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. 2024 Jan-Feb;39(1):E1-E14.
doi: 10.1097/HTR.0000000000000922.

Provider Perceived Facilitators and Barriers to Identifying, Perceiving, and Seeking Healthcare for Chronic Pain After TBI: A Qualitative NIDILRR and VA TBI Model Systems Collaborative Project

Risa Nakase-Richardson  1 , Bridget A Cotner, Stephanie D Agtarap, Aaron M Martin, Deveney Ching, Danielle R O'Connor, Amanda Tweed, Jolie N Haun, Robin A Hanks, Thomas F Bergquist, Flora M Hammond, Ross D Zafonte, Jeanne M Hoffman
Affiliations

Provider Perceived Facilitators and Barriers to Identifying, Perceiving, and Seeking Healthcare for Chronic Pain After TBI: A Qualitative NIDILRR and VA TBI Model Systems Collaborative Project

Risa Nakase-Richardson et al. J Head Trauma Rehabil. 2024 Jan-Feb.

Abstract

Objective: Identify determinants to chronic pain healthcare for persons with traumatic brain injury (TBI) informed by an Access to Care Framework. Findings related to the Access Framework's core domains of identifying a need, perceptions of the need, and seeking healthcare are reported.

Setting: Community.

Participants: Healthcare providers (n = 63) with 2 or more years of experience treating persons with TBI interviewed between October 2020 and November 2021.

Design: Descriptive, qualitative study.

Main measures: Semi-structured interviews with open-ended questions of chronic pain management for persons with TBI. Informed by the Access Framework, responses were coded by and categorized within the domains of identifying healthcare needs, perceptions of needs, and factors related to healthcare seeking from the supply and demand perspective.

Results: For the overall sample, 14 facilitators and 6 barriers were endorsed by more than 20% of the provider cohort. Top facilitators included on-site availability of needed resources and treatments (94%), adequate time and provider capability to ensure patient comprehension of diagnosis and treatment plans (83%), and establishing patient motivation and buy-in with the treatment plan (75%). Barriers most endorsed included policies impacting access (46%), wait times for services (41%), and patient uncertainty regarding telehealth commonly due to cognitive and physical challenges (37%). Unique determinants are reported across civilian versus Department of Veterans Affairs (VA) healthcare systems and different provider types.

Conclusion: This is the first evidence-based study to inform policy and planning to improve access to high-quality chronic pain treatments for persons with TBI. Results will inform future interventions at the systems, patient, and policy levels of healthcare that can be tailored to healthcare settings (VA, Civilian) and types of providers (rehabilitation therapists, psychologists, and medical). Evidence-informed interventions may help minimize healthcare disparities experienced by persons with TBI and facilitate access to high-quality, evidence-informed chronic pain care.

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Conflict of interest statement

The authors declare no conflicts of interests.

Figures

Figure 1.
Figure 1.
The Levesque Access to Care conceptual framework altered to reflect the reaching and utilization of high-quality healthcare. CC BY 2.0 Deed | Attribution 2.0 Generic | Creative Commons
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References

    1. . Lahz S, Bryant RA. Incidence of chronic pain following traumatic brain injury. Arch Phys Med Rehabil. 1996;77(9):889–891. doi:10.1016/s0003-9993(96)90275–0 - DOI - PubMed
    1. . Nampiaparampil DE. Prevalence of chronic pain after traumatic brain injury: A systematic review. JAMA. 2008;300(6):711–719. doi: 10.1001/jama.300.6.711 - DOI - PubMed
    1. . Schoneboom BA, Perry SM, Barnhill WK, Giordano NA, Nicely KLW, Polomano RC. Answering the call to address chronic pain in military service members and veterans: Progress in improving pain care and restoring health. Nurs Outlook. 2016;64(5):459–484. doi:10.1016/j.outlook.2016.05.010 - DOI - PubMed
    1. . Helmick KM, Spells CA, Malik SZ, Davies CA, Marion DW, Hinds SR. Traumatic brain injury in the US military: Epidemiology and key clinical and research programs. Brain Imaging Behav. 2015;9(3):358–366. doi:10.1007/s11682-015-9399-z - DOI - PubMed
    1. . AMA Pain Care Task Force. Addressing obstacles to evidence-informed pain care. AMA J Ethics. 2020;22(1):E709–E717. Published 2020 Aug 1. doi:10.1001/amajethics.2020.709 - DOI - PubMed