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

Abstract

\n 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.