Abstract
Study design
Cross-sectional observational study using data from the second community survey of the Swiss Spinal Cord Injury Cohort Study (Survey 2017) conducted between 03/2017 and 03/2018.
Objectives
To identify facilitators of and barriers to utilizing SCI-specialized outpatient clinic and inpatient care by individuals with spinal cord injury (SCI).
Setting
Community.
Methods
Multivariable logistic regression was used to identify factors influencing (1) the attendance at annual check-ups at SCI-specialized treatment facilities, (2) the utilization of SCI-specialized outpatient clinic care by those who utilized any outpatient clinic care, and (3) the utilization of SCI-specialized inpatient care by those who were hospitalized. Multiple imputation was used to account for missing data.
Results
Out of 3959 eligible individuals, 1294 completed the questionnaire (response rate 33%). In the last 12 months, 51% of study participants attended the annual check-up, 33% of outpatient clinic care users utilized SCI-specialized outpatient clinic care, and 44% of those who were hospitalized were hospitalized at a SCI center. Annual check-ups were attended less by women, the elderly, and those with nontraumatic SCI. SCI-specialized outpatient clinic care was less likely to be utilized when individuals with SCI were living with cancer, lived farther away from SCI-specialized treatment facilities or in a minority language region. Specialized inpatient care was less likely to be utilized by women and those with incomplete lesions.
Conclusions
SCI-specialized outpatient clinic care must be provided near the residence of individuals with SCI, otherwise non-specialized care is utilized. The reasons why women utilize SCI-specialized care less frequently than men merits further investigation.
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Data availability
Owing to our commitment to SwiSCI study participants and their privacy, datasets generated during the current study are not made publicly available but can be provided by the SwiSCI Study Center based on reasonable request (contact@swisci.ch).
References
European Spinal Cord Injury Federation. ESCIF Policy statement on the treatment, rehabilitation and life-long care of persons with spinal cord injuries (SCI). 2008. http://www.escif.org/ESCIF,,policy_statement.htm.
Braaf SC, Lennox A, Nunn A, Gabbe BJ. Experiences of hospital readmission and receiving formal carer services following spinal cord injury: a qualitative study to identify needs. Disabil Rehabil. 2018;40:1893–9.
McColl MA, Forster D, Shortt SED, Hunter D, Dorland J, Godwin M, et al. Physician experiences providing primary care to people with disabilities. Health Policy. 2008;4:e129.
McColl MA, Aiken A, McColl A, Sakakibara B, Smith K. Primary care of people with spinal cord injury Scoping review. Can Fam Physician. 2012;58:1207–16.
van Loo MA, Post MWM, Bloemen JHA, van Asbeck FWA. Care needs of persons with long-term spinal cord injury living at home in the Netherlands. Spinal Cord. 2010;48:423–8.
Bockenek WL. A fragmented model of care for persons with spinal cord injuries. Am J Phys Med Rehabil. 1997;76:43–46.
De Vivo MJ, Richards JS, Stover SL, Go BK. Spinal cord injury. Rehabilitation adds life years West J Med. 1991;154:602–6.
Parent S, Barchi S, LeBreton M, Casha S, Fehlings MG. The impact of specialized centers of care for spinal cord injury on length of stay, complications, and mortality: a systematic review of the literature. J Neurotrauma. 2011;28:1363–70.
Richard-Denis A, Feldman DE, Thompson C, Mac-Thiong JM. The impact of acute management on the occurrence of medical complications during the specialized spinal cord injury acute hospitalization following motor-complete cervical spinal cord injury. J Spinal Cord Med. 2018;41:388–96.
Spreyermann R, Lüthi H, Michel F, Baumberger ME, Wirz M, Mäder M. Long-term follow-up of patients with spinal cord injury with a new ICF-based tool. Spinal Cord. 2011;49:230–5.
Chhabra HS, International Spinal Cord Society (ISCoS). Follow-Up after spinal cord injury. In: ISCoS textbook on comprehensive management of spinal cord injuries. New Delhi: Wolters Kluwer; 2015, pp 888–905.
Ronca E, Scheel-Sailer A, Koch HG, Essig S, Brach M, Münzel N, et al. Satisfaction with access and quality of healthcare services for people with spinal cord injury living in the community. J Spinal Cord Med. 2020;43:111–21.
Ronca E, Brunkert T, Koch HG, Jordan X, Gemperli A. Residential location of people with chronic spinal cord injury: the importance of local health care infrastructure. BMC Health Serv Res. 2018;18. https://doi.org/10.1186/s12913-018-3449-3.
Guilcher SJT, Munce SEP, Couris CM, Fung K, Craven BC, Verrier M, et al. Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study. Spinal Cord. 2010;48:45–50.
Hamilton R, Driver S, Noorani S, Callender L, Bennett M, Monden K. Utilization and access to healthcare services among community-dwelling people living with spinal cord injury. J Spinal Cord Med. 2017;40:321–8.
LaVela SL, Smith B, Weaver FM, Miskevics SA. Geographical proximity and health care utilization in veterans with SCI&D in the USA. Soc Sci Med. 2004;59:2387–99.
Gross-Hemmi MH, Gemperli A, Fekete C, Brach M, Schwegler U, Stucki G. Methodology and study population of the second Swiss national community survey of functioning after spinal cord injury. Spinal Cord. 2020. https://doi.org/10.1038/s41393-020-00584-3.
