Health Services Research
Health services research deals with the use and quality of healthcare services. We are examining how the needs-based access to medical services can be improved for persons with disabilities in Switzerland, for example healthcare provision in rural areas.
In contrast to persons without disabilities, persons with spinal cord injury (SCI) require that each medical evaluation is done from a paraplegiological point of view. In Switzerland this is offered by specialized paraplegic centers. What is missing is the availability of follow-up examination and checkup services throughout Switzerland as well as outpatient treatment of minor issues. This makes the provision of adequate care through non-specialized providers such as family physicians, the «Spitex», nursing homes or relatives who provide care at home more difficult.
It is our goal to improve existing health services so that they can offer comprehensive, low-threshold treatments for persons with SCI in the same way as for persons without disabilities. We are therefore assessing the existing need, especially in rural areas. Through collaborative models between joint practices and experts, we want to disseminate the expertise in therapy and nursing from the clinics to the family physician practices.
We are examining the difficulties for caregiving relatives at home. From those findings, we derive measures for better health services and possibilities to increase one’s own quality of life. Our findings are used for the dialogue with relevant authorities and service providers of healthcare provision with the goal to improve the health system. Persons with disabilities shall be informed in detail so that they are able to use the existing range of medical services effectively.
Support provided by family members
Family members are the most direct, trustworthy and often most inexpensive caregivers for persons who need care. In Switzerland, it is estimated that more than one hundred thousand relatives provide care services worth several billion Swiss Francs each year, relieving the public sector at the expense of their own career, family and leisure time.
We conduct research with and for caregiving family members of persons with spinal cord injury. By means of statistical surveys and individual interviews, we determine the value of the provided care services and analyze the effects on the professional, family and financial situation of the caregivers. Our research sheds light on the following questions: Which factors have a beneficial effect on the balance between the obligations towards the family member and the cargiver‘s own needs and which factors have a negative effect? Based on this, we develop solutions to improve the situation of caregiving relatives. They are based on individual changes for the affected person as well as political measures that can be implemented accordingly by the decision-makers.
Access to and quality of healthcare services
Within this research focus area, we examine how healthcare services are used by persons with spinal cord injury. We evaluate how the use of and satisfaction with healthcare services are affected by the disability. In particular we analyze geographical factors, such as:
- The extent of restriction when it comes to the ideal use of healthcare services by persons in rural areas;
- Possible differences between the language regions. We also investigate whether these differences are cultural differences or if they result from different supply structures;
- The distance to specialized paraplegic centers and whether it makes optimal care more difficult.
In doing so, we identify groups of persons who do not have the best possible access to medical or care services. Furthermore, we try to find solutions to improve the care of these persons, e.g. by establishing specialized, out-patient centers in regions with inadequate healthcare or by promoting collaborations between regional hospitals and paraplegic centers.
Long-term care close to the people
Whereas serious complications of a spinal cord injury (SCI) have to be treated in a special clinic, this is often not necessary when it comes to routine checks and smaller treatments. Sometimes, these special clinics are also located too far away. In this case, general practitioners in private practices and caregivers at home play an important role. They can ensure that persons with SCI have access to basic medical care, in order to diagnose frequent chronic diseases at an early stage. Since life expectancy of persons with SCI is increasing while their mobility is decreasing with age, it is especially important to provide assistance close to the patient.
This requires a close cooperation between the special clinics on the one hand and the doctors and caregivers in the outpatient clinics and services on the other hand. Together with the Institute of Primary and Community Care Lucerne, we explore how to improve primary and long-term care. In particular, we focus on strengthening the cooperation between experts, general practitioners and caregivers.
Provision of assistive devices
Persons with spinal cord injury (SCI) strongly depend on assistive technology to take part in social life and to assume their role within their family, at school, at work and within society. Assistive devices facilitate daily activities and the care of persons with SCI provided by relatives as well as self-care. Certain factors can make optimum care more difficult, such as:
- High costs, e.g. for lifts or height-adjustable kitchen facilities;
- poor adaptation or insufficient maintenance of the assistive devices;
- conflicts due to different opinions of healthcare professionals, paying agency and user regarding the necessity of assistive devices – e.g. traction devices for wheelchairs;
- lack of awareness among potential users of new assistive devices - e.g. new environment control systems, computer input systems or special mattresses.
Our research on the provision of assistive devices monitors the need and supply of different assistive devices for persons with SCI. Our aim is to ensure an ideal distribution. We determine obstacles that make the access to assistive devices more difficult and identify risk groups that are undersupplied. Based on that we develop strategies to reduce over- and undersupply of the identified subgroups with certain assistive devices while considering the different expectations of manufacturers, paying agencies, healthcare providers, users of assistive devices and the public sector.