Muenchberger Heidi, Kendall Elizabeth, Collings Catherine
Griffith Health Institute, Brisbane, Australia.
J Prim Care Community Health. 2011 Jan 1;2(1):60-4. doi: 10.1177/2150131910383578. Epub 2010 Dec 15.
The aim of this commentary was to bring together the various significant issues associated with delivering brain injury rehabilitation in Australia. Through observational critique, the authors aimed to identify gaps in practice and opportunities for change.
In light of Australia's national health reform process, it is necessary to consider rehabilitation practices and models for brain injury service delivery. There are lessons to be learned within the Australian system, but also opportunities to apply international reform.
For those within the service delivery system, brain injury rehabilitation can often appear to be a crisis-driven response. Gaps in service provision persist, leaving individuals who have reduced cognitive and emotional capacity to self-navigate an unpredictable health system at a time in their lives when they are least prepared to do so. Deficiencies in the delivery of timely and appropriate psychosocial or behavioral rehabilitation services undoubtedly contribute to the current pressures on the health system created by increased length of stay in neurological and slow-to-recover rehabilitation units, repeat presentations to primary care, and frequent use of community mental health services.
The experiences of people with acquired brain injury highlights the need for early and targeted interventions that can deal with emerging complexities and support needs, interorganizational approaches, and new accommodation options with a matched service philosophy. Rather than count on good fortune, individual outcomes, and the future of brain injury, rehabilitation ought to depend on deliberate and systemic design.
本评论的目的是汇集与澳大利亚脑损伤康复服务相关的各种重要问题。通过观察性批判,作者旨在找出实践中的差距以及变革的机会。
鉴于澳大利亚的国家卫生改革进程,有必要考虑脑损伤服务提供的康复实践和模式。澳大利亚系统中有经验可吸取,同时也有应用国际改革的机会。
对于服务提供系统中的人员而言,脑损伤康复往往看似是一种危机驱动的应对措施。服务提供方面的差距依然存在,使得认知和情感能力下降的个体在其最无准备应对的时候,要自行应对不可预测的卫生系统。及时且恰当的心理社会或行为康复服务的提供不足,无疑加剧了当前卫生系统面临的压力,这些压力包括神经科和康复缓慢的康复单元住院时间延长、反复就诊于初级保健机构以及频繁使用社区心理健康服务。
后天性脑损伤患者的经历凸显了对早期针对性干预措施的需求,这些措施应能应对新出现的复杂情况和支持需求、跨组织方法以及具有匹配服务理念的新住宿选择。康复不应依赖于运气、个体结果和脑损伤的未来,而应依靠精心设计和系统规划。