First Contact of Care for Persons With Spinal Cord Injury: A General Practitioner or a Spinal Cord Injury Specialist?

Abstract

Background. Inter-professional collaboration between general practitioners (GPs) and spinal cord injury (SCI) specialists is needed to improve the health outcomes of persons with 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. The mean ± standard deviation of the total SCI-SCS was significantly lower in persons who initially consulted GPs (13.1±7.7) than SCI-specialists (14.6±7.3). 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 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= 4.78, 95%-CI= 1.99–11.50), Italian speakers (OR= 5.11, 95%-CI= 2.47–10.54), had incomplete lesions (OR 2.51, 95%-CI 1.78–3.54) or diabetes mellitus (OR= 1.81, 95%-CI= 1.03–3.18), but lower for those situated closer to SCI centers (OR= 0.69, 95%-CI= 0.51–0.93) or experiencing bowel dysfunction (OR= 0.71, 95%-CI= 0.52–0.98).Conclusion. The choice of first contact for SCI-specific care may be partly explained by the complementary roles of GPs and SCI specialists, but the reasons for variation are still unclear. Developing a transparent shared-care model between GPs and SCI specialists, with defined roles and responsibilities, may improve the management of secondary health conditions.

Who Wants To Improve Collaboration in Services for Individuals with Chronic Conditions? Specialists and Rural General Practitioners Taking Action in a Fragmented Health Care System

“…For these physicians, the low level of interaction between physicians results in low interest in the topic, which then results in a lower collaboration quality. As non-participating GPs would bene t the most from our intervention and patients with SCI wish to have a GP that can be contacted (21,22,25), we need to nd possibilities to engage some of them after our intervention study in a policy improvement scheme.…”

“…Spinal cord injury (SCI) is an exempli cation of a chronic condition that requires lifelong care for secondary health conditions. These patients' needs blur boundaries and responsibilities of care providers at the interface of primary and secondary care (21,22). In Switzerland, individuals with SCI who live close to one of four specialised SCI centres seem to bene t from a good interface, as patient-reported primary care services were rated of high quality (23).…”

The healthcare needs and general practice utilization of people with acquired neurological disability and complex needs: A scoping review

“…[7][8][9] Although primary care can involve several service providers (e.g., medical and allied health), encounters with general practitioners (GPs) are particularly important given their role as coordinators between patients and multiple healthcare providers. 8,10 However, the literature suggests that healthcare provided by GPs falls short of best-practice care. 7,11 For people with acquired neurological disabilities and complex needs, early intervention and management of their conditions are particularly important as they can prevent the development of comorbidities and complications.…”

“…7,11 For people with acquired neurological disabilities and complex needs, early intervention and management of their conditions are particularly important as they can prevent the development of comorbidities and complications. 8 High-quality care provided by GPs has the potential to avoid unnecessary hospitalizations and improve health outcomes, individual function and well-being over time. 10 GPs focus on the holistic view of the patient, with a focus on prevention 12 and understanding the whole patient.…”

“…1 These issues often fall to primary care for initial management. 7 , 8 , 9 Although primary care can involve several service providers (e.g., medical and allied health), encounters with general practitioners (GPs) are particularly important given their role as coordinators between patients and multiple healthcare providers. 8 , 10 However, the literature suggests that healthcare provided by GPs falls short of best‐practice care.…”