Abstract
Study design:
Retrospective cohort study.
Objectives:
To describe the physician utilization patterns (family physicians (FP), specialist and emergency department (ED) visits) of adults with traumatic spinal cord injury (SCI) 1 year after the initial injury.
Setting:
Ontario, Canada.
Methods:
A total of 559 individuals with a traumatic SCI were identified. Five administrative databases were linked to examine health-care utilization in acute care, inpatient rehabilitation, chronic care rehabilitation, outpatient physician visits and ED visits. Factors predicting frequent physician, specialist and ED use were identified.
Results:
The mean number of physician visits for traumatic SCI patients during the first year after their injury onset was 31.7 (median 26). FPs had the greatest number of visits (mean 11.6, median 7) followed by physiatrists (mean 6.1, median 2). Factors predicting 50 or more physician visits included age 70 or above (OR=3.6, 95% CI=2.0–6.5), direct discharge to chronic care (OR=3.6, 95% CI=1.0–13.1) and in-hospital complication (OR=2.34, 95% CI=1.3–4.3). Age 70 or less (OR=0.19, 95% CI=0.0–0.9) and direct discharge to chronic care were associated with 50 or more specialist visits. Only rurality predicted two or more visits to the ED.
Conclusions:
Individuals with traumatic SCI show significant physician utilization, especially among their FPs and physiatrists. Although the factors predicting higher physician and specialist utilization may reflect individuals with the most severe impairment, comorbid conditions or lack of social support, the model for higher ED visits may point to limited accessibility to/availability of primary care services for SCI patients in rural regions.
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Acknowledgements
This research was supported by a grant from the Ontario Neurotrauma Foundation (ONF). Dr Jaglal is the Toronto Rehabilitation Institute Chair at the University of Toronto in Health Services Research. Dr Couris’ post-doctoral fellowship was supported by the Toronto Rehabilitation Institute and the University of Toronto.
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Appendix 1: Definition of SCI from Discharge Abstract Database:
Appendix 1: Definition of SCI from Discharge Abstract Database:
Traumatic SCI ICD-10 codes (obtained from Rick Hansen Foundation)
S14.0 Concussion and oedema of cervical spinal cord
S14.10 Complete lesion of cervical spinal cord
S14.11 Central cord lesion of cervical spinal cord
S14.12 Anterior cord syndrome of cervical spinal cord
S14.13 Posterior cord syndrome of cervical spinal cord
S14.18 Other injuries of cervical spinal cord
S14.19 Unspecified lesion of cervical spinal cord
S24.0 Concussion and oedema of thoracic spinal cord
S24.10 Complete lesion of thoracic spinal cord
S24.11 Central cord lesion of thoracic spinal cord
S24.12 Anterior cord syndrome of thoracic spinal cord
S24.13 Posterior cord syndrome of thoracic spinal cord
S24.18 Other injuries of thoracic spinal cord
S24.19 Unspecified lesion of thoracic spinal cord
S34.0 Concussion and oedema of lumbar spinal cord
S34.10 Complete lesion of lumbar spinal cord
S34.11 Central cord lesion of lumbar spinal cord
S34.12 Anterior cord syndrome of lumbar spinal cord
S34.13 Posterior cord syndrome of lumbar spinal cord
S34.18 Other injuries of lumbar spinal cord
S34.19 Unspecified lesion of lumbar spinal cord
S34.30 Laceration of cauda equina
S34.38 Other and unspecified injury of cauda equina
T06.0 Injuries of brain and cranial nerves with injuries of nerves and spinal cord at neck level
T06.1 Injuries of nerves and spinal cord involving other multiple body regions.
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Munce, S., Guilcher, S., Couris, C. et al. Physician utilization among adults with traumatic spinal cord injury in Ontario: a population-based study. Spinal Cord 47, 470–476 (2009). https://doi.org/10.1038/sc.2008.173
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DOI: https://doi.org/10.1038/sc.2008.173
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