Lee Joseph, Varghese Jithin, Brooks Rose, Turpen Benjamin J
The Centre for Family Medicine, Kitchener, Ontario, Canada.
McMaster University, Hamilton, Ontario, Canada.
Top Spinal Cord Inj Rehabil. 2020 Spring;26(2):79-84. doi: 10.46292/sci2602-79.
Individuals with spinal cord injury (SCI) continue to have shorter life expectancies, limited ability to receive basic health care, and unmet care needs when compared to the general population. Primary preventive health care services remain underutilized, contributing to an increased risk of secondary complications. Three broad themes have been identified that limit primary care providers (PCPs) in providing good quality care: physical barriers; attitudes, knowledge, and expertise; and systemic barriers. Making significant physical alterations in every primary care clinic is not realistic, but solutions such as seeking out community partnerships that offer accessibility or transportation and scheduling appointments around an individual's needs can mitigate some access issues. Resources that improve provider and staff disability literacy and communication skills should be emphasized. PCPs should also seek out easily accessible practice tools (SCI-specific toolkit, manuals, modules, quick reference guides, and other educational materials) to address any knowledge gaps. From a systemic perspective, it is important to recognize community SCI resources and develop collaboration between primary, secondary, and tertiary care services that can benefit SCI patients. Providers can address some of these barriers that lead to inequitable health care practices and in turn provide good quality, patient-centered care for such vulnerable groups. This article serves to assist PCPs in identifying the challenges of providing equitable care to SCI individuals.
与普通人群相比，脊髓损伤（SCI）患者的预期寿命仍然较短，获得基本医疗保健的能力有限，护理需求未得到满足。初级预防性医疗保健服务的利用率仍然较低，导致继发性并发症的风险增加。已确定了三个广泛的主题，这些主题限制了初级保健提供者（PCP）提供高质量护理：身体障碍；态度、知识和专业技能；以及系统障碍。在每个初级保健诊所进行重大的物理改造是不现实的，但诸如寻求提供无障碍设施或交通的社区伙伴关系以及根据个人需求安排预约等解决方案可以缓解一些就医问题。应强调提高提供者和工作人员残疾知识素养和沟通技能的资源。初级保健提供者还应寻找易于获取的实践工具（特定于脊髓损伤的工具包、手册、模块、快速参考指南和其他教育材料）来填补任何知识空白。从系统角度来看，认识社区脊髓损伤资源并发展初级、二级和三级护理服务之间的合作对脊髓损伤患者有益，这一点很重要。提供者可以解决一些导致医疗保健不公平做法的障碍，进而为这类弱势群体提供高质量的、以患者为中心的护理。本文旨在帮助初级保健提供者识别为脊髓损伤患者提供公平护理的挑战。
