Article

The Department of Veterans Affairs (VA) has separate clinical structures and care
processes for traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). However, because veterans are returning from the wars in Iraq and
Afghanistan with TBI (most frequently mild TBI [mTBI]) and PTSD, the VA needs to
evaluate current service delivery systems. We conducted key informant interviews
with 40 providers from across the United States who represented separate clinical
teams providing specialized TBI or PTSD services. We identified challenges
providers perceive in scheduling and engaging patients with co-occurring mTBI and
PTSD (mTBI/PTSD) in treatment, determining the etiology of patients' presenting
problems, coordinating services, and knowing whether or how to alter standard
treatments. We found consensus that patients with mTBI/PTSD often have other
morbidities requiring specialized treatment, including pain and sleep
disturbance. Another important theme we found was the need for patient and family
educational material on mTBI/PTSD or pain and mTBI/PTSD and provider education
tailored to provider specialty. Together, findings point to the need for guidance
for providers on best practices to assess and treat mTBI/PTSD given available
information, a systematic approach toward patient and provider education, and
research to build the evidence base for practice.

Langue : ANGLAIS