Why do challenges still exist in primary care for patients with spinal cord injury?

Abstract


 
 
 Despite having high healthcare needs, individuals with spinal cord injury (SCI) receive suboptimal primary care; they are less likely than able-bodied persons to receive preventive care and more likely to have unmet health care needs. The aim of this mixed quantitative (surveys) and qualitative (interviews) study was to gather primary care health provider and rehabilitation specialists’ perspectives on why these challenges persist despite the increasing body of evidence identifying delivery service gaps. Surveys were completed by 12 family physicians who referred individuals with SCI to an interprofessional primary care mobility clinic. Interviews were completed with eight SCI rehabilitation providers. Questions in both the survey and interviews were asked related to the barriers to the provision of optimal care for SCI, potential solutions, and preferred methods for knowledge dissemination. Skill and attitudinal reasons were offered for the lack of evidence to practice transfer including: the absence of patient self-management, poor access to specialists, lack of education for family practice physicians, fragmentation of community resources and co-ordination upon hospital discharge. Solutions offered included greater patient self-management, better access to specialists, specialized primary care services and provision of SCI guidelines and protocols. Participant explanations and solutions were then analyzed through a social disability lens to see if new understandings could be identified to explain the lack of uptake from research findings to clinical practice for this underserviced vulnerable population.
 
 

Autonomic Dysreflexia following Spinal Cord Injury

“…17 28 40 42 The compression of surrounding organs by enlarged uterus, as well as labors, delivery, breast-feeding, and changes arising during puerperal period are also strong triggering factors in women with cervical or high-thoracic lesions. 5 7 40 43 44…”

“…Nevertheless, this type of AD may also advance to the true emergency characterized by extreme hypertension (systolic blood pressure may exceed 300 mm Hg and diastolic 200 mm Hg), cardiac arrhythmia, pulmonary edema, and lethal outcome. 5 12 14 15 17 34 40 In the review of 26 studies analyzing 32 cases of life-threatening or fatal complications associated with AD, Wan and Krassioukov 28 identified 23 as central nervous system-related, 7 cardiovascular-related, and 2 pulmonary-related. Seven patients died; six due to intracerebral hemorrhage and one due to heart failure and pulmonary edema.…”

“…1 2 3 4 It occurs in 70 to 90% of patients with spinal cord injury (SCI) at or above T6. 2 5 6 7 8 Although rarely, AD-like symptoms were also observed in patients with degenerative disc disease, intramedullary tumors, or multiple sclerosis plaques in the cervical or thoracic region. 9 10 11 12 AD is typically presented as a sudden, uncontrolled high blood pressure accompanied by cardiac arrhythmia, blurred vision, intense headache, skin erythema, and profuse sweating in the part of the body above the SCI.…”

“…9 10 11 12 AD is typically presented as a sudden, uncontrolled high blood pressure accompanied by cardiac arrhythmia, blurred vision, intense headache, skin erythema, and profuse sweating in the part of the body above the SCI. 5 13 14 Episode of the high blood pressure might be associated with a high risk of intracranial or retinal hemorrhage, seizures, heart failure, or pulmonary edema. 2 14 15 16 17 This fact represents an emergent situation demanding immediate medical attention.…”

“…The paucity of familiarity with this clinical entity may cause misdiagnosis, hesitancy, delay in the appropriate management, and thus irreversible harm to the patient. 5 17 18 The aforementioned reasons inspired the authors to review literature dealing with current treatment strategies of the serious clinical condition.…”