title: Health care utilization and barriers experienced by individuals with spinal cord injury.
abstract: OBJECTIVE
  To identify from whom individuals with spinal cord injury (SCI) seek health care, the percentage who receive preventative care screenings, and the frequency and types of barriers they encounter when accessing primary and specialty care services; and to examine how sociodemographic factors affect access to care and receipt of preventative screenings.
  
  
  METHODS
  Cross-sectional, observational study using an Internet-based survey.
  
  
  METHODS
  Internet based.
  
  
  METHODS
  Adults (N=108) with SCI who use a wheelchair as their primary means of mobility in the community.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Health care utilization during the past year, barriers encountered when accessing health care facilities, and receipt of routine care and preventative screenings.
  
  
  RESULTS
  All but 1 participant had visited a primary care provider within the past 12 months, and 85% had had ≥ 1 visit to specialty care providers. Accessibility barriers were encountered during both primary care (91.1%) and specialty care (80.2%) visits; most barriers were clustered in the examination room. The most prevalent barriers were inaccessible examination tables (primary care=76.9%; specialty care=51.4%) and lack of transfer aids (primary care=69.4%; specialty care=60.8%). Most participants had not been weighed during their visit (89%) and had remained seated in their wheelchair during their examinations (85.2%). Over one third of individuals aged ≥ 50 years had not received a screening colonoscopy, 60% of women aged ≥ 50 years had not had a mammogram within the past year, 39.58% of women had not received a Papanicolaou smear within the previous 3 years, and only 45.37% of respondents had ever received bone density testing.
  
  
  CONCLUSIONS
  Individuals with SCI face remediable obstacles to care and receive fewer preventative care screenings than their nondisabled counterparts. We recommend that clinics conduct Americans with Disabilities Act self-assessments, ensure that their clinical staff are properly trained in assisting individuals with mobility disabilities, and take a proactive approach in discussing preventative care screenings with their patients who have SCI.
authors.affiliation: Department of Internal Medicine, School of Medicine, University of Louisville, Louisville, KY. Electronic address: michael.stillman1972@gmail.com.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stillman
authors.affiliation: Bioengineering, J.B. Speed School of Engineering, University of Louisville, Louisville, KY.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Frost
authors.affiliation: Bioengineering, J.B. Speed School of Engineering, University of Louisville, Louisville, KY.
authors.forename: Craig
authors.initials: C
authors.lastname: Smalley
authors.affiliation: Bioengineering, J.B. Speed School of Engineering, University of Louisville, Louisville, KY.
authors.forename: Gina
authors.initials: G
authors.lastname: Bertocci
authors.affiliation: Neurosurgery, School of Medicine, University of Louisville, Louisville, KY.
authors.forename: Steve
authors.initials: S
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000534:rehabilitation / Q000628:therapy*; D014481:United States; D055815:Young Adult
keywords: Rehabilitation; Spinal cord injuries