Department of Health Sciences and Medicine, University of Lucerne, 6002, Lucerne, Switzerland.
Swiss Paraplegic Research, 6207, Nottwil, Switzerland.
BMC Fam Pract. 2021 Oct 2;22(1):195. doi: 10.1186/s12875-021-01547-0.
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.
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).
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).
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.
尽管全科医生（GP）通常被认为是护理的第一接触点，但对于脊髓损伤（SCI）等复杂疾病的患者，情况可能有所不同。本研究的目的是通过检查（1）SCI 健康问题的首次就诊，（2）发病情况和与首次就诊相关的医疗保健服务利用情况，以及（3）与首次就诊选择相关的因素，了解 GP 和 SCI 专家提供的长期护理之间的差异。
在这项基于瑞士脊髓损伤队列研究社区调查 2017 年数据的横断面研究中，主要结局指标是报告的 SCI 特定护理的首次就诊。使用卡方检验和基于患者特征、医疗保健服务利用情况和使用脊髓损伤二次状况量表（SCI-SCS）评估的二次健康状况的逻辑回归分析来分析该信息。
在 1294 名受访者中，有 1095 名报告了他们的 SCI 特定护理的首次就诊；56%的人表示是 SCI 专家，44%的人指定了全科医生。平均而言，首次联系全科医生的参与者报告了更多的全科医生就诊次数（5.1±5.2 次与 3.9±7.2 次）、计划门诊就诊次数（3.7±7.3 次与 3.6±6.7 次）和住院次数（GP，1.9±1.7 次与 1.5±1.3 次），但 SCI 专家就诊次数（1.7±1.8 次与 2.6±1.7 次）和住院天数（22.8±43.2 天与 31.0±42.8 天）较低。75 岁及以上（OR=4.44，95%CI=1.85-10.69）、意大利语使用者（OR=5.06，95%CI=2.44-10.47）、存在不完全损伤（OR=2.39，95%CI=1.71-3.35）、有疼痛（OR=1.47，95%CI=1.04-2.09）或糖尿病（OR=1.85，95%CI=1.05-3.27）的人更有可能首次联系全科医生，而距离 SCI 中心较近（OR=0.69，95%CI=0.51-0.93）或 SCI-SCS 评分较高（OR=0.92，95%CI=0.86-0.99）的人则较少。
年龄、语言区域、前往 SCI 中心的旅行距离、损伤的完整性以及二次状况的发生在确定护理的首次就诊选择方面起着重要作用，但仍存在一些不必要的差异，这些差异仍不清楚，需要进一步研究。
