# Territorial Continuity of Care for Patients with Spinal Cord Injury: A Focus Group Study
## 4 Discussion  
The present qualitative study was conducted in accordance with the Standards for Reporting Qualitative Research (SRQR) [18]. In accordance with the research question, the present study highlighted some central concerns about the care pathway of patients with SCI, by its definition to main opportunities or challenges that health systems should face. Our aim was in alignment with the WHO's framework on integrated patient-centered health services (IPCHSs) [19]: engaging patients, professionals, caregivers and community represents a central strategy to achieve the co-production of health, in which each one is seen as a co-protagonist in improving the approach. Moreover, even in accordance with WHO principles, territorial care necessitates the assurance of a seamless and integrated patient-centered trajectory, characterized by an absence of fragmentation across diverse healthcare delivery tiers (e.g., inpatient facilities, community-based services, domiciliary care) and among the multidisciplinary team, thus achieving quality, resilience and efficiency. The analysis of the FGs was consistent with such premises, revealing a significant emphasis on a patient-centric model of healthcare delivery, prioritizing individual needs, preferences and therapeutic goals [8; 20]. The general perspective that emerged from the FGs regarding the nature of territorial continuity is that it evolves together with disease history: our patients revealed that, while in the initial years the strongest need is rehabilitation, to improve functional abilities, time brings out the pivotal role of managing other complications: autonomous dysfunctions, internal medicine complications and social isolation. This finding seems in line with the preceding literature [21], and results in a greater involvement of all other professionals within the multidisciplinary team: doctors, nurses, occupational therapists and social assistants. In this scenario, multidisciplinary teamwork was highlighted as central to promoting wellbeing and health, reinforcing the idea that long-term interventions should be versatile and provide for the continuous entry of new professionals, according to the patient's needs; this approach already has supporting evidence in the literature [22; 23; 24]. Regarding barriers to territorial continuity, FG participants reported different types of obstacles: physical barriers due to structures, lack of specialized healthcare professionals within the community setting and a lack of communication; these concerns result in the impossibility of addressing the complex needs of individuals with SCI [22]. On the other hand, healthcare professionals and patients recognized some opportunities to improve territorial care: among these, a strong emphasis on integrating technology in everyday work emerged. Having technology for telerehabilitation and teleconsultation provides powerful tools that would allow for more requests to be taken on board and patients to be directed to the correct service, preventing the worsening of clinical situations; the finding was in agreement with recent studies [22; 25], which describe the usefulness of informatics in promoting connections between people with SCI and local services, improving equity of access to care and reducing travel for people who live in more remote locations. Teleconsultation services could represent an efficient and effective management of follow-up visits and nurses' interventions on bowel and bladder functions [26]; a further development would be integrating a teleconsultation service for all healthcare professionals (i.e., physiotherapists). The involvement of a multidisciplinary team or a specialized consulting team, also available remotely, seems to be universally approved in the literature [25]. Other suggestions emerged about implementing communication strategies among multidisciplinary team members, through regular in-person/online meetings involving both hospital professionals and territorial ones.