Health Care Utilization and Barriers Experienced by Individuals With Spinal Cord Injury

Stillman, Michael; Frost, Karen; Smalley, Craig; Bertocci, Gina; Williams, Steve

doi:10.1016/j.apmr.2014.02.005

Cited by 93 publications

(128 citation statements)

References 15 publications

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“…The most frequent HCP seen was a general practitioner (79.5%; n = 904), and 1.0% to 38.6% (n = 7-439) visited a specialist in the past year. HCU reported in this study was lower compared to a recent study by Stillman and colleagues who reported almost all subjects seeing a general practitioner and 85% visiting a specialist, 17 but it was still quite high. Despite these high levels of HCU, it was surprising to find such a high rate of unmet care needs.…”

Section: Discussioncontrasting

confidence: 53%

Health Care Utilization in Persons with Traumatic Spinal Cord Injury: The Importance of Multimorbidity and the Impact on Patient Outcomes

Noonan¹,

Fallah²,

Park³

et al. 2014

Topics in Spinal Cord Injury Rehabilitation

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Background:Persons with spinal cord injury (SCI) living in the community have high health care utilization (HCU). To date, the interrelationships among multiple secondary health conditions (multimorbidity due to comorbidities and complications) that drive HCU and their impact on patient outcomes are unknown. Objective: To determine the association among multimorbidity, HCU, health status, and quality of life. Methods: Community-dwelling persons with traumatic SCI participated in an online/phone SCI Community Survey. Participants were grouped using the 7-item HCU questionnaire (group 1 did not receive needed care and/or rehospitalized; group 2 received needed care but rehospitalized; group 3 received needed care and not rehospitalized). Personal, injury, and environmental factors; multimorbidity (presence/absence of 30 comorbidities/ complications); health status (Short Form-12); and quality of life measures (Life Satisfaction-11 first question and single-item quality of life measure) were collected. Associations among these variables were assessed using multivariate analysis. Results: The 1,137 survey participants were divided into 3 groups: group 1 (n = 292), group 2 (n = 194), and group 3 (n = 650). Group 1 had the greatest number of secondary health conditions (15.14 ± 3.86) followed by group 2 (13.60 ± 4.00) and group 3 (12.00 ± 4.16) (P < .05). Multimorbidity and HCU were significant risk factors for having a lower SF-12 Mental (P < .001) and Physical Component Score (P < .001). They in turn were associated with participants reporting a lower quality of life (P < .001, for both questions). Conclusions: Multimorbidity and HCU are interrelated and associated with lower health status, which in turn is associated with lower quality of life. Future work will include the development of a screening tool to identify persons with SCI at risk of inappropriate HCU (eg, rehospitalization, not able to access care), which should lead to better patient outcomes and cost savings.

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Section: Discussioncontrasting

confidence: 53%

Health Care Utilization in Persons with Traumatic Spinal Cord Injury: The Importance of Multimorbidity and the Impact on Patient Outcomes

Noonan¹,

Fallah²,

Park³

et al. 2014

Topics in Spinal Cord Injury Rehabilitation

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“…In retrospect, this is not surprising given our site observations that few clinics owned an ADA-compliant examination table. It is also consistent with findings of others obtained by surveying physicians, practice managers, and patients regarding healthcare services provided to patients with mobility and other disabilities [2,10,[15][16]. It also reinforces our previous study of wheelchair users with SCI, in which 85 percent of patients with SCI reported being examined while they remained seated in their wheelchairs and nearly twothirds believed they had been offered incomplete medical care because of their disability [10].…”

Section: Discussionsupporting

confidence: 79%

“…It is also consistent with findings of others obtained by surveying physicians, practice managers, and patients regarding healthcare services provided to patients with mobility and other disabilities [2,10,[15][16]. It also reinforces our previous study of wheelchair users with SCI, in which 85 percent of patients with SCI reported being examined while they remained seated in their wheelchairs and nearly twothirds believed they had been offered incomplete medical care because of their disability [10]. While some examinations (e.g., ear, nose, and throat) may be provided equitably whether or not the patient is seated in a wheelchair or on an examination table, standard protocols often require the patient to be placed in a supine or prone position to permit palpation or further examination/testing.…”

Section: Discussionsupporting

confidence: 78%

“…Perhaps more importantly, 19 percent felt they received inadequate care and 22 percent perceived that their disability prevented them from receiving appropriate care [9]. More recently, Stillman et al surveyed wheelchair users with spinal cord injury (SCI) and found that 77 percent of patients could not access the examination table in primary care settings and 89 percent had not been weighed during their visit [10]. Physical accessibility barriers included narrow hallways or doorways that prevented entry to or within a clinic, examination tables that were not height-adjustable, and check-in counters and restrooms that were inaccessible to wheelchair users.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Accessibility of outpatient healthcare providers for wheelchair users: Pilot study

