Article

OBJECTIVE: To explore perceptions of barriers and facilitators to the diagnosis
and receipt of treatment for neuropsychiatric disturbances (NPDs) after traumatic
brain injury (TBI). DESIGN: Qualitative study using semistructured interviews and
focus groups. SETTING:
A clinic specializing in the treatment of TBI NPDs, an
urban trauma center, and a large urban academic hospital. PARTICIPANTS: A sample
(N=33) of health care providers (n=10) who treat individuals with TBI, persons
with TBI (n=18), and caregivers (n=5). INTERVENTIONS: Not applicable. MAIN
OUTCOME MEASURES: Topic guides for the interviews and focus groups were guided by
previous literature, clinical experience, and the goals of the project and
focused on the 3 most common TBI NPDs: depression, anxiety, and posttraumatic
stress disorder. The interviews and focus groups were audio-recorded and
transcribed verbatim. We performed a conventional content analysis on the
transcripts and grouped concepts into overall themes, incorporating feedback from
stakeholders. RESULTS: Patient education, insurance, provider type, time since
TBI, caregiver support, and recognition or screening for TBI NPDs were the most
frequently mentioned barriers or facilitators to the diagnosis and treatment of
TBI NPDs by both interview and focus group participants. We grouped these and
other frequently mentioned concepts into 3 broad themes: education, access, and
support. Each of these themes is explored in depth and supported with direct
quotations. CONCLUSIONS: This study explored patient, caregiver, and health care
provider and identified barriers and facilitators to the diagnosis and receipt of
treatment for TBI NPDs. Barriers included poor provider education on TBI NPDs and
limited access to care due to lack of insurance, transportation, and income.
Facilitators included patient education on TBI NPDs and strong caregiver support.
Future studies should develop and pilot interventions aimed at quality of care
that address the identified barriers and facilitators.
CI - Copyright (c) 2017 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS