Differential Impact of the COVID-19 Pandemic on Health Care Utilization Disruption for Community-Dwelling Individuals With and Without Acquired Brain Injury

Abstract

Objective: To delineate health care disruption for individuals with acquired brain injury (ABI) during the peak of the pandemic and to understand the impact of health care disruption on health-related quality of life (HRQoL).

Design: Cross-sectional survey.

Setting: General community.

Participants: Volunteer sample of adults with traumatic brain injury (TBI; n=33), adults with stroke (n=66), and adults without TBI or stroke (n=108) with access to the internet and personal technology (N=207).

Interventions: Not applicable.

Main outcome measures: Not applicable.

Results: Participants with TBI and stroke reported high rates of disruption in care specific to their diagnosis (53%-54.5%), while participants across all groups reported disruption for major medical care (range, 68.2%-80%), general health care (range, 60.3%-72.4%), and mental health care (range, 31.8%-83.3%). During the pandemic, participants with TBI and stroke used telehealth for care specific to their diagnosis (40.9%-42.4%), whereas all participants used telehealth for major medical care (range, 50%-86.7%), general health care (range, 31.2%-53.3%), and mental health care (range, 53.8%-72.7%). Disruption in TBI or stroke care and type of ABI explained 27.1% of the variance in HRQoL scores (F_2,95=16.82, P<.001, R ²=0.262), and disruption in mental health care explained 14.8% of the variance (F_1,51=8.86, P=.004, R ²=0.148).

Conclusions: Individuals with and without ABI experienced pronounced disruption in health care utilization overall. However, individuals who experienced a disruption in care specific to TBI or mental health care were most vulnerable to decreased HRQoL. Telehealth was a viable alternative to in-person visits for individuals with and without ABI, but limitations included difficulty with technology, difficulty with comprehensive examination, and decreased rapport with providers.

Keywords: ABI, acquired brain injury; ANOVA, analysis of variance; Brain injuries, traumatic; COVID-19; HRQoL, health-related quality of life; Healthcare disparities; Patient acceptance of health care; Quality of life; Rehabilitation; Stroke; TBI, traumatic brain injury; Telemedicine.

Fig 1

Health care disruption during the pandemic for TBI group, stroke group, and group without ABI. Health care disruption: missed or delayed appointments, variable group sample sizes reflect the number of participants that indicated participation in each type of health care. *Significantly higher for TBI group than stroke group and group without ABI (P<.05).

Fig 2

Health care utilization during the pandemic for in-person and telehealth visits for TBI group, stroke group, and group without ABI. Variable group sample sizes reflect participants who indicated participation in each type of health care. *Significantly higher for TBI group than stroke group and group without ABI (P<.05). ^†Missing data (n=1).

Fig 3

Self-reported reasons for telehealth satisfaction/dissatisfaction in TBI group, stroke group, and group without ABI (n=43). For Convenient category, participant responses included: easy, fast, appointment starts on time, and more appointment availability. For Routine visits category, participant responses included: requesting COVID-19 test, diagnosis, medication prescription, follow-ups. For Safe category, participant responses included decrease the risk of infection. For Difficulties with technology category, participant responses included: inaccessible technology, poor internet connection, no technical assistance, and technical issues. For Noncomprehensive examination, category, participant responses included: not able to cover all needs, limited physical examination, difficulties with diagnosis, and limitations on what health care providers can see via a video call. (1) All groups experienced notable disruption in health care utilization. (2) Disruption in care for traumatic brain injury or mental health was associated with decreased health-related quality of life. (3) Telehealth was a viable alternative to in-person visits. (4) Telehealth is not a panacea and should be adopted using a nuanced approach.