First contact of care for persons with spinal cord injury: a general practitioner or a spinal cord injury specialist?

Abstract

Background Although general practitioners (GPs) are generally considered as the first point of contact for care, this may be different for persons with complex conditions, such as those with spinal cord injury (SCI). The objective of this study is to understand the differences in long-term care provision by GPs and SCI-specialists, by examining (1) the first contact of care for SCI health problems, (2) the morbidity profile and use of health-care services in relation to first contact, and (3) the factors associated with the choice of first contact. Methods In this cross-sectional study based on data derived from the Swiss Spinal Cord Injury Cohort Study Community Survey 2017, the main outcome measure was the reported first contact for SCI-specific care. This information was analysed using the chi-square test and logistic regression analysis of groups based on patient characteristics, use of health-care services and secondary health conditions assessed using the Spinal Cord Injury Secondary Conditions Scale (SCI-SCS). Results Out of 1294 respondents, 1095 reported their first contact for SCI-specific care; 56% indicated SCI-specialists and 44% specified GPs. On average, participants who first contacted a GP reported higher number of GP consultations (5.1 ± 5.2 vs. 3.9 ± 7.2), planned visits to ambulatory clinics (3.7 ± 7.3 vs. 3.6 ± 6.7) and hospital admissions (GP, 1.9 ± 1.7 vs. 1.5 ± 1.3), but lower number of visits to SCI-specialists (1.7 ± 1.8 vs. 2.6 ± 1.7) and of hospital days (22.8 ± 43.2 vs. 31.0 ± 42.8). The likelihood to contact a GP first was significantly higher in persons ≥75 years old (OR = 4.44, 95% CI = 1.85–10.69), Italian speakers (OR = 5.06, 95% CI = 2.44–10.47), had incomplete lesions (OR = 2.39, 95% CI = 1.71–3.35), experiencing pain (OR = 1.47, 95% CI = 1.04–2.09) or diabetes mellitus (OR = 1.85, 95% CI = 1.05–3.27), but lower for those situated closer to SCI centres (OR = 0.69, 95% CI = 0.51–0.93) or had higher SCI-SCS scores (OR = 0.92, 95% CI = 0.86–0.99). Conclusion Age, language region, travel distance to SCI centres, lesion completeness, and occurrence of secondary conditions play a significant role in determining the choice of first contact of care, however there is still some unwarranted variation that remains unclear and requires further research.

Does the socioeconomic status predict health service utilization in persons with enhanced health care needs? Results from a population-based survey in persons with spinal cord lesions from Switzerland

“…The trend that persons granted supplementary benefits were more likely to visit general practitioners has been observed for the general Swiss population [ 10 ] and might be explained by the fact that persons with supplementary benefits more often live in institutions, where basic health care is provided by the general practitioners. Moreover, elderly persons are at higher risk to be granted supplementary benefits, and elderly persons more often report long-term care relationships with general practitioners than younger persons [ 41 ]. The higher support from home care services in persons receiving supplementary benefits might be explained by financial reasons, as health insurance fully covers the cost of home care for persons who are granted supplementary benefits, whereas others usually have to contribute a considerable part of the financing for home care services by themselves.…”

Clinical Prediction Rule Validation for Ambulation Outcome After Traumatic Spinal Cord Injury in a Spanish Population

“…Furthermore, neurological assessments performed at acute care hospitalization may not be available at admission to specialized rehabilitation centers. The worldwide fragmentation of services and the lack of integrated care across physicians also challenge meeting the health care needs of persons with traumatic SCI (Touhami et al, 2021).…”

Why Do Community-Dwelling Persons with Spinal Cord Injury Visit General Practitioners: A Cross-Sectional Study of Reasons for Encounter in Swiss General Practice

“…3,10,13 Several studies investigated GP visits of persons with SCI. 10,12,14,15 A cross-sectional study of Donnelly et al examined the utilization of and access to primary care for persons with SCI in the United States, Canada, and the United Kingdom. 10 The majority considered their GP the most appropriate provider of care for new conditions or problems such as fatigue, pain, and bowel or bladder issues.…”

“…16 While specialized SCI care is the recommended choice in Switzerland, GPs remained the most visited health-care professionals by the vast majority of persons with SCI and the first point of contact for SCI-specific problems in 44% of cases. 11,14 Most reported contacting a GP for acute problems at an average of 4.5 visits per year. 11,14 Conversely, SCI specialists were predominately visited for check-ups by almost half of the participants at an average of 1.5 visits per year and were further pronounced as the first contact of care for 56% of cases.…”

“…11,14 Most reported contacting a GP for acute problems at an average of 4.5 visits per year. 11,14 Conversely, SCI specialists were predominately visited for check-ups by almost half of the participants at an average of 1.5 visits per year and were further pronounced as the first contact of care for 56% of cases. 11,14 However, specialists' support and availability of SCI outreach teams were foreseen as central to meeting the SCI-specific needs of the SCI population.…”