Historically, many patients with SCI have used specialists
(particularly physiatrists) to provide their primary
care.49-52 While this approach ensures a high degree
of expertise in SCI, there are a number of arguments
against it—not least among these is the clear preference
by physiatrists to resist responsibility for primary care.35
The literature is unequivocal that a robust system
of primary care is the best assurance of good health
outcomes for the population and of reasonable health
service use.53 The primary care system is best positioned
to provide high-quality, holistic care for all,
including people with SCI. Although the evidence is
not strong, there appears to be sufficient consensus
to advance several recommendations. We suggest
that optimal primary care for patients with SCI might
include the following:
• routine annual comprehensive health evaluation;
• multidisciplinary follow-up to address issues that
accompany long-term disability;
• accessible premises that permit full examination of
presenting health complaints;
• access to disability-specific expertise in the form of specialists,
regarding common secondary complications
such as pain and bowel and bladder complications; and
• awareness of areas in which there are often unmet
needs, such as psychological concerns, sexual and
reproductive health, and lifestyle issues.
Further research is needed to evaluate the validity of
these recommendations.