Frost

Bertocci²,

Stillman³

et al. 2015

J Rehabil Res Dev

Self Cite

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Abstract-The Americans with Disabilities Act (ADA) requires full and equal access to healthcare services and facilities, yet studies indicate individuals with mobility disabilities receive less than thorough care as a result of ADA noncompliance. The objective of our pilot study was to assess ADA compliance within a convenience sample of healthcare clinics affiliated with a statewide healthcare network. Site assessments based on the ADA Accessibility Guidelines for Buildings and Facilities were performed at 30 primary care and specialty care clinics. Clinical managers completed a questionnaire on standard practices for examining and treating patients whose primary means of mobility is a wheelchair. We found a majority of restrooms (83%) and examination rooms (93%) were noncompliant with one or more ADA requirements. Seventy percent of clinical managers reported not owning a heightadjustable examination table or wheelchair accessible weight scale. Furthermore, patients were examined in their wheelchairs (70%-87%), asked to bring someone to assist with transfers (30%), or referred elsewhere due to an inaccessible clinic (6%). These methods of accommodation are not compliant with the ADA. We recommend clinics conduct ADA selfassessments and provide training for clinical staff on the ADA and requirements for accommodating individuals with mobility disabilities.

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“…Stillman et al 4 outlined the challenges and lower than expected preventative screenings, such as mammogram and Papanicolaou smear, that were encountered by persons with SCI. These are examples of what standardized SCI primary care guidelines may include-the recommendations for the management of common SCI-related medical issues using existing evidence and expert consensus, the emphasis on preventative screenings and the processes required to achieve them, as well as the recommendations for various models of care that will facilitate these processes to occur.…”

mentioning

confidence: 99%

Response to Letter

2017

The Journal of Spinal Cord Medicine

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Response to "On Primary Care and Spinal Cord Injury"Thank you for the opportunity to respond to the letter to the editors, "On Primary Care and Spinal Cord Injury". This letter was submitted in response to the article, "Primary care for persons with spinal cord injury -not a novel idea but still under-developed". 1The authors of the letter had concerns for the call for the development of standardized spinal cord injury (SCI) primary care guidelines, which were discussed in the article.The authors argued that due to the lack of outcomes research focusing on common secondary complications, it is premature to call for standardized SCI primary care guidelines to be considered. While I agree with the authors' opinions that more research needs to be done on primary medical care issues for persons with SCI, one must take into account broader primary care issues beyond specific medical issues that the authors focus on, when considering the care of persons with SCI in the primary care setting. These include, but are not limited to the following:1. Ensure physical accessibility in the primary care office 2. Establish appropriate interdisciplinary support in the primary care setting 3. Set up direct access to SCI specialist support (e.g.Physiatrists, Neurologists, spinal surgeons, wound care specialists) 4. Collaborate with local advocacy and consumer organizations for psychosocial, housing, vocational and community reintegration supportThese are all issues that may not be typically available or even considered in a primary care setting. It would be useful for primary care offices which serve persons with SCI to follow standardized recommendations on these issues, in order to enhance their care for persons with SCI. Such guidelines will also provide the rationale and justification when primary care practices request and apply for financial and infrastructure support to modify, renovate or expand their current practice environment and to create a comprehensive, interdisciplinary structure to support persons with SCI in their practice.As for medical issues that need to be addressed in the primary care setting, a recent article by Mishori et al.2 outlined a number of SCI-related medical issues and provided pragmatic recommendations on how to approach them in the primary care setting, recognizing that some of them do not have strong evidence or specific recommendations for SCI yet. Another recent article (Hamilton et al. 3) described the patient-centered medical home model for the primary and preventative health care services for community-dwelling persons with SCI. Stillman et al.4 outlined the challenges and lower than expected preventative screenings, such as mammogram and Papanicolaou smear, that were encountered by persons with SCI. These are examples of what standardized SCI primary care guidelines may include-the recommendations for the management of common SCI-related medical issues using existing evidence and expert consensus, the emphasis on preventative screenings and the processes required to achieve them, as well ...

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Health Care Utilization and Barriers Experienced by Individuals With Spinal Cord Injury

Cited by 93 publications

References 15 publications

Health Care Utilization in Persons with Traumatic Spinal Cord Injury: The Importance of Multimorbidity and the Impact on Patient Outcomes

Health Care Utilization in Persons with Traumatic Spinal Cord Injury: The Importance of Multimorbidity and the Impact on Patient Outcomes

Accessibility of outpatient healthcare providers for wheelchair users: Pilot study

Response to Letter

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