The Tipping Point: Perspectives on SCI Rehabilitation Service Gaps in Canada

Craven, B. Catharine; Balioussis, Christina; Verrier, Molly C.

doi:10.4172/2329-9096.1000165

Cited by 15 publications

(14 citation statements)

References 21 publications

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“…Individuals with SCI have rated their sexual functioning as either their first or second priority, with respect to quality of life, on a needs survey. 44 Anderson identified sexual function as the most important Domain for quality of life of individuals with paraplegia. 32 The current gaps in the area of sexual functioning, discomfort of patients and regulated health care professionals in dealing with this Domain, in concert with reduced inpatient rehabilitation length of stay over the last decade, have all resulted in limited attention to the Sexual Health Domain within Canadian rehabilitation service delivery models, with rare exceptions.…”

Section: Discussionmentioning

confidence: 99%

Prioritization of rehabilitation Domains for establishing spinal cord injury high performance indicators using a modification of the Hanlon method: SCI-High Project

Alavinia

Hitzig

Farahani

et al. 2019

The Journal of Spinal Cord Medicine

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Objectives: To prioritize Domains of SCI Rehabilitation Care (SCI-Care) based on clinical importance and feasibility to inform the development of indicators of quality SCI-Care for adults with SCI/D in Canada. Methods: A 17-member external advisory committee, comprised of key stakeholders, ranked 15/37 Domains of rehabilitation previously flagged by the E-scan project team for gaps between knowledge generation and clinical implementation. Priority scores (D) were calculated using the Hanlon formula: D = [A + (2 × B)] × C, where A is prevalence, B is seriousness, and C is the effectiveness of available interventions. A modified "EAARS" (Economic, Acceptability, Accessibility, Resources, and Simplicity) criterion was used to rank feasibility on a scale of 0-4 (4 is high). The product of these two scores determined the initial Domain ranking. Following the consensus process, further changes were made to the Domain rankings. Results: Despite a low feasibility score, Sexual Health was ranked as high priority; and, the Community Participation and Employment Domains were merged. The 11 final prioritized Domains in alphabetic order were:

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Section: Discussionmentioning

confidence: 99%

Prioritization of rehabilitation Domains for establishing spinal cord injury high performance indicators using a modification of the Hanlon method: SCI-High Project

Alavinia

Hitzig

Farahani

et al. 2019

The Journal of Spinal Cord Medicine

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“…4 Craven and colleagues argued that NTSCI and TSCI 'do not equate' ( p.2) and the system needs to acknowledge and be responsive to the unique and similar needs of persons with NTSCI. 4 In support of Craven and colleagues' argument, only 26% of individuals with a NTSCI were discharged from an acute trauma/spine center to an inpatient rehabilitation facility compared to 59% with TSCI. Further, a very small proportion of individuals who were discharged to the community from hospital received home care services.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Most individuals experience significant secondary health complications, 1,2 chronic conditions and multimorbidities, [3][4][5] which have substantial impact on overall health and wellbeing, reintegration into the workplace, and quality of life. 6,7 While many of these secondary health complications are potentially preventable, such as urinary tract infections, pressure ulcers and pain, they are purported to be key precipitants for emergency department (ED) visits, re-hospitalizations and/or mortality in the post-acute phase following discharge from inpatient SCI rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Developing quality of care indicators for patients with traumatic and non-traumatic spinal cord injury (SCI): A feasibility study using administrative health data

