A study published in the journal Physical Medicine and Rehabilitation indicates that a more targeted approach may be needed to prevent hospitalisations in patients with congenital spinal anomalies.
Richard Wilson, MetroHealth Rehabilitation Institute of Ohio, USA, and colleagues, the authors of the study, found further evidence that patients with spina bifida or congenital spine anomalies are hospitalised more often than the general population and that some of the causes for these hospitalisations may be preventable.
Previous studies have identified that certain conditions (known as spina bifida sensitive conditions; SBSCs), such as urinary tract infections, increase the risk of hospitalisation in patients with spina bifida and are therefore, potential targets for preventing hospitalisation in this population. However, prior to this study, it was not known how these conditions affected the general population.
Unsurprisingly, Wilson et al, in their study, found that the hospitalisations related to SBSCs were increased in patients with spina bifida compared with the general population. However, surprisingly, patients with spina bifida also had more hospitalisations due to ambulatory care sensitive conditions (conditions that are the result of inadequate outpatient care, such as unstable angina) and a greater proportion of their overall hospitalisations were related to ambulatory care sensitive conditions (ACSCs) than the general population. When the results were stratified by age, patients with spina bifida had more SBSC related hospitalisations in all age groups compared with the general population but only the youngest group of patients (18–39) with spina bifida had more ACSCs hospitalisations than the general population. Wilson et al reported: “It appears that younger patients are at greater risk, although in this study we are not able to explain why. It could be that the younger patients who are experiencing more health problems related to ACSCs have poor access to care or may receive lower quality of care for these conditions than older individuals.”
They added that there are many possible reasons why patients with spina bifida or congenital spine anomalies in the study had more hospitalisations due to SBSCs or ACSCs, one being that this group of patients may be at greater risk of such conditions and have additional health needs than the general population. “It is possible that prevention of SBSCs and ACSCs requires a comprehensive medical home approach with physiatry, primary care, and others providing medical care to patients with spina bifida.”
Concluding their paper, Wilson et al report that “more work” needs to be done to review the efficacy of programmes aimed at preventing SBSCs and ACSCs in patients with spina bifida.
Wilson said: “We currently do not know the best methods to prevent hospitalisations for ACSCs and SBSCs in those with spina bifida. It seems that targeted prevention should first be attempted for younger adults with severe disability. It has been suggested that the comprehensive medical home approach, where specialists and primary providers work together as a team to provide care, would prevent some of the complications experienced by those with spina bifida and encourage better health. More studies into the reasons why this disparity exists need to be done to determine how best to approach the solution.”
