Research highlights health care disparities in patients with spinal cord injury

Several studies in the current issue of Topics of Spinal Cord Injury Rehabilitation put a needed spotlight on the health and health care disparities experienced by individuals with spinal cord injury. This research highlights the disparities in access for patients and lack of awareness about SCI by health care providers.

"We health care providers can do a better job of dealing with health and health care disparities related to individuals with spinal cord injury, if we are better informed as to how and where the disparities occur," says Michelle A. Meade, Ph.D., assistant professor in the University of Michigan Medical School's Department of Physical Medicine and Rehabilitation, and guest editor for the issue, which published this week.

Meade selected six articles for the issue based on the Institute of Medicine's recommendations that efforts to address health disparities should based on a thorough understanding of the associated issues. The current issue of the journal was designed to increase awareness about how health and health care disparities relate to individuals with spinal cord injury and to provide recommendations for potential ways to address them.

"This issue explores both the personal and systemic factors that contribute to health and health care disparities, recognizing the role that the health care system may unwittingly play in creating or perpetuating them," adds Meade.

U-M faculty wrote or co-authored four of the articles in the issue.

One article by Meade and colleagues uses the narratives of individuals with SCI from traditionally underrepresented groups, specifically women and African American men, to illustrate how the attitudes, education and experience of their providers has impacted their health and use of health care services. Participants talked about their difficulties in finding knowledgeable providers, the importance of educating and collaborating with health care providers, and how their perceptions of their provider's respect, bias and discrimination have a strong impact on the health outcomes.

An article written by Lisa DiPonio, M.D., assistant professor, and Randy S. Roth, Ph.D., professor, both with the U-M Department of Physical Medicine and Rehabilitation and the VA Ann Arbor Healthcare System, and several colleagues, highlights how Emergency Room providers might not have the knowledge to effectively treat individuals with chronic SCI. Conclusions were based on a survey of how familiar emergency medicine physicians were with SCI medicine and their responses to clinical vignettes about patients with SCI receiving critical care.

In an article about women with violently acquired SCI, Meade and her colleague Martin Forchheimer, MMP, also with the U-M Department of Physical Medicine and Rehabilitation, describe this vulnerable population and compare them to other women with SCI and men with violently acquired SCI.

A fourth article outlines the extent of the challenges that individuals with SCI face and lays out potential solutions to better meet the ongoing post-rehabilitation health care needs of people with SCI. Access to timely and appropriate health care is vital to the well-being of individuals with SCI, and they often have problems obtaining the kinds of health services they need when they need them.

There are approximately 265,000 people living with traumatic SCI in the U.S. More than 40 percent are the result of motor vehicle crashes, 27.9 percent are the result of falls, 15 percent from interpersonal violence and 8 percent from sports injuries. There are approximately 12,000 new cases of SCI in the U.S. each year.

Damage to the spinal cord can result in a loss of function that impacts the central, peripheral and autonomic nervous systems. The extent of impact depends on the degree and level of injury, which determines what muscles and functions might be affected. Individuals with SCI range in ability from those with high level or "complete" tetraplegia who require a ventilator to breathe, to individuals with incomplete paralysis who may be able to walk.

Following initial inpatient rehabilitation, many individuals with SCI face challenges accessing health care services. Lack of knowledgeable providers, insurance coverage, difficulties with transportation and inaccessible physical environments become barriers to receiving health care and equipment and needed supports after SCI.

Source: University of Michigan