Residential location of people with chronic spinal cord injury: the importance of local health care infrastructure

Abstract

BackgroundPeople with spinal cord injury (SCI) suffer from complex secondary health conditions and rely on specialized health care services, which are often centralized and difficult to reach for individuals living in remote areas. As a consequence, they might move to regions where they expect better access to care. The aims of this study were: 1) to identify regions where people with SCI live compared with the general population, 2) to examine whether their choice of residence is related to the availability of local health care infrastructure, and 3) to ascertain determinants of their consideration to change residence when aging.MethodsThis study used information from a nationwide Swiss SCI cohort and inpatient hospital discharge data. To detect clusters in the distribution of people with chronic SCI in Switzerland, a spatial cluster detection test was conducted using the normative population of a region as offset. To identify associations between the residential location of people with SCI and infrastructure variables, a negative binomial model was set up at a regional level with the frequency of people with SCI as outcome, geographical indicators as explanatory variables, and the normative population as offset. Determinants of the consideration to change residence when aging were investigated using logistic regression models.ResultsPeople with SCI were not living equally distributed among the normative population, but clustered in specific areas. They were more likely than the general population to reside close to specialized SCI centers, in areas with a high density of outpatient physicians, and in urban regions. People with SCI living in rural areas were more likely to consider relocating when aging than those living in urban areas. However, only a few people with SCI considered moving closer to specialized centers when such a move required crossing language barriers.ConclusionsGood access to appropriate health care services and amenities of daily life seems to play such an important role in the lives of people with SCI that they are willing to choose their residential location based on local availability of appropriate health care services.

Who are the beneficiaries and what are the reasons for non-utilization of respite care? A cross-sectional study on family caregivers

“…Households with persons with SCI tend to cluster in cantons where the SCI-speci c services are well established [22]. However, the participants in the present study rarely mentioned unavailability as a reason for non-use.…”

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

“…As described by Ronca et al, persons living farther from SCI centres tend to prefer proximate but less specialized care over comprehensive services at SCI centres [11,39]. Moreover, persons with more severe lesions are more likely to be situated closer to specialized SCI centres [40]. This further explains the choice of rst contact based on proximity to SCI centres.…”

Who are the beneficiaries and what are the reasons for non-utilization of care respite and support services? A cross-sectional study on family caregivers

“…Similarly, health care use in Switzerland is linked to the cantonal supply of services and financing [ 26 ]. Households with persons with SCI tend to be clustered in cantons where the SCI-specific services are well established [ 27 ]. However, participants in the present study rarely mentioned unavailability as a reason for non-use.…”