title: Utilization and access to healthcare services among community-dwelling people living with spinal cord injury.
abstract: Describe the utilization, accessibility, and satisfaction of primary and preventative health-care services of community-dwelling individuals with spinal cord injury (SCI).
  
  
  
  Cross sectional, in-person or telephonic survey, utilizing a convenience sample.
  
  
  
  Community.
  
  
  
  Individuals with SCI greater than 12-months post injury.
  
  
  
  N/A.
  
  
  
  Demographic, injury related, and 34-item questionnaire of healthcare utilization, accessibility, and satisfaction with services.
  
  
  
  The final sample consisted of 142 participants (50 female, 92 male). Ninety-nine percent of respondents had a healthcare visit in the past 12-months with primary care physicians (79%), with SCI physiatrists (77%) and urologists (50%) being the most utilized. 43% of the sample reported an ER visit within the past 12-months, with 21% reporting multiple visits. People who visited the ER had completed significantly less secondary education (P = 0.0386) and had a lower estimate of socioeconomic status (P = 0.017). The majority of individuals (66%) were satisfied with their primary care physician and 100% were satisfied with their SCI physiatrist. Individuals who did not visit an SCI physiatrist were significantly more likely to live in a rural area (P = 0.0075), not have private insurance (P = 0.0001), and experience a greater decrease in income post injury (P = 0.010).
  
  
  
  The delivery of care for people with SCI with low socioeconomic status may be remodeled to include patient-centered medical homes where care is directed by an SCI physiatrist. Further increased telehealth efforts would allow for SCI physiatrists to monitor health conditions remotely and focus on preventative treatment.
authors.affiliation: a Baylor Institute for Rehabilitation , Dallas , TX , USA.
authors.forename: Rita
authors.initials: R
authors.lastname: Hamilton
authors.affiliation: a Baylor Institute for Rehabilitation , Dallas , TX , USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Driver
authors.affiliation: a Baylor Institute for Rehabilitation , Dallas , TX , USA.
authors.forename: Shayan
authors.initials: S
authors.lastname: Noorani
authors.affiliation: a Baylor Institute for Rehabilitation , Dallas , TX , USA.
authors.forename: Librada
authors.initials: L
authors.lastname: Callender
authors.affiliation: b Baylor Scott & White Health , Dallas , TX , USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Bennett
authors.affiliation: c Baylor University Medical Center , Dallas , TX , USA.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Monden
mesh_terms: D000293:Adolescent; D000328:Adult; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000534:rehabilitation*
keywords: Accessibility; Disability; Healthcare services; Injury; Outpatient; Rehabilitation; Satisfaction; Spinal cord injury