Persons with disability from spinal cord injury (SCI) are subject to high risk of pathological events and need a regular followup even after discharge from the rehabilitation hospital. To help in followup, we developed a web portal for providing online specialist as well as GP support to SCI persons. After a feasibility study with 13 subjects, the portal has been introduced in the regional healthcare network in order to make it compliant with current legal regulations on data protection, including smartcard authentication. Although a number of training courses have been made to introduce SCI persons to portal use (up to 50 users), the number of accesses remained very low. Reasons for that have been investigated by means of a questionnaire submitted to the initial feasibility study subjects and included the still easier use of telephone versus our web-based smartcard-authenticated portal, in particular, because online communications are still perceived as an unusual way of interacting with the doctor. To summarize, the overall project has been appreciated by the users, but when it is time to ask for help to, the specialist, it is still much easier to make a phone call. 1. Introduction Persons with disability from spinal cord injury (SCI) are subject to high risk of pathological events and need a regular followup even after discharge from the rehabilitation hospital [1]. SCI causes sensory, motor, and autonomic impairments, but often in long-term also a variety of secondary conditions on different domains, for example, physical (bladder and bowel problems, pain, spasms, pressure sores, and sexuality), psychological (anxiety and depression), and social (transport, finance, equipment, housing, care management, and employment). SCI is not a static condition, but rather a process of continuous adaptation due to interactions with the aging process. Advanced age has been associated with increases in a number of secondary health complications including bowel complications, cardiovascular and respiratory complications, pressure ulcers, urinary tract infections, renal stones, and musculoskeletal pain. Like in other countries, also in the Italian health-care system the GP is the first contact point for the person in need of health care. The same is true for people with SCI, encouraged to contact first their GP for health problems, but the limited expertise on SCI of the GP was seen by persons with an SCI as the greatest barrier to needs being met [1]. Thus most of SCI persons turn to either specialists of spinal units or rehabilitation centers, whose intervention
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