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Historically, many patients with SCI have used specialists(particularly physiatrists) to provide their primarycare.49-52 While this approach ensures a high degreeof expertise in SCI, there are a number of argumentsagainst it—not least among these is the clear preferenceby physiatrists to resist responsibility for primary care.35The literature is unequivocal that a robust systemof primary care is the best assurance of good healthoutcomes for the population and of reasonable healthservice use.53 The primary care system is best positionedto provide high-quality, holistic care for all,including people with SCI. Although the evidence isnot strong, there appears to be sufficient consensusto advance several recommendations. We suggestthat optimal primary care for patients with SCI mightinclude the following:• routine annual comprehensive health evaluation;• multidisciplinary follow-up to address issues thataccompany long-term disability;• accessible premises that permit full examination ofpresenting health complaints;• access to disability-specific expertise in the form of specialists,regarding common secondary complicationssuch as pain and bowel and bladder complications; and• awareness of areas in which there are often unmetneeds, such as psychological concerns, sexual andreproductive health, and lifestyle issues.Further research is needed to evaluate the validity ofthese recommendations.
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