the nature of expertise BARBARA BOWERS 1 , SARAH ESMOND 1 *, BARBARA LUTZ 2 & NORA JACOBSON 3 1 University of Wisconsin-Madison, School of Nursing, 600 Highland Avenue, CSC, Madison, WI 53792-2455, USA, 2 University of Florida, College of Nursing, Department of Health Care Environments and Systems, P.O. Box 100197, Gainesville, FL 32610-0197, USA, and 3 Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, Canada M5S 2S1 ABSTRACT It has been well documented that persons with disabilities (PWDs) have a more vulnerable health status than persons without disabilities; yet, they often receive inadequate primary care within the US health care system. This study explores how PWDs think about the health care they receive, particularly how primary care providers facilitate or hinder quality care for PWDs. The findings from this study expand the concept of expertise in health care, suggesting it goes well beyond technical competence of health care providers. For PWDs, expertise is multi-dimensional, not solely the domain of providers and includes having knowledge and using that knowledge within the context of the provider–pa- tient relationship. PWDs identified three distinct areas of expertise: medical/technical, medical/biographical, and systems. Expertise can be brought to health care encounters by both PWDs and providers, and it can be developed through collaboration during interac- tions between providers and PWDs. Introduction In the United States the provision of health promotion and disease prevention services in clinical settings by general and family practitioners, general internists and paediatricians is known as primary care. Patients seek care from primary care providers in the US much like patients in the United Kingdom (UK), and other developed nations utilise the services of a general practitioner (GP). It has been well documented that persons with disabilities (PWDs) have a more vulnerable health status than persons without disabilities (Batavia et al., 1988–89; Pope & Tarlov, 1991; Sutton & DeJong, 1998; DeJong et al., 2002). Yet, community-living PWDs in the US receive inadequate health promotion and disease prevention services *Corresponding author. ISSN 0968-7599 (print)/ISSN 1360-0508 (online)/03/040443-13  2003 Taylor & Francis Ltd DOI: 10.1080/0968759032000080995