Non-adherence to follow-up care in persons with spinal cord injury within 10 years after initial rehabilitation.

Abstract

This study aimed to describe the temporal dynamics of and risk factors for non-adherence to outpatient follow-up care in the first 10 years after spinal cord injury. Retrospective single-centre cohort study using data from medical records and municipal resident registers. Patients admitted to a specialized spinal cord injury centre in Switzerland discharged between 1 January 2010 and 31 December 2012 (n = 225). Time-to-event analysis was used to investigate the timing of the first non-adherence event, its association with spinal cord injury, and sociodemographic characteristics. 36% of patients were adherent to annual follow-up appointments; 2% formally transferred to another SCI centre; 44% were non-adherent for general reasons (patient's will to discontinue care [12%] or unknown reasons [32%]); and 18% were non-adherent due to death. Risk factors for non-adherence included older age, lack of long-term partner, and more than 2 h of travel time to the clinic. In the youngest age group (18-30 years), 55% were non-adherent after 10 years. A relevant proportion of individuals with spinal cord injury were lost to annual follow-up care. A holistic approach to patient engagement integrating solutions such as telemedicine and involvement of support networks could reduce the risk of non-adherence.