Summary of the evidence from selected studies of primary care and SCI
| FINDING* | REFERENCE | D&B SCORE† | N |
|---|---|---|---|
| There is level 2 evidence that ... | |||
| • An outreach program (transmural care—nurse liaison from rehabilitation to primary care) does not appear to be effective in reducing pressure sores, urinary tract infections, or hospital readmission rates | Bloemen-Vrencken et al,19 2007 | 15 | 62 |
| There is level 3 evidence that ... | |||
| • Depression rates are higher and onset is earlier among individuals with disabilities, especially traumatic-onset disabilities, such as SCI, compared with controls | McDermott et al,25 2005 | 15 | 35 |
| There is level 4 evidence that ... | |||
| • An annual comprehensive preventive health evaluation conducted at the SCI centre is related to improved health care use and having health, psychosocial, and equipment needs met | Collins et al,23 2005 | 16 | 853 |
| • Clinician adherence to bowel and bladder guidelines improves with a targeted implementation plan | Goetz et al,24 2005 | 13 | 4432 |
| • GP use is related to older age, complications, and chronic care living; individuals living in more rural areas are twice as likely to visit the ED as those living in cities | Munce et al,17 2009 | 12 | 559 |
| • Outreach in the form of home visits from a multidisciplinary team from a rehabilitation centre led to fewer readmissions and improved rehabilitation outcomes | Prabhaka and Thakker,27 2004 | 8 | 546 |
| • A multidisciplinary Health Maintenance Education Program improves patient satisfaction with primary care and increases knowledge of respiratory complications, autonomic hyperreflexia, spasticity, aging, and community resources | Beck and Scroggins,29 2001 | 6 | 19 |
| • A specialized nurse-led community clinic provided up-to-date and readily applicable knowledge about bowel and bladder issues and skin breakdown, and was preferred over a medical clinic | Williams,26 2005 | 4 | 31 |
| There is level 5 evidence that ... | |||
| • Half of those with a perceived need for physical rehabilitation receive it; significant predicting factors of access to health services include health plan type, health condition, health status, severity of condition, income level, and age | Beatty et al,28 2003 | 14 | 800 |
| • 52% of contact with GPs was for secondary complications; 34% of secondary complications are believed to be preventable; 72% of patients report an unmet need for health care, particularly rehabilitation services | Van Loo et al,18 2010 | 12 | 453 |
| • Individuals with chronic SCI would like more information regarding aging with SCI and SCI research, and SCI educational information; ethnic minorities have the greatest unmet needs for information | Gontkovsky et al,22 2007 | 12 | 82 |
| • 40% of physiatrists are willing to provide primary care to those with disabilities; 38% feel prepared by residency training to do so | Francisco et al,35 1995 | 11 | 104 |
| • Physiatrists consider bone health after SCI to be an important issue and favour pharmacologic treatment over rehabilitation | Ashe et al,16 2009 | 11 | 22 |
| • There is considerable duplication between primary care and physiatry; there is high satisfaction with primary care and physiatry; needs for lifestyle and emotional issues often go unmet; there are differences in service use between those in Canada, the United States, and the United Kingdom, but no difference in access to and satisfaction with the services | Donnelly et al,21 2007 | 10 | 373 |
| • 90% of individuals with SCI would like to receive written information about their conditions following medical checkups | Vaidyanathan et al,30 2001 | 10 | 128 |
| • 80% of issues raised by patients with SCI in primary care are related to disability; health promotion and counseling needs are typically unmet | Warms,36 1987 | 9 | 59 |
| • Barriers to specialized multidisciplinary outreach services are limited local expert knowledge, lack of funding, and service fragmentation | Cox et al,31 2001 | 9 | 54 |
| • Most medical residents are not comfortable treating a women with tetraplegia who has recently become pregnant | Oshima et al,32 1998 | 9 | 44 |
| • Patients receiving transitional, home-based rehabilitation as an outreach program from a rehabilitation centre experienced benefits in coordination and education of local providers, as well as family, community, and specialist involvement | Booth and Kendall,20 2007 | 9 | 40 |
| • Half of SCI outpatients consider physiatry to be their primary care; 90% have little difficulty receiving medical care in the community | Bockeneck,33 1997 | 8 | 144 |
| • 75% of people with SCI have multiple clinical problems; patients made an average of 4 GP visits and received an average 4.5 home visits a year | Glickman et al,34 1996 | 6 | 139 |
ED—emergency department, SCI—spinal cord injury.
↵* Levels of evidence according to Sackett et al, 2000.38 Level 2 evidence includes quasi-experimental studies such as prospective studies and non-randomized comparison group and observational studies; level 3 evidence includes pre-experimental studies such as uncontrolled studies and historical and retrospective reviews; level 4 evidence includes observational studies including posttest-only designs, case series, and secondary analyses of administrative data; level 5 evidence includes surveys, case reports, and single-subject studies.
↵† Methodologic rigour score, evaluated on a scale from 1 to 20, with higher scores corresponding to higher levels of methodologic rigour; Downs and Black, 1998.37