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T - New Perspectives From E-Scan

Make Employment an Outcome of Critical Importance With shortened rehabilitation length of stay and erosion of infrastructure to support inpatient rehabilitation, over time, there has been a profound overemphasis on self-care activities, and a de-emphasis on employment as an important outcome. This de-emphasis has profound economic and health consequences for the individual with SCI over his or her lifetime. In addition, there are substantial systemic and financial disincentives for individuals to return to employment or to complete a work trial, that contribute to career disability and abysmally low employment rates - despite advancing technology and growing acceptance of flextime and flexible work environments. Policy Barriers to Best Practice Abound One of the most common and frustrating refrains heard from rehabilitation service providers is their ability to identify the best therapy available, for specific health conditions, and their inability to provide it to individuals with SCI, who receive provincial disability support. It is not the lack of a clinician’s knowledge of best available therapies, but rather the lack of funding that routinely precludes provision of best care. Development of a national body (akin to the Ontario SCI Solutions Alliance and its member organizations), to lobby and routinely advocate for changes in health policy - that enable optimization of service delivery, and elimination of the observed regional disparity in access to medication, devices and supplies - is critical to future service enhancement. Conduct of the E-Scan also highlights the inequity and perceived challenges inherent in bringing about policy change for individuals with a relatively rare disease, compared to those individuals with large scale, common diseases (e.g., diabetes, heart disease or cancer). It is extremely difficult to conduct clinical trials - never mind provide the necessary efficacy data from both clinical trials and economic evaluations, demonstrating that the cost-utility of the proposed interventions is favourable - prior to obtaining provincial service enhancements. Mechanisms to enable early adoption of effective therapy among neurologic populations need to be explored with provincial formularies. Technology Offers Opportunity to Enhance Rehabilitation Service Delivery Technology is rapidly changing the face of healthcare delivery, and offers an opportunity to advance the field in two ways: through efficient use of informatics to ensure timely and accurate assessment, and communication of outcomes; and to interface with devices, that enhance recovery, and assist or compensate for specific functional impairments. The typical lag time from development of a new therapy to routine practice implementation for drug therapy is about 17 years. The lag time for uptake of novel rehabilitation devices is often longer, due to the barriers associated with regulatory approvals and established funding mechanisms. A focus on bioinformatics, our strengths in biomedical engineering in Canada, and widespread use of mobile devices should enable rapid cycle changes in communication and data transmittal. Practice transformation and early adoption of clinically effective technologies and/or devices will require a national implementation strategy. NEW PERSPECTIVES FROM E-SCAN 205


T - New Perspectives From E-Scan
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