Application of the Andersen’s health care utilization framework to secondary complications of spinal cord injury: a scoping review

Abstract

Purpose: The purpose of this scoping review was to identify research priority areas related to secondary complications and associated health care use for individuals with spinal cord injury (SCI). Method: Data Sources: Peer-reviewed journals were identified using CINAHL, MEDLINE, PubMed, Embase, Social Sciences Abstracts, Social Works Abstract and PsycInfo search engines. Key references were hand searched. Study Selection: A total of 289 abstracts were identified from the initial search strategy. We removed studies that did not measure health care and those that did not involve analytical investigation. Data Extraction: The selected 31 studies were reviewed in detail using a coding template based on the domains and sub-components of the Andersen model (i.e. environmental, population characteristics, health behavior and outcome). Results: Most studies measured predisposing characteristics (e.g. age, gender) and need characteristics (e.g. level of injury). There was a notable absence of environmental characteristics (e.g. health system, neighborhood variables), enabling characteristics and health behaviors (beyond diet and nutrition). Conclusions: We identified a gap in the SCI literature. Future research should focus on longitudinal study designs with more representation of non-traumatic spinal cord injury, as well as utilizing more advanced statistical analyses (i.e. multivariate level) to adjust for confounding variables.

Implications for Rehabilitation

• Secondary complications are problematic for individuals with a spinal cord injury (SCI).

• This scoping review aimed to identify research priority areas related to secondary complications and associated health care use for individuals with spinal cord injury.

• This research showed a gap in the SCI health services literature.

• Future research should focus on longitudinal study designs with more representation of non-traumatic spinal cord injury as well as utilizing more advanced statistical analyses (e.g. multivariate level) to adjust for confounding variables.

Keywords::

• Andersen model
• environmental characteristics
• health care use
• secondary complications
• spinal cord injury

Acknowledgments

The authors acknowledge the support of the Toronto Rehabilitation Institute (TRI), which receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long-Term Care in Ontario. The views expressed do not necessarily reflect those of the Ministry.

Declaration of interest: Ms. Guilcher’s doctoral training has been supported by the Canadian Institute for Health Research, Women’s College Research Institute, Ontario Neurotrauma Foundation, TRI, Community University Research Alliance, and Ontario Training Collaborative Program in Health Services and Policy Research. Dr. Jaglal is the TRI Chair at the University of Toronto in Health Services Research.