Table 4. Key themes generated from the primary care provider panel discussion, with illustrative quotes.

Theme	Illustrative quote
Primary care providers are well positioned to provide SCI care within shared care and team approaches	Continuity of care is so important, be it your primary care provider or your family health team, because it takes a team to take care of [persons with SCI]. A team that’s well coordinated, and we don’t have that in every aspect but when the patient does go into the hospital, it’s really good to have the family doctor as part of that team because he can actually help to guide that patient and the team of providers through the past 20 years of what this patient has been exposed since their SCI and all the individuals’ comorbidities. So I think that the team is very important and continuity of care is even more important, more critical. You need a team leader to provide that continuity of care and the family doctor is in the best position to be the team leader.
SCI is a complex condition to manage	That chart review really drove home for me was how complex our patients that we do provide care for are medically … Getting everybody that needs to be seen can be really challenging and the urgency that accompanies that with things like infections that need to be seen immediately or with skin issues that can turn in to pressure sores if you don’t get on top of them.
Primary care and home care providers receive minimal formal education in their training on SCI and require resource supports to optimally manage SCI	While I received absolutely no training in helping people with spinal cord injuries formally in my education. The learning curve is vertical … Guidelines for care [are needed] to help with that steep learning curve if you don’t have 90 patients and if you do have 2 patients, having comprehensive guidelines would make all the difference and better system wide communication and coordination between specialists and their primary care providers.
Technology has an important role in supporting SCI care	Our closest centre, if we have a traumatic spinal cord injury and a need a neurosurgeon is 300 km away in Sudbury. We can’t change that. However, in our organization with today’s technology I really think we should improve accessibility to OTN or e-health … when you need to see a specialist instead of taking 31/2 years to see someone to solve osteomyelitis, is there someone we can connect with through OTN to help with this? This is my wish list.
Social and financial determinants of health are significant in SCI	I have a couple of patients that I’m thinking of. One had a good insurance and really had a lot of things covered and I had another patient that ended up having nothing. The economics, social determinants of health and all those factors, I think that plays a big role.
Physicians have an important role in advocacy	Think about the kind of care that you want to receive. Think about the kind of care you want to provide and advocate for the changes that will truly make that possible.
Greater reflection is needed on accessibility of medical offices	A few months ago we had a patient come to our site to talk to the health care team about her challenges. She talked about from the point of phoning the office to leaving the office … She talked about having to check in. At our particular site we have these large glass partitions with a small hole you can talk into, which have been there since days of SARS. I kind of have to tip toe to shout into the hole. She talked about having to shout so that everyone could hear her and mentioning all her personal information to communicate with the front desk. And then having to go back to the waiting room where there is no real room for a wheelchair … This was all really eye opening for us.
Information system inadequacies make it difficult to obtain objective information about SCI care	The biggest gap I found was that we don’t have a good search model to find all the SCI patients. So we need a more rigorous IT network to help us search for different types of patients. We look for cardiovascular, heart failure, we can look at certain MIs but we don’t have a good search model to look at SCI.