title: Physician utilization among adults with traumatic spinal cord injury in Ontario: a population-based study.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To describe the physician utilization patterns (family physicians (FP), specialist and emergency department (ED) visits) of adults with traumatic spinal cord injury (SCI) 1 year after the initial injury.
  
  
  METHODS
  Ontario, Canada.
  
  
  METHODS
  A total of 559 individuals with a traumatic SCI were identified. Five administrative databases were linked to examine health-care utilization in acute care, inpatient rehabilitation, chronic care rehabilitation, outpatient physician visits and ED visits. Factors predicting frequent physician, specialist and ED use were identified.
  
  
  RESULTS
  The mean number of physician visits for traumatic SCI patients during the first year after their injury onset was 31.7 (median 26). FPs had the greatest number of visits (mean 11.6, median 7) followed by physiatrists (mean 6.1, median 2). Factors predicting 50 or more physician visits included age 70 or above (OR=3.6, 95% CI=2.0-6.5), direct discharge to chronic care (OR=3.6, 95% CI=1.0-13.1) and in-hospital complication (OR=2.34, 95% CI=1.3-4.3). Age 70 or less (OR=0.19, 95% CI=0.0-0.9) and direct discharge to chronic care were associated with 50 or more specialist visits. Only rurality predicted two or more visits to the ED.
  
  
  CONCLUSIONS
  Individuals with traumatic SCI show significant physician utilization, especially among their FPs and physiatrists. Although the factors predicting higher physician and specialist utilization may reflect individuals with the most severe impairment, comorbid conditions or lack of social support, the model for higher ED visits may point to limited accessibility to/availability of primary care services for SCI patients in rural regions.
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: S E P
authors.initials: SE
authors.lastname: Munce
authors.forename: S J T
authors.initials: SJ
authors.lastname: Guilcher
authors.forename: C M
authors.initials: CM
authors.lastname: Couris
authors.forename: K
authors.initials: K
authors.lastname: Fung
authors.forename: B C
authors.initials: BC
authors.lastname: Craven
authors.forename: M
authors.initials: M
authors.lastname: Verrier
authors.forename: S B
authors.initials: SB
authors.lastname: Jaglal
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018672:Community Health Planning; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D010821:Physicians, Family / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000628:therapy*; D055815:Young Adult