Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2021

Open Access 01-12-2021 | Care | Research article

First contact of care for persons with spinal cord injury: a general practitioner or a spinal cord injury specialist?

Authors: Dima Touhami, Mirjam Brach, Stefan Essig, Elias Ronca, Isabelle Debecker, Inge Eriks-Hoogland, Anke Scheel-Sailer, Nadja Münzel, Armin Gemperli

Published in: BMC Primary Care | Issue 1/2021

Login to get access

Abstract

Background

Although general practitioners (GPs) are generally considered as the first point of contact for care, this may be different for persons with complex conditions, such as those with spinal cord injury (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. 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 visits to SCI-specialists (1.7 ± 1.8 vs. 2.6 ± 1.7) and 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 = 4.44, 95% CI = 1.85–10.69), Italian speakers (OR = 5.06, 95% CI = 2.44–10.47), had incomplete lesions (OR = 2.39, 95% CI = 1.71–3.35), experiencing pain (OR = 1.47, 95% CI = 1.04–2.09) or diabetes mellitus (OR = 1.85, 95% CI = 1.05–3.27), but lower for those situated closer to SCI centres (OR = 0.69, 95% CI = 0.51–0.93) or had higher SCI-SCS scores (OR = 0.92, 95% CI = 0.86–0.99).

Conclusion

Age, language region, travel distance to SCI centres, lesion completeness, and occurrence of secondary conditions play a significant role in determining the choice of first contact of care, however there is still some unwarranted variation that remains unclear and requires further research.
Literature
1.
Chrvala CA, Sharfstein SS. Definition of serious and complex medical conditions. ProQuest, editor. Washington, DC: National Academy Press; 1999.
2.
Sezer N, Akkuş S, Uğurlu FG. Chronic complications of spinal cord injury. World J Orthop. 2015;6(1):24–33.CrossRef
3.
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(11):1207–e635.PubMedPubMedCentral
4.
Ho CH. Primary care for persons with spinal cord injury - not a novel idea but still under-developed. J Spinal Cord Med. 2016;39(5):500–3.CrossRef
5.
6.
Yang H, Huang X, Zhou Z, Wang HH, Tong X, Wang Z, et al. Determinants of initial utilization of community healthcare services among patients with major non-communicable chronic diseases in South China. PLoS One. 2014;9(12):e116051.CrossRef
7.
8.
Donnelly C, McColl MA, Charlifue S, Glass C, O'Brien P, Savic G, et al. Utilization, access and satisfaction with primary care among people with spinal cord injuries: a comparison of three countries. Spinal Cord. 2007;45(1):25–36.CrossRef
9.
Gemperli A, Ronca E, Scheel-Sailer A, Koch HG, Brach M, Trezzini B. Health care utilization in persons with spinal cord injury: part 1-outpatient services. Spinal Cord. 2017;55(9):823–7.CrossRef
10.
Wanzenried G, Nocera S. The evolution of physician density in Switzerland. SJES. 2008;144:247–82.
11.
Ronca E, Scheel-Sailer A, Koch HG, Essig S, Brach M, Munzel 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(1):111–21.CrossRef
12.
Ronca E, Scheel-Sailer A, Koch HG, Gemperli A. Health care utilization in persons with spinal cord injury: part 2-determinants, geographic variation and comparison with the general population. Spinal Cord. 2017;55(9):828–33.CrossRef
13.
Kodner DL. All together now: a conceptual exploration of integrated care. Healthc Q. 2009;13 Spec No:6–15.CrossRef
14.
Schmitz C, Atzeni G, Berchtold P. Challenges in interprofessionalism in Swiss health care: the practice of successful interprofessional collaboration as experienced by professionals. Swiss Med Wkly. 2017;147:w14525.PubMed
15.
Schusselé Filliettaz S, Berchtold P, Kohler D, Peytremann-Bridevaux I. Integrated care in Switzerland: results from the first nationwide survey. Health Policy. 2018;122(6):568–76.CrossRef
16.
Buzzell A, Chamberlain JD, Eriks-Hoogland I, Jordan X, Schubert M, Zwahlen M, et al. Etiology-specific variation in survival following non-traumatic spinal cord injury: a causal inference approach using data from a population-based cohort. Spinal Cord. 2021;59(3):257–65.
17.
Newman ED, Simonelli PF, Vezendy SM, Cedeno CM, Maeng DD. Impact of primary and specialty care integration via asynchronous communication. Am J Manag Care. 2019;25(1):26–31.PubMed
18.
19.
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. 2021;59(4):363–72.
20.
