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Health Maintenance Checklist

  1. Ensure general preventive care is up to date and be aware of secondary complications (e.g., spasticity, bowel and bladder dysfunction).
  2. Schedule appointments according to patient cares/needs (i.e., later day, transportation availability, attendant care).
  3. Solicit feedback from patient regarding overall clinic accessibility.
  4. Refer to rehabilitation specialists accordingly.

Case Report

John is a 50-year-old man who is a new patient presenting for a periodic health exam. He sustained a complete T3 spinal cord injury (SCI), American Spinal Injury Association Impairment Scale (AIS) B, at age 30. Since being discharged from rehabilitation 20 years ago, he has rarely seen a primary care physician (PCP). He reports that he has “put on a few pounds” and is coming in for a check-up; he’s been having difficulty with a wound on his buttocks that does not seem to be healing. He comes in his full-time manual wheelchair and requires significant assistance with transfers. What barriers might he face in your office?

Introduction

The incidence and prevalence of traumatic SCI in the United States is approximately 12,500 per year and 906 cases per million, respectively.1 The average life expectancy for individuals with SCI remains significantly lower when compared to persons without SCI, and this is virtually unchanged since the 1980s. Although milestones and expected outcomes are based on level and completeness of injury, nearly three-quarters of patients are typically discharged into the community following inpatient rehabilitation.1 Typical functional outcomes for individuals with SCI have been described in detail.2 At 1-year post injury, 91% of SCI patients live in a private residence and 4% live in a skilled nursing facility (SNF). At 20 years post injury, the numbers are essentially similar, with 97% living in private residence and less than 1% in an SNF.3 PCPs are typically the first line of contact within the health care system, and they have the unique opportunity to help manage SCI patients’ comprehensive health needs and serve as a link between the individual and multiple health care providers. However, the literature has shown that individuals with SCI are less likely to receive the same basic health care when compared to their peers and have unmet health care needs.4

The Institute of Medicine states that primary care is “the...

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