Response to Letter

Abstract

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 ...