Gender differences in patient experience among persons with spinal cord injury: A comparison across 22 countries.

BACKGROUND: Due to the majority of males within the population of persons with spinal cord injuries (SCI), a male-oriented perception of persons with SCI might affect care provision in the way of prioritizing male needs. OBJECTIVE: The objective of this cross-sectional study is to describe the patient experience of persons with SCI by gender. METHODS: This study was based on the International Spinal Cord Injury Survey with 12,588 participants from 22 countries. An interval-based patient experience score was attained by partial credit model. Regression analysis was used in exploring the association between patient experience and gender. RESULTS: Participants reported very good and good patient experience. Respectful treatment was reported by 78 % of participants; clear explanations by 75 %; involvement in decision-making by 71 %; satisfaction with services by 62 %. The average patient experience score was equal among males and females (average: 64, range: 0-100), with the highest score in participants from the USA (78) and the lowest - in Morocco (44). Patient experience score was not associated with gender. Females had lower odds of reporting better decision-making involvement, yet higher odds of better satisfaction. Older participants, with higher household income and better self-rated health, had lower odds of being satisfied. CONCLUSION: The majority of persons with SCI rated their experience as good or very good. Females were more likely to report higher satisfaction with services and lower involvement in decision-making. For other patient experience categories and the overall patient experience score, no association with gender was found.

Health System's Role in Facilitating Health Service Access among Persons with Spinal Cord Injury across 22 Countries.

(1) Background: Despite efforts to improve access to health services, between- and within-country access inequalities remain, especially for individuals with complex disabling conditions like spinal cord injury (SCI). Persons with SCI require regular multidisciplinary follow-up care yet experience more access barriers than the general population. This study examines health system characteristics associated with access among persons with SCI across 22 countries. (2) Methods: Study data are from the International Spinal Cord Injury Survey with 12,588 participants with SCI across 22 countries. Cluster analysis was used to identify service access clusters based on reported access restrictions. The association between service access and health system characteristics (health workforce, infrastructure density, health expenditure) was determined by means of classification and regression trees. (3) Results: Unmet needs were reported by 17% of participants: lowest (10%) in Japan, Spain, and Switzerland (cluster 1) and highest (62%) in Morocco (cluster 8). The country of residence was the most important factor in facilitating access. Those reporting access restrictions were more likely to live in Morocco, to be in the lowest income decile, with multiple comorbidities (Secondary Conditions Scale (SCI-SCS) score > 29) and low functioning status (Spinal Cord Independence Measure score < 53). Those less likely to report access restriction tended to reside in all other countries except Brazil, China, Malaysia, Morocco, Poland, South Africa, and South Korea and have fewer comorbidities (SCI-SCS < 23). (4) Conclusions: The country of residence was the most important factor in facilitating health service access. Following the country of residence, higher income and better health were the most important facilitators of service access. Health service availability and affordability were reported as the most frequent health access barriers.

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

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.

Healthcare service utilization patterns and patient experience in persons with spinal cord injury: a comparison across 22 countries.

BACKGROUND: Persons with spinal cord injury frequently visit numerous clinical settings. Such all-around experience of the system may serve as a comprehensive experience indicator. This study compared the patient experience of persons with chronic SCI in relation to healthcare service utilization patterns in 22 countries, hypothesizing that primary-care oriented patterns would offer a better experience. METHODS: This study was based on International Spinal Cord Injury Survey with 12,588 participants across 22 countries worldwide. Utilization patterns/clusters were identified by cluster analysis and experience score - by the partial credit model. The association between healthcare utilization and experience at the provider and cluster level was explored by regression analysis. RESULTS: The highest share of visits was to primary care physicians (18%) and rehabilitation physicians (16%). Utilization patterns had diverse orientations: from primary care to specialized and from inpatient to outpatient. The experience was reported as very good and good across different dimensions: 84% reported respectful treatment; 81% - clear explanations; 77% - involvement in decision making; 65% - satisfaction with care. The average experience score (0-100) was 64, highest - 74 (Brazil) and the lowest - 52 (Japan, South Korea). Service utilization at provider and at cluster levels were associated with patient experience, but no utilization pattern resulted in uniformly better patient experience. CONCLUSION: While there are distinct patterns between countries on how persons with chronic SCI navigate the healthcare system, we found that different utilization patterns led to similar patient experience. The observed difference in patient experience is likely determined by other contextual factors than service utilization.