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Health Care Utilization and Barriers Experienced by Individuals With Spinal Cord Injury

Published:February 24, 2014DOI:https://doi.org/10.1016/j.apmr.2014.02.005

      Abstract

      Objectives

      To identify from whom individuals with spinal cord injury (SCI) seek health care, the percentage who receive preventative care screenings, and the frequency and types of barriers they encounter when accessing primary and specialty care services; and to examine how sociodemographic factors affect access to care and receipt of preventative screenings.

      Design

      Cross-sectional, observational study using an Internet-based survey.

      Setting

      Internet based.

      Participants

      Adults (N=108) with SCI who use a wheelchair as their primary means of mobility in the community.

      Interventions

      Not applicable.

      Main Outcome Measures

      Health care utilization during the past year, barriers encountered when accessing health care facilities, and receipt of routine care and preventative screenings.

      Results

      All but 1 participant had visited a primary care provider within the past 12 months, and 85% had had ≥1 visit to specialty care providers. Accessibility barriers were encountered during both primary care (91.1%) and specialty care (80.2%) visits; most barriers were clustered in the examination room. The most prevalent barriers were inaccessible examination tables (primary care=76.9%; specialty care=51.4%) and lack of transfer aids (primary care=69.4%; specialty care=60.8%). Most participants had not been weighed during their visit (89%) and had remained seated in their wheelchair during their examinations (85.2%). Over one third of individuals aged ≥50 years had not received a screening colonoscopy, 60% of women aged ≥50 years had not had a mammogram within the past year, 39.58% of women had not received a Papanicolaou smear within the previous 3 years, and only 45.37% of respondents had ever received bone density testing.

      Conclusions

      Individuals with SCI face remediable obstacles to care and receive fewer preventative care screenings than their nondisabled counterparts. We recommend that clinics conduct Americans with Disabilities Act self-assessments, ensure that their clinical staff are properly trained in assisting individuals with mobility disabilities, and take a proactive approach in discussing preventative care screenings with their patients who have SCI.

      Keywords

      List of abbreviations:

      ADA (Americans with Disabilities Act), Pap (Papanicolaou), PCP (primary care physician), SCI (spinal cord injury)
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