title: Utilization, access and satisfaction with primary care among people with spinal cord injuries: a comparison of three countries.
abstract: METHODS
  Cross-sectional; survey.
  
  
  OBJECTIVE
  To describe the utilization, accessibility and satisfaction of primary and preventive health-care services to individuals with long-term spinal cord injuries, and compare results among three countries: the United States, Canada and the United Kingdom.
  
  
  METHODS
  The Canadian sample was obtained from the Canadian Paraplegic Association-Ontario and Manitoba Divisions. The British sample was recruited from the Northwest Regional Spinal Injuries Centre in Southport and National Spinal Injuries Centre at Stoke Mandeville Hospital in Aylesbury. The American sample was recruited through Craig Hospital in Englewood, CO, USA.
  
  
  METHODS
  A total sample of 373 individuals aging with a spinal cord injury participated in a mailed survey. The Health Care Questionnaire was used to measure utilization, access and satisfaction with primary care and preventive services.
  
  
  RESULTS
  In total, 93% of individuals reported having a family doctor, 63% had a spinal injuries specialist and 56% had both a family doctor and spinal injuries specialist. Considerable duplication of services occurred for general medical and preventive services, although lifestyle and emotional issues were not addressed for over 75% of the participants. Significant differences were found in utilization among Canada, US and UK, with Canadians most likely to receive health care from family physicians and Americans most likely to receive care from specialists. Access to and satisfaction with health services was not significantly different among countries.
  
  
  CONCLUSIONS
  People with long-standing spinal cord injuries develop complex maps by which they seek out appropriate primary health-care and preventive services. Given the differences among countries, it is clear that the health delivery model plays an important role in how and where individuals receive health services.
authors.affiliation: School of Rehabilitation Sciences, Queen's University, 31 George Street, Kingston, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Donnelly
authors.forename: M A
authors.initials: MA
authors.lastname: McColl
authors.forename: S
authors.initials: S
authors.lastname: Charlifue
authors.forename: C
authors.initials: C
authors.lastname: Glass
authors.forename: P
authors.initials: P
authors.lastname: O'Brien
authors.forename: G
authors.initials: G
authors.lastname: Savic
authors.forename: K
authors.initials: K
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000628:therapy; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology