Enhancing primary care for persons with spinal cord injury: More than improving physical accessibility

Milligan, James; Lee, Joseph

doi:10.1179/2045772315y.0000000041

Cited by 18 publications

(19 citation statements)

References 8 publications

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“…The resources and home modifications required for individuals returning to the community represent a huge cost for the patient, insurance provider, and the healthcare system as a whole but are unlikely to be incurred multiple times as the majority of individuals may remain in their own homes. With the increasing awareness about the importance of accessible communities 38 and the availability of emerging tele-health enabling “virtual” interactions with primary care providers in the community setting, 31 , 32 it may be possible to reduce the environmental barriers experienced.…”

Section: Discussionmentioning

confidence: 99%

Rural and Urban Living in Persons with Spinal Cord Injury and Comparing Environmental Barriers, Their Health, and Quality-of-Life Outcomes

Glennie

Batke

Fallah

et al. 2017

Journal of Neurotrauma

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There is worldwide geographic variation in the epidemiology of traumatic spinal cord injury (tSCI). The aim of this study was to determine whether environmental barriers, health status, and quality-of-life outcomes differ between patients with tSCI living in rural or urban settings, and whether patients move from rural to urban settings after tSCI. A cohort review of the Rick Hansen SCI Registry (RHSCIR) was undertaken from 2004 to 2012 for one province in Canada. Rural/urban setting was determined using postal codes. Outcomes data at 1 year in the community included the Short Form-36 Version 2 (SF36v2™), Life Satisfaction Questionnaire, Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF), Functional Independent Measure® Instrument, and SCI Health Questionnaire. Statistical methodologies used were t test, Mann-Whitney U test, and Fisher's exact or χ2 test. In the analysis, 338 RHSCIR participants were included; 65 lived in a rural setting and 273 in an urban setting. Of the original patients residing in a rural area at discharge,10 moved to an urban area by 1 year. Those who moved from a rural to urban area reported a lower SF-36v2™ Mental Component Score (MCS; p = 0.04) and a higher incidence of depression at 1 year (p = 0.04). Urban patients also reported a higher incidence of depression (p = 0.02) and a lower CHIEF-SF total score (p = 0.01) indicating fewer environmental barriers. No significant differences were found in other outcomes. Results suggest that although the patient outcomes are similar, some patients move from rural to urban settings after tSCI. Future efforts should target screening mental health problems early, especially in urban settings.

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Section: Discussionmentioning

confidence: 99%

Rural and Urban Living in Persons with Spinal Cord Injury and Comparing Environmental Barriers, Their Health, and Quality-of-Life Outcomes

Glennie

Batke

Fallah

et al. 2017

Journal of Neurotrauma

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“…In this issue of The Journal of Spinal Cord Medicine, Milligan and his team described a progressive effort to enhance primary care for persons with spinal cord injury (SCI). 1 The article describes the process of establishing this successful, inter-professional effort, in their Family Medicine-based clinic in Ontario, Canada which has been funded by provincial funding agencies. Persons with SCI have been actively engaged in the design of this clinic, and there is access to Physiatrists in Spinal Cord Medicine through electronic consultation.…”

mentioning

confidence: 99%

Primary care for persons with spinal cord injury — not a novel idea but still under-developed

2016

The Journal of Spinal Cord Medicine

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Primary care for persons with spinal cord injury (SCI) has long been recognized as an important issue. Over the last two decades, there has not been any consensus on its contents, pathway or delivery model. Despite the lack of attention on this issue, various health care organizations and settings have successfully developed their own version of primary care for persons with SCI. On the other hand, persons with SCI have also found different ways to obtain primary care through Family Physicians and specialists, often depending on the health care structure of their country. This has blurred the line between what is traditionally seen as primary vs. specialist care. The "medical home" model may be ideal for SCI primary care, and it may be establishsed in different care settings. In order to create this model, health care funding structure, appropriate access to physical facility and SCI knowledge, interdisciplinary provider availability and collaboration, as well as active engagement with persons with SCI are necessary. The SCI community should endorse SCI primary care with effective advocacy and implementation.

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“…For example, in the United States the Patient-Centered Medical Homes are emerging as delivery models with the aim of improving continuity of care [ 28 ]. Persons with SCI would likely benefit from a similar model of care that involves colocation of services [ 29 , 30 ], particularly with access to pharmacists who can provide comprehensive medication management [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Prescription drug claims following a traumatic spinal cord injury for older adults: a retrospective population-based study in Ontario, Canada

et al. 2018

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Study designRetrospective cohort study.ObjectivesThe objectives for this study were to examine the prevalence of polypharmacy for people with traumatic spinal cord injury (SCI) following injury and to determine risk factors.SettingOntario, CanadaMethodsWe used provincial-level administrative health services data of publicly funded healthcare encounters housed at the Institute for Clinical Evaluative Sciences, Toronto, Ontario. We examined prescription medications dispensed over a 1 year period post injury for persons 66+ years with an index traumatic SCI between 2004 and 2014. Polypharmacy was defined as being on 10 or more drug classes. Descriptive and analytical statistics were conducted. Relative risks and 95% confidence limits for factors related to polypharmacy were calculated using a robust Poisson multivariate regression model.ResultsWe identified 418 cases of persons with traumatic SCI during the observation window. A total of 233 patients (56%) were taking at least 10 drug classes in the year following discharge from care for traumatic SCI. The mean number of drug classes taken post injury was 11 (SD = 6). Continuity of care was significantly associated with polypharmacy, with a higher continuity of care (having at least 75% of visits with the same doctor) reducing the risk of polypharmacy. The most common drugs prescribed were laxatives, opioids and cardiovascular-related drugs.ConclusionFindings suggest that polypharmacy is extensive among older adults with traumatic SCI. Persons with better continuity of care are less likely to have polypharmacy compared to those with less continuity.SponsorshipThis project was funded by a Connaught New Investigator Award (University of Toronto), and the Craig H. Neilsen Foundation Psychosocial Research Pilot Grant (Grant #441259).

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Enhancing primary care for persons with spinal cord injury: More than improving physical accessibility

Cited by 18 publications

References 8 publications

Rural and Urban Living in Persons with Spinal Cord Injury and Comparing Environmental Barriers, Their Health, and Quality-of-Life Outcomes

Rural and Urban Living in Persons with Spinal Cord Injury and Comparing Environmental Barriers, Their Health, and Quality-of-Life Outcomes

Primary care for persons with spinal cord injury — not a novel idea but still under-developed

Prescription drug claims following a traumatic spinal cord injury for older adults: a retrospective population-based study in Ontario, Canada

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