Leading Canadian spinal cord injury (SCI) experts have launched the unprecedented Spinal Cord Injury: A Manifesto for Change—a call to action and a plea for Canadian health-care providers and stakeholders to work in coordination to improve care and the health of people living with SCI in Canada.
The Manifesto, based on the consensus of 23 experts, outlines the long-term issues for people living with SCI: secondary health concerns; increased need and utilization of health-care services; and disparate access to care, services and expertise.
It presents four necessary actions to transform SCI health-care delivery for three health problems: pressure ulcers, fractures and cardiovascular disease. These conditions are associated with significant burden of illness and in extreme cases, risk of death among people with SCI.
"A huge gap in Canada is that these secondary conditions are not being recognized or managed in an appropriate setting," said Dr. Cathy Craven, lead author and physiatrist, Toronto Rehab, UHN. "Too often people with these complex conditions seek out urgent care, present to the ER, or are unnecessarily hospitalized."
The Manifesto lays out an action plan that needs to be taken by the Canadian SCI health sector collectively. This will augment the health and reduce the personal burden and societal resources required for living with a chronic SCI.
"Living with a spinal cord injury is challenging enough," said Paul Peer, father and husband living with SCI. "But being paralyzed also means dealing with complications, like pressure ulcers, fractures and cardiovascular problems. I've fractured my leg, and experienced first-hand the perils of osteoporosis at a young age."
"The access to care and services for people living with SCI is not equal across Canada," said Dr. Craven. "We would like to change that. We have learned a great deal from development of specialty outpatient services within SCI programs like Toronto Rehab's skin and wound clinic, post fracture care and non-invasive cardiovascular screening. These can be adopted across the country for a coordinated and consistent approach to SCI health-care delivery."
To transform SCI care over the next five years, the following four action items will need to be carried out:
• Invest in specialty outpatient rehabilitation services to reduce the number of inappropriate SCI-related emergency room visits and unnecessary hospital admission for pressure ulcers, fractures and cardiovascular disease in the next five years.
• Reduce the incidence and severity of pressure ulcers, fractures and cardiovascular disease among people with SCI.
• Accelerate access to new technologies and advanced rehabilitation therapies.
• Create a widely-accessible national dataset to track the diagnosis and management of pressure ulcers, fractures and cardiovascular disease among Canadians with SCI.
"To move forward with our action plan we are engaging with our partners." said Craven. "We have existing tools, technologies, expertise and services that need to be refined and improved upon and this can only be done by working together to transform care for the 86,000 Canadians living with SCI."
The Manifesto was launched today at the annual National SCI Conference in Toronto, Canada.
Spinal Cord Injury statistics
• People with SCI see a physician three time more often and are re-hospitalized 2.6 times more often
• A decade after a SCI, most people report having seven concurrent secondary health conditions
• Pressure ulcers affect 95% of individuals with SCI over the course of their life; In Ontario, the cost of treating pressure ulcers is estimated at $5,000 per month for each patient. However, use of prevention best practices can reduce treatment-related costs by 90%
• 10% of people with SCI get a lower extremity fracture each year; patients who are hospitalized for fractures stay seven times longer than those who don't have fractures. Further there is an increased risk of mortality for five years following a fracture
• The incidence of heart disease in people with SCI is as high as 70%; Heart disease is the leading cause of death after injury among people living with a SCI
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