Swiss Spinal Cord Injury Cohort Study - SwiSCI. Survey 2017. 2020. https://swisci.ch/en/research-projects-home/study-design/community-survey/survey-2017.
Reinhardt JD, Ballert C, Brinkhof MWG, Post MWM. Perceived impact of environmental barriers on participation among people living with spinal cord injury in Switzerland. J Rehabil Med. 2016;48:210–8.
Hinrichs T, Prodinger B, Brinkhof MWG, Gemperli A. Subgroups in epidemiological studies on spinal cord injury: evaluation of international recommendations in the Swiss Spinal Cord Injury Cohort Study. J Rehabil Med. 2016;48:141–8.
Brinkhof MWG, Al-Khodairy A, Eriks-Hoogland I, Fekete C, Hinrichs T, Hund-Georgiadis M, et al. Health conditions in people with spinal cord injury: contemporary evidence from a population-based community survey in Switzerland. J Rehabil Med. 2016;48:197–209.
Google Developers. Google Maps Distance Matrix Application Programming Interface. 2020. https://developers.google.com/maps/documentation/distance-matrix/start.
van Buuren S, Groothuis-Oudshoorn K. mice: Multivariate imputation by chained equations in R. J Stat Softw. 2011;45:1–67.
van Buuren S. Flexible imputation of missing data. 2nd ed. Boca Raton: CRC Press, Taylor and Francis; 2018. https://stefvanbuuren.name/fimd/.
Rubin DB. Multiple imputation for nonresponse in surveys. New York: John Wiley and Sons; 1987.
Lenth R. emmeans: Estimated Marginal Means, aka Least-Squares Means. 2019. https://cran.r-project.org/package=emmeans.
Chamberlain JD, Ronca E, Brinkhof MWG Estimating the incidence of traumatic spinal cord injuries in Switzerland: use of administrative data to identify potential coverage error in a cohort study. Swiss Med Wkly. 2017;147. https://doi.org/10.4414/smw.2017.14430.
Noonan VK, Thorogood NP, Fingas M, Batke J, Bélanger L, Kwon BK, et al. The validity of administrative data to classify patients with spinal column and cord injuries. J Neurotrauma. 2013;30:173–80.
Gemperli A, Ronca E, Scheel-Sailer A, Koch HGG, Brach M, Trezzini B. Health care utilization in persons with spinal cord injury: part 1—outpatient services. Spinal Cord. 2017;55:823–7.
Ronca E, Scheel-Sailer A, Koch HG, Metzger S, Gemperli A. Inpatient migration patterns in persons with spinal cord injury: a registry study with hospital discharge data. SSM - Popul Heal. 2016;2:259–68.
Burns AS, Lanig I, Grabljevec K, New PW, Bensmail D, Ertzgaard P, et al. Optimizing the management of disabling spasticity following spinal cord damage: The Ability Network—an international initiative. Arch Phys Med Rehabil. 2016;97:2222–8.
Lanig IS, New PW, Burns AS, Bilsky G, Benito-Penalva J, Bensmail D, et al. Optimizing the management of spasticity in people with spinal cord damage: a clinical care pathway for assessment and treatment decision making from The Ability Network, an international initiative. Arch Phys Med Rehabil. 2018;99:1681–7.
Cipriano CA, Pill SG, Keenan MA. Heterotopic ossification following traumatic brain injury and spinal cord injury. JAAOS - J Am Acad Orthop Surg. 2009;17:689–97.
Acknowledgements
We thank the SwiSCI Steering Committee with its members Xavier Jordan, Fabienne Reynard (Clinique Romande de Réadaptation, Sion); Michael Baumberger, Hans Peter Gmünder (Swiss Paraplegic Center, Nottwil); Armin Curt, Martin Schubert (University Clinic Balgrist, Zürich); Margret Hund-Georgiadis, Kerstin Hug (REHAB Basel, Basel); Laurent Prince (Swiss Paraplegic Association, Nottwil); Heidi Hanselmann (Swiss Paraplegic Foundation, Nottwil); Daniel Joggi (Representative of persons with SCI); Nadja Münzel (Parahelp, Nottwil); Mirjam Brach, Gerold Stucki (Swiss Paraplegic Research, Nottwil); Armin Gemperli (SwiSCI Coordination Group at Swiss Paraplegic Research, Nottwil).
Funding
SwiSCI is hosted and funded by Swiss Paraplegic Research.
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ER, AG, ID, and AKS were responsible for conceptualization of the analysis. ER and AG were responsible for data analysis and ER, AG, AKS, ID, IEH, and MB were responsible for the interpretation of results.
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Ethical approval was granted by the Ethikkommision Nordwest- und Zentralschweiz (EKNZ, Project-ID: 11042 PB_2016-02608, approved Dec 2016). We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.
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Ronca, E., Scheel-Sailer, A., Eriks-Hoogland, I. et al. Factors influencing specialized health care utilization by individuals with spinal cord injury: a cross-sectional survey. Spinal Cord 59, 381–388 (2021). https://doi.org/10.1038/s41393-020-00581-6
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DOI: https://doi.org/10.1038/s41393-020-00581-6
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