Department of Neuroscience, Central Clinical School, Monash University, Clayton, Vic., Australia.
Occupational Therapy Department, Alfred Health, Melbourne, Vic., Australia.
Health Expect. 2021 Apr;24(2):352-362. doi: 10.1111/hex.13176. Epub 2020 Dec 2.
Brain injury rehabilitation is an expensive and long-term endeavour. Very little published information or debate has underpinned policy for service delivery in Australia. Within the context of finite health budgets and the challenges associated with providing optimal care to persons with brain injuries, members of the public were asked 'What considerations are important to include in a model of care of brain injury rehabilitation?'
Qualitative study using the Citizen Jury method of participatory research. Twelve adult jurors from the community and seven witnesses participated including a health services funding model expert, peak body representative with lived experience of brain injury, carer of a person with a brain injury, and brain injury rehabilitation specialists. Witnesses were cross-examined by jurors over two days.
Key themes related to the need for a model of rehabilitation to: be consumer-focused and supporting the retention of hope; be long-term; provide equitable access to services irrespective of funding source; be inclusive of family; provide advocacy; raise public awareness; and be delivered by experts in a suitable environment. A set of eight recommendations were made.
Instigating the recommendations made requires careful consideration of the need for new models of care with flexible services; family involvement; recruitment and retention of highly skilled staff; and providing consumer-focused services that prepare individuals and their carers for the long term.
As jury members, the public deliberated information provided by expert witnesses (including a person with a head injury) and wrote the key recommendations.
脑损伤康复是一项昂贵且长期的工作。在澳大利亚,为服务提供提供政策提供的信息和辩论很少。在有限的健康预算和为脑损伤患者提供最佳护理相关的挑战的背景下,公众被问到“在脑损伤康复护理模式中,有哪些考虑因素很重要?”
使用公民陪审团参与式研究方法进行的定性研究。来自社区的十二名成年陪审员和七名证人参加了研究,其中包括卫生服务资金模式专家、有脑损伤经历的脑损伤患者代表、脑损伤患者的照顾者以及脑损伤康复专家。证人在两天内接受了陪审员的交叉讯问。
与康复模式相关的关键主题包括:以消费者为中心并支持保持希望;长期提供服务;无论资金来源如何,都要公平地获得服务;包括家庭;提供宣传;提高公众意识;并由专家在合适的环境中提供服务。提出了八项建议。
实施所提出的建议需要仔细考虑需要新的护理模式,具有灵活的服务;家庭参与;招聘和留住高技能员工;并提供以消费者为中心的服务,使个人及其照顾者为长期做好准备。
作为陪审团成员,公众审议了专家证人(包括头部受伤者)提供的信息,并撰写了关键建议。