中度至重度创伤性脑损伤5年后的自我感知医疗需求及医疗服务提供情况
Self-perceived health care needs and delivery of health care services 5 years after moderate-to-severe traumatic brain injury.
作者信息
Andelic Nada, Soberg Helene L, Berntsen Svein, Sigurdardottir Solrun, Roe Cecilie
机构信息
Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway.∗; Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway†.
Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway.∗; Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway†
出版信息
PM R. 2014 Nov;6(11):1013-21; quiz 1021. doi: 10.1016/j.pmrj.2014.05.005. Epub 2014 May 15.
OBJECTIVE
To describe the self-perceived health care needs of patients with moderate-to-severe traumatic brain injury (TBI) and to assess the impact of the functional level at 1 year after injury on patients' unmet needs at the 5-year follow-up.
DESIGN
A prospective follow-up study.
SETTING
Clinical research.
PARTICIPANTS
A total of 93 patients participated in the 5-year follow-up.
METHODS
We registered demographic and injury-related data at the time of admission and the scores for the Disability Rating Scale, Glasgow Outcome Scale-Extended, and Short Form 36 subscales for physical functioning and mental health at 1 and 5 years. The patients' self-perceived health care needs and use of health care services at 5 years were the main outcome measurements.
RESULTS
At the 5-year follow-up, 70% of patients reported at least 1 perceived need. The self-perceived health care needs were met for 39% of the patients. The patients with unmet needs (n = 29 [31%]) reported frequent needs in emotional (65%), vocational (62%), and cognitive (58%) domains. These patients were significantly more likely to present a less severe disability on the Disability Rating Scale at the 1-year follow-up (odds ratio [OR] 0.11 [95% confidence interval {CI}, 0.02-0.7]; P = .02). Worse mental health at the 1-year follow-up and a younger age (16-29 years) largely predicted unmet needs at the 5-year follow-up (OR 3.28 [95% CI, 1.1-10.04], P = .04; and OR 4.93 [95% CI, 0.16-15.2], P = .005, respectively).
CONCLUSION
Gaps between self-perceived health care needs and health care services received at the 5-year follow-up were found. An important message to clinicians who provide health care services in the late TBI phase is that they should be aware of patients' long-term needs regarding cognitive and emotional difficulties. Of equal importance is an emphasis on long-term vocational rehabilitation services. To ensure the appropriateness of health care service delivery, health care services after TBI should be better targeted at less-severe TBI population as well.
目的
描述中重度创伤性脑损伤（TBI）患者自我感知的医疗保健需求，并评估伤后1年时的功能水平对患者5年随访时未满足需求的影响。
设计
一项前瞻性随访研究。
设置
临床研究。
参与者
共有93名患者参与了5年随访。
方法
我们记录了入院时的人口统计学和损伤相关数据，以及1年和5年时残疾评定量表、扩展格拉斯哥预后量表和简明健康状况调查量表中身体功能和心理健康方面的得分。患者5年时自我感知的医疗保健需求和医疗保健服务的使用情况是主要的结局指标。
结果
在5年随访时，70%的患者报告至少有1项感知到的需求。39%的患者自我感知的医疗保健需求得到了满足。未满足需求的患者（n = 29 [31%]）报告在情感（65%）、职业（62%）和认知（58%）领域有频繁需求。这些患者在1年随访时在残疾评定量表上出现较轻残疾的可能性显著更高（优势比[OR] 0.11 [95%置信区间{CI}，0.02 - 0.7]；P = 0.02）。1年随访时较差的心理健康状况和较年轻的年龄（16 - 29岁）在很大程度上预测了5年随访时未满足的需求（分别为OR 3.28 [95% CI，1.1 - 10.04]，P = 0.04；以及OR 4.93 [95% CI，0.16 - 15.2]，P = 0.005）。
结论
发现了5年随访时自我感知的医疗保健需求与所接受的医疗保健服务之间的差距。对于在TBI后期提供医疗保健服务的临床医生来说，一个重要信息是他们应该意识到患者在认知和情感困难方面的长期需求。同样重要的是强调长期职业康复服务。为确保医疗保健服务提供的适当性，TBI后的医疗保健服务也应更好地面向伤情较轻的TBI人群。
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