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An Investigation of the Journey of Care Related to Secondary Health Conditions for Community-dwelling Persons with Spinal Cord Injury

Year: 2014
Type: dissertation
Study design: Observational Study
Abstract: This thesis comprises an in-depth analysis of the journey of care in managing secondary health conditions (SHCs) for community dwelling persons with a spinal cord injury (SCI) in Ontario. Persons with SCI are at high risk of preventable secondary health conditions. The Network Episode Model was used to help conceptually guide the thesis. To determine whether potentially preventable SHCs may be related to emergency department (ED) use, in the first study, I examined patterns of emergency department use (ED) such as the number of visits by year post injury and characteristics of these visits (e.g., acuity level, timing of visits, reasons for visits). Results from this study suggest that the ED is being used as an inappropriate substitute for primary health care for individuals with traumatic SCI. In the second study, to better understand care provision in the community, I examined the caregiving networks, in particular the structure and roles of informal care. While networks are smaller for persons with SCI compared to the general population, these ties are strong, which is essential when the roles involve a level of trust and flexibility. These informal networks serve as critical key players and secondary team members. Finally, in the third study, the journey of care related to SHCs was examined at the micro (individual level), meso (care provider level) and macro (health system level). Significant challenges at the macro health system level were identified such as rigid policies, wait-times for services, funding and social inequities. These analyses have led to a better understanding of the journey of care, which seems to be a challenging and an uphill struggle for persons with SCI, care providers, and community-based advocates. If we are to make significant gains in minimizing the incidence and severity of SHCs, we need to tailor efforts at the health system.
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W2756812423
Cites: 120
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Related to: 10