Albrecht Jennifer S, O'Hara Lyndsay M, Moser Kara A, Mullins C Daniel, Rao Vani
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
Arch Phys Med Rehabil. 2017 Dec;98(12):2548-2552. doi: 10.1016/j.apmr.2017.06.007. Epub 2017 Jul 5.
To explore perceptions of barriers and facilitators to the diagnosis and receipt of treatment for neuropsychiatric disturbances (NPDs) after traumatic brain injury (TBI).
Qualitative study using semistructured interviews and focus groups.
A clinic specializing in the treatment of TBI NPDs, an urban trauma center, and a large urban academic hospital.
A sample (N=33) of health care providers (n=10) who treat individuals with TBI, persons with TBI (n=18), and caregivers (n=5).
Not applicable.
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.
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.
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.
探讨对创伤性脑损伤（TBI）后神经精神障碍（NPDs）诊断及接受治疗的障碍和促进因素的看法。
采用半结构化访谈和焦点小组的定性研究。
一家专门治疗TBI NPDs的诊所、一个城市创伤中心和一家大型城市学术医院。
样本（N = 33）包括治疗TBI患者的医疗保健提供者（n = 10）、TBI患者（n = 18）和护理人员（n = 5）。
不适用。
访谈和焦点小组的主题指南以前期文献、临床经验和项目目标为指导，聚焦于3种最常见的TBI NPDs：抑郁症、焦虑症和创伤后应激障碍。访谈和焦点小组进行了录音并逐字转录。我们对转录本进行了常规内容分析，并将概念归纳为总体主题，纳入了利益相关者的反馈。
患者教育、保险、提供者类型、TBI后的时间、护理人员支持以及对TBI NPDs的识别或筛查是访谈和焦点小组参与者提及的TBI NPDs诊断和治疗最常见的障碍或促进因素。我们将这些及其他频繁提及的概念归纳为3个广泛主题：教育、可及性和支持。每个主题都进行了深入探讨，并辅以直接引语。
本研究探讨了患者、护理人员和医疗保健提供者，并确定了TBI NPDs诊断及接受治疗的障碍和促进因素。障碍包括医疗保健提供者对TBI NPDs的教育不足，以及由于缺乏保险、交通和收入导致的就医机会有限。促进因素包括对TBI NPDs的患者教育和强大的护理人员支持。未来的研究应开发并试点旨在提高护理质量的干预措施，以解决已确定的障碍和促进因素。
