Does stronger primary care improve access to health services for persons with spinal cord injury? Evidence from eleven European countries.

Abstract

Objective: To determine the association between the strength of primary care and perceived access to follow-up care services among persons with chronic spinal cord injury (SCI).

Design: Data analysis of the International Spinal Cord Injury (InSCI) cross-sectional, community-based questionnaire survey conducted in 2017-2019. The association between the strength of primary care (Kringos et al., 2003) and access to health services was established using univariable and multivariable logistic regression analysis, adjusted for socio-demographic and health status characteristics.

Setting: Community in eleven European countries: France, Germany, Greece, Italy, Lithuania, the Netherlands, Norway, Poland, Romania, Spain and Switzerland.

Participants: 6658 adults with chronic SCI.

Intervention: None.

Outcome measures: Share of persons with SCI that reported unmet healthcare needs as a measure of access.

Results: Twelve percent of the participants reported unmet healthcare needs: the highest in Poland (25%) and lowest in Switzerland and Spain (7%). The most prevalent access restriction was service unavailability (7%). Stronger primary care was associated with lower odds of reporting unmet healthcare needs, service unavailability, unaffordability and unacceptability. Females, persons of younger age and lower health status, had higher odds of reporting unmet needs.

Conclusions: In all investigated countries, persons with chronic SCI face access barriers, especially with service availability. Stronger primary care for the general population was also associated with better health service access for persons with SCI, which argues for further primary care strengthening.