The effect of the general practitioner as the first point of contact for care on the satisfaction with health care services in persons living with chronic spinal cord injury: A cross-sectional study.

OBJECTIVE: The primary objective of this study was to investigate the effect of having a general practitioner (GP) as a first point of contact for care on the satisfaction with care services in persons with spinal cord injury (SCI), and how this effect is related to socio-demographic and health-related factors. METHODS: This is a cross-sectional survey conducted within the framework of the Swiss Spinal Cord Injury Cohort Study Community Survey 2017. Outcome measures comprised three aspects of care (treatment with respect, understandability of explanations, and involvement in decision-making) and satisfaction with GP care and SCI centres. Information was grouped by first contact of care (GP or SCI specialist) and compared using the Mann-Whitney U test and logistic regression analysis. RESULTS: Out of 3,959 invitees, 1,294 participants (33%) completed the survey. No significant association was found between the three aspects of care and the first contact of care. Persons who first contacted a GP and lived within a 10-minute travel distance to the GP practice were significantly less likely to be satisfied with their GP care (-5.7 percentage points, CI 95% = -10.7, -0.7), as compared to those living farther away. Persons who first contacted a GP rather than an SCI specialist were more likely to be satisfied with their GP care if married (7.1 percentage points, CI 95% = 1.4, 12.7), employed (6.6 percentage points, CI 95% = 0.9, 12.3), had a high social status (11.0 percentage points, CI 95% = 2.0, 20.1), or had tetraplegia (10.8 percentage points, CI 95% = 3.6, 18.1). For the same group, satisfaction with SCI centres was significantly higher in persons with good (10.1 percentage points, CI 95% = 0.1, 20.1) or very good health (8.2 percentage points, CI 95% = 1.0, 15.4), as compared to those with poor health. CONCLUSION: The majority of participants were satisfied with the services offered by their first contact point for care, with variations due to factors endogenous to the participants. Socio-demographic and health-related factors should be integrated into health care planning strategies and improvement initiatives to ensure equitable access and better quality of health care services.

Why Do Community-Dwelling Persons with Spinal Cord Injury Visit General Practitioners: A Cross-Sectional Study of Reasons for Encounter in Swiss General Practice.

Purpose: In a country of free selection of providers, general practitioners (GPs) remain the most visited health-care professionals by the vast majority of persons with spinal cord injury (SCI) in Switzerland; yet, little is known about these contacts. The study aims to explore reasons for encounters (RFEs) in general practice, and their relationships to first-contact of care (GP or specialist) and GP's competence in managing SCI-specific problems. Patients and Methods: Cross-sectional study from baseline data of non-randomized controlled trial. Persons with SCI in the chronic phase and living in Swiss rural communities were invited. Participants were asked about RFEs (reasons and health problems) of their last visit to a GP. RFEs were coded according to the International Classification of Primary Care (ICPC-2), and analyzed according to first-contact and participants' ratings of GPs' competence in managing SCI-specific problems. Results: Out of 395, 226 (57%) persons participated, of which 89% have reported 2.1 (SD ±1.4) RFEs and 2.4 (±1.7) health problems per GP visit, on average. Participants visited GPs for medications (49%), urgent medical problems (33%) and follow-up (30%). Most RFEs were related to general/unspecified problems (65%). Persons whose first contact was a specialist were more likely to visit GPs for medications (Specialist = 60% vs GP = 42%). There were no associations between RFEs and the perceived GP's competence at P < 0.05. Conclusion: Irrespective of first contact of care, persons with SCI visit GPs for medication, urgent issues, and follow-up care, and more often for general problems than for secondary health conditions. Strengthening collaboration between GPs in rural communities and specialized centers is recommended; promoting such a connection potentially aids GPs in meeting their information needs for managing secondary health conditions and improving the quality of SCI care for this population.

Shared responsibility between general practitioners and highly specialized physicians in chronic spinal cord injury: Study protocol for a nationwide pragmatic nonrandomized interventional study.

INTRODUCTION: To improve the continuity of care for persons with spinal cord injury (SCI) living in peripheral areas, collaboration between general practitioners (GPs) and specialists is needed. This pragmatic non-randomized interventional study assesses feasibility and effectiveness of a new primary care model based on this collaboration. METHODS: The intervention is medical education on SCI related topics offered by specialists to GPs practicing in rural areas. Outcomes are assessed and analyzed in physicians and patients. Group allocation of persons with SCI follows intention-to-treat principle with intervention group being those in close proximity to a participating GP. RESULTS: It is expected that ten GPs and sixteen specialists will take part in the study's intervention. An average difference in "Doctor's opinion on collaboration questionnaire" score (mean 44; SD ± 12) from baseline after two years post-intervention in the group of participating GPs is hypothesized at P-value level <0.05; meanwhile, the control group remains at an average score of 56. Of persons with SCI (n = 395), 230 are expected to take part in the study at baseline. An average modified "Spinal Cord Injury-Secondary Conditions Scale" change in score from baseline to 24 months post intervention is expected to fall from 12.0 to 9.0 in the intervention group and to stay at 12.0 in the control group. CONCLUSION: The study aims to improve patients' outcomes and providers' experience with delivery of care for persons with SCI, as compared to current best practice. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04071938. Registered August 28, 2018, https://www.clinicaltrials.gov/ct2/show/NCT04071938.

First contact of care for persons with spinal cord injury: a general practitioner or a spinal cord injury specialist?

BACKGROUND: 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. METHODS: 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). RESULTS: 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). CONCLUSION: 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.

The use of ultrasound in primary care: longitudinal billing and cross-sectional survey study in Switzerland.

BACKGROUND: Ultrasound imaging is utilized in Swiss primary care; however, little is known regarding the extent to which it is performed. With this study, we aim to (1) provide an overview of ultrasound use by general practitioners (GPs), and (2) determine the clinical indications of ultrasound in Swiss general practice. METHODS: This is a quantitative study, analyzing 15 years of billing data from 213 GPs in Central Switzerland, and cross-sectional survey data completed by 61 GPs attending 26 certification and refresher courses offered by the Swiss Society of Ultrasound in Medicine (SGUM). RESULTS: According to billing data, 49% of the GPs used ultrasound and provided 130,245 exams to 67,180 patients between 2004 and 2018. Over the years, ultrasound use became more frequent among GPs. Male GPs provide more ultrasound exams than female GPs. Patients that are female, ≥65 years, and multi-morbid had more ultrasound exams compared to males, patients < 65 years, and those with only one morbidity, respectively. GPs provided a mean of 129 ultrasound exams per physician-year. Abdominal ultrasound comprised almost 69% of all exams. According to survey data, indications covered many organ systems and clinical conditions, with abdominal indications being most frequent among them. CONCLUSIONS: The use of ultrasound is high among general practitioners and it covers a wide range of clinical indications. Ultrasound is utilized primarily in the diagnosis of clinical indications of the abdomen, and more often for female than male patients.