Department of Internal Medicine, School of Medicine, University of Louisville, Louisville, KY.
Bioengineering, J.B. Speed School of Engineering, University of Louisville, Louisville, KY.
Arch Phys Med Rehabil. 2014 Jun;95(6):1114-26. doi: 10.1016/j.apmr.2014.02.005. Epub 2014 Feb 22.
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.
Cross-sectional, observational study using an Internet-based survey.
Internet based.
Adults (N=108) with SCI who use a wheelchair as their primary means of mobility in the community.
Not applicable.
Health care utilization during the past year, barriers encountered when accessing health care facilities, and receipt of routine care and preventative screenings.
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.
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.
从寻求医疗保健的脊髓损伤（SCI）个体中确定接受预防保健筛查的百分比，以及他们在获得初级保健和专科保健服务时遇到的障碍的频率和类型；并检查社会人口因素如何影响获得医疗保健的机会和接受预防性筛查的情况。
使用基于互联网的调查进行的横断面观察性研究。
基于互联网。
使用轮椅作为主要社区移动方式的成年 SCI 患者（N=108）。
不适用。
过去一年的医疗保健利用情况、获得医疗保健设施时遇到的障碍，以及接受常规护理和预防筛查的情况。
除 1 名参与者外，所有参与者在过去 12 个月内都曾就诊过初级保健提供者，85%的人至少就诊过 1 次专科保健提供者。在初级保健（91.1%）和专科保健（80.2%）就诊时都遇到了可达性障碍；大多数障碍都集中在检查室。最常见的障碍是无法使用的检查台（初级保健=76.9%；专科保健=51.4%）和缺乏转运辅助工具（初级保健=69.4%；专科保健=60.8%）。大多数参与者在就诊时没有称重（89%），并且在检查期间一直坐在轮椅上（85.2%）。超过三分之一的年龄≥50 岁的人未接受结肠镜筛查，60%的年龄≥50 岁的女性过去 1 年未进行乳房 X 光检查，39.58%的女性过去 3 年未进行巴氏涂片检查，只有 45.37%的受访者接受过骨密度测试。
SCI 患者面临可纠正的护理障碍，并且接受的预防保健筛查比非残疾患者少。我们建议诊所进行美国残疾人法案自我评估，确保其临床工作人员在协助行动障碍患者方面得到适当培训，并主动与 SCI 患者讨论预防保健筛查。