Biering-Sørensen F, DeVivo MJ, Charlifue S, Chen Y, New PW, Noonan V, et al. International spinal cord injury Core data set (version 2.0)—including standardization of reporting. Spinal Cord. 2017;55(8):759–64.CrossRef
21.
Biering-Sørensen F, Noonan VK. Standardization of data for clinical use and research in spinal cord injury. Brain Sci. 2016;6(3):29.CrossRef
22.
Chen B, Covinsky KE, Stijacic Cenzer I, Adler N, Williams BA. Subjective social status and functional decline in older adults. J Gen Intern Med. 2012;27(6):693–9.CrossRef
23.
24.
25.
Munce SE, Guilcher SJ, Couris CM, Fung K, Craven BC, Verrier M, et al. Physician utilization among adults with traumatic spinal cord injury in Ontario: a population-based study. Spinal Cord. 2009;47(6):470–6.CrossRef
26.
Bockenek WL. A fragmented model of Care for Persons with spinal cord Injuries1. Am J Phys Med Rehabil. 1997;76(3):43–6.CrossRef
27.
DeJong G, Tian W, Hsieh CH, Junn C, Karam C, Ballard PH, et al. Rehospitalization in the first year of traumatic spinal cord injury after discharge from medical rehabilitation. Arch Phys Med Rehabil. 2013;94(4 Suppl):S87–97.CrossRef
28.
Koopman R, May K. Specialist management and coordination of "out-of-domain care". Fam Med. 2004;36:46–50.PubMed
29.
Glickman MS, Dalrymple-Hay MM, Phillips MG. Spinal cord injury after rehabilitation: the general practice experience. Br J Ther Rehabil. 1996;3(3):168–71.CrossRef
30.
Noonan VK, Fallah N, Park SE, Dumont FS, Leblond J, Cobb J, et al. Health care utilization in persons with traumatic spinal cord injury: the importance of multimorbidity and the impact on patient outcomes. Top Spinal Cord Inj Rehabil. 2014;20(4):289–301.CrossRef
31.
Ronca E, Scheel-Sailer A, Eriks-Hoogland I, Brach M, Debecker I, Gemperli A. Factors influencing specialized health care utilization by individuals with spinal cord injury: a cross-sectional survey. Spinal Cord. 2021;59(4):381–8.
32.
Rizza A, Kaplan V, Senn O, Rosemann T, Bhend H, Tandjung R. Age- and gender-related prevalence of multimorbidity in primary care: the Swiss FIRE project. BMC Fam Pract. 2012;13:113.CrossRef
33.
Tandjung R, Hanhart A, Bartschi F, Keller R, Steinhauer A, Rosemann T, et al. Referral rates in Swiss primary care with a special emphasis on reasons for encounter. Swiss Med Wkly. 2015;145:w14244.PubMed
34.
Marge M. Health promotion for persons with disabilities: moving beyond rehabilitation. Am J Health Promot. 1988;2(4):29–44.CrossRef
35.
Marcinowicz L, Pawlikowska T, Oleszczyk M. What do older people value when they visit their general practitioner? A qualitative study. Eur J Ageing. 2014;11(4):361–7.CrossRef
36.
Bastiaens H, Van Royen P, Pavlic DR, Raposo V, Baker R. Older people's preferences for involvement in their own care: a qualitative study in primary health care in 11 European countries. Patient Educ Couns. 2007;68(1):33–42.CrossRef
37.
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 Health. 2016;2:259–68.CrossRef
38.
Trezzini B, Brach M, Post M, Gemperli A. SwiSCI Study Group. Prevalence of and factors associated with expressed and unmet service needs reported by persons with spinal cord injury living in the community. Spinal Cord. 2019;57(6):490–500.
Metadata
Title
First contact of care for persons with spinal cord injury: a general practitioner or a spinal cord injury specialist?
Authors
Dima Touhami
Mirjam Brach
Stefan Essig
Elias Ronca
Isabelle Debecker
Inge Eriks-Hoogland
Anke Scheel-Sailer
Nadja Münzel
Armin Gemperli
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Care
Published in
BMC Primary Care / Issue 1/2021
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-021-01547-0

Other articles of this Issue 1/2021

BMC Primary Care 1/2021 Go to the issue

Research

Performance of primary health care workers in detection of mental disorders comorbid with epilepsy in rural Ethiopia

Research Article

Individual-level socioeconomic status and contact or familiarity with people with mental illness: a cross-sectional study in Wuhou District, Chengdu, Southwest China

Research article

Challenges to implementing electronic trial data collection in primary care: a qualitative study

Research article

Making care more patient centered; experiences of healthcare professionals and patients with multimorbidity in the primary care setting

Research article

Examining primary care physician rationale for not following geriatric choosing wisely recommendations

Research

Experiences of family caregivers of patients with COVID-19