Guilcher¹,

Parsons

Craven³

et al. 2015

The Journal of Spinal Cord Medicine

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Objectives: (1) to inform the development of health system quality indicators for traumatic and non-traumatic spinal cord injury from acute care admission to community care discharge using administrative data, and (2) to examine characteristics and differences in care among type of care facility, and type of pathology using administrative data. Design: Retrospective cohort study using administrative health data. Setting: Ontario, Canada. Participants: Using administrative health data, we used International Classification codes 10 th version Canadian Edition to identify incident cases of SCI from April 1, 2006 to March 31, 2012. Results: We identified 7,693 cases in our cohort, of whom 1,537 (20.0%) were categorized as traumatic spinal cord (TSCI) and 6,156 (80.0%) as non-traumatic (NTSCI). Of those identified with NTSCI, more than half (54.0%) were diagnosed with either Guillain Barré syndrome and Multiple Sclerosis (n = 3,326). More individuals admitted to a trauma/spine center were seen by an orthopedic surgeon or a neurosurgeon (20.3% compared to 5.6% for NTSCI; 77.7% compared to 24.9% for TSCI). Only 25.7% (n = 724) of the NTSCI cohort were admitted to a rehabilitation facility from a trauma/spine center, compared to 58.9% (n = 754) of those with TSCI. Conclusions: Important challenges in data completeness and utility were identified. Province wide processes to flag incomplete data and provision of incentives for comprehensive data are urgently needed to develop quality indicators across the care continuum. Consensus on the coding for NTSCI for the purposes of developing health system indicators is required.

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“…People with spinal cord injury or dysfunction (SCI/D) typically take multiple medications (also known as polypharmacy) to manage secondary health complications (e.g., spasticity, urinary tract infections, pressure sores, respiratory infections) and multimorbidity (e.g., heart disease and diabetes) [1][2][3][4][5][6]. The reported polypharmacy rates among persons with SCI/D vary between 31 to 87% [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Ideal MTM can be defined as "patient-centred care to optimize safe, effective and appropriate drug therapy" [19], with the "care" being a collaboration between the patient and care team members [19]. The lack of research on optimal MTM for SCI/D is surprising given that most persons with SCI/D experience significant complications directly and indirectly related to their injuries [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“The strategies are the same, the problems may be different”: a qualitative study exploring the experiences of healthcare and service providers with medication therapy management for individuals with spinal cord injury/dysfunction

et al. 2020

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Background: Persons with spinal cord injury/dysfunction (SCI/D) often take multiple medications to treat their secondary complications and chronic conditions (multimorbidity). Multiple healthcare and service providers are often involved in care, which can result in increased risk of fragmentation of care. Optimal medication therapy management (MTM) is essential to ensure therapeutic benefit from medication regimens. However, little is known about the experiences of providers in supporting persons with SCI/D with MTM. Methods: Telephone interviews were conducted to explore healthcare and service providers' experiences with MTM for persons with SCI/D. Participants were recruited through clinical organizations and researchers' personal contacts. Participants were purposefully selected for diversity in profession and were required to be English speaking and to have provided care to at least one person with SCI/D. The qualitative interviews followed a semistructured interview guide. Data display matrices were used in a constant comparative process for descriptive and interpretive analysis. Results: Thirty-two interviews were conducted from April to December 2018. Each profession had distinct views on their roles in facilitating MTM for persons with SCI/D, which aligned with their respective scopes of practice. Shared provider tasks included tailoring medications, providing education, and exploring medication alternatives. Most participants felt that the care they provided for persons with SCI/D was similar to the care that they provided to other patients, with some differences relating to the physical limitations and medical complexity associated with SCI/D. Five factors were identified that impacted participants' abilities to provide MTM for persons with SCI/D: patient self-management skills, provider knowledge and confidence, provider-patient relationships, interprofessional collaboration, and provider funding models including the use of technology-supported consultations.

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The Tipping Point: Perspectives on SCI Rehabilitation Service Gaps in Canada

Cited by 15 publications

References 21 publications

Prioritization of rehabilitation Domains for establishing spinal cord injury high performance indicators using a modification of the Hanlon method: SCI-High Project

Prioritization of rehabilitation Domains for establishing spinal cord injury high performance indicators using a modification of the Hanlon method: SCI-High Project

Developing quality of care indicators for patients with traumatic and non-traumatic spinal cord injury (SCI): A feasibility study using administrative health data

“The strategies are the same, the problems may be different”: a qualitative study exploring the experiences of healthcare and service providers with medication therapy management for individuals with spinal cord injury/dysfunction

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