Richardson J1, Draaistra H2, Sinclair S1, McRae L2, Le Blanc C2, Fleck R2
1McMaster University, School of Rehabilitation Science, Hamilton, Canada, 2Hamilton Health Sciences, Hamilton, Canada
Background: Spinal cord injury (SCI) is associated with multiple secondary health conditions (pain, bowel and bladder dysfunction, muscle spasm) and chronic conditions associated with aging. Primary care providers manage secondary conditions and the provision of preventive health care for people with SCI. Accessing primary care services is often difficult, due to physical barriers, negative attitudes toward disability, and lack expertise of primary care providers related to SCI.
Purpose: To increase collaboration between primary and acute care and to improve access to care for patients with SCI.
To evaluate whether coordinated management between acute care, primary care and rehabilitation improves the primary care management of patients with SCI
Methods: Participants were assessed at baseline, 9, and 24 months on the following outcomes:
Access to Primary Care; Health-related quality of life (WHOQOL-BREF);
Patient satisfaction (PSQ-18); Self-efficacy (Self-Efficacy to Perform Self-Management Behaviours); Secondary conditions (Secondary Conditions Scale)
The SCI Nurse Clinician acted as a conduit between the PC provider and the Acute Care spinal cord team and facilitated referrals to PT.
SCI Nurse Clinician undertook:
1.Collaborative problem identification and goal setting using the Self-Management Primary Care Checklist
2.Tailored recommendations
3.A joint visit between the nurse and engaged family physicians
4.Ongoing self-management support from the SCI Nurse Clinician during study.
5.Ongoing patient coaching by the SCI Nurse Clinician to increase patient self-advocacy.
Results: 62 persons with SCI were followed over 24 months, 73% (n=45) were male; 17.1- 83.4 years (𝑥̅ = 52 ± 16.8 years); 52% (n=31) were paraplegic.
Participants reported that care from their primary care physicians increasingly met their needs over the 24 months, p=0.005.
General satisfaction with care (t=1.93, p=0.05) and satisfaction with the technical aspects of care (t=2.76, p=0.006) improved across the 3 time points.
Quality of life improved in the domains of physical health and the environment but not in social relationships.
There was no significant change in self-efficacy as a result of the intervention.
The number of secondary conditions decreased but was not significant nor sustained over 24 months.
Referrals to physiotherapy increased over the course of the study.
Conclusion(s): Self reported physical health of persons with SCI was positively impacted over 24 months and the number of visits to physiotherapy also increased. With the increasing role that PTs in primary care settings and with the expertise that PTs have in the physical management of persons with SCI (often a barrier to access of PC services) PTs are well positioned to facilitate access to PC services for this patient group and hence improve their overall health and well being.
Implications: Access to PC services for persons with SCI was facilitated by self advocacy and advocacy by a health professional. Physiotherapists are experts in management of many of the secondary issues that SCI patients experience. In this study their self reported physical health improved. PTs can improve access to primary care for persons with SCI through their physical handling skills, and offering leadership in primary care teams and hence improve preventive services for this patient group.
Keywords: Spinal cord injury, primary care, phsyiotherapy
Funding acknowledgements: Ontario Neurotrauma Foundation
Purpose: To increase collaboration between primary and acute care and to improve access to care for patients with SCI.
To evaluate whether coordinated management between acute care, primary care and rehabilitation improves the primary care management of patients with SCI
Methods: Participants were assessed at baseline, 9, and 24 months on the following outcomes:
Access to Primary Care; Health-related quality of life (WHOQOL-BREF);
Patient satisfaction (PSQ-18); Self-efficacy (Self-Efficacy to Perform Self-Management Behaviours); Secondary conditions (Secondary Conditions Scale)
The SCI Nurse Clinician acted as a conduit between the PC provider and the Acute Care spinal cord team and facilitated referrals to PT.
SCI Nurse Clinician undertook:
1.Collaborative problem identification and goal setting using the Self-Management Primary Care Checklist
2.Tailored recommendations
3.A joint visit between the nurse and engaged family physicians
4.Ongoing self-management support from the SCI Nurse Clinician during study.
5.Ongoing patient coaching by the SCI Nurse Clinician to increase patient self-advocacy.
Results: 62 persons with SCI were followed over 24 months, 73% (n=45) were male; 17.1- 83.4 years (𝑥̅ = 52 ± 16.8 years); 52% (n=31) were paraplegic.
Participants reported that care from their primary care physicians increasingly met their needs over the 24 months, p=0.005.
General satisfaction with care (t=1.93, p=0.05) and satisfaction with the technical aspects of care (t=2.76, p=0.006) improved across the 3 time points.
Quality of life improved in the domains of physical health and the environment but not in social relationships.
There was no significant change in self-efficacy as a result of the intervention.
The number of secondary conditions decreased but was not significant nor sustained over 24 months.
Referrals to physiotherapy increased over the course of the study.
Conclusion(s): Self reported physical health of persons with SCI was positively impacted over 24 months and the number of visits to physiotherapy also increased. With the increasing role that PTs in primary care settings and with the expertise that PTs have in the physical management of persons with SCI (often a barrier to access of PC services) PTs are well positioned to facilitate access to PC services for this patient group and hence improve their overall health and well being.
Implications: Access to PC services for persons with SCI was facilitated by self advocacy and advocacy by a health professional. Physiotherapists are experts in management of many of the secondary issues that SCI patients experience. In this study their self reported physical health improved. PTs can improve access to primary care for persons with SCI through their physical handling skills, and offering leadership in primary care teams and hence improve preventive services for this patient group.
Keywords: Spinal cord injury, primary care, phsyiotherapy
Funding acknowledgements: Ontario Neurotrauma Foundation
Topic: Disability & rehabilitation; Health promotion & wellbeing/healthy ageing; Musculoskeletal: spine
Ethics approval required: Yes
Institution: McMaster University
Ethics committee: Hamilton Institution Research Ethics Board
Ethics number: #11-624
All authors, affiliations and abstracts have been published as submitted.
