提供者感知到的脑外伤后慢性疼痛识别、感知及寻求医疗护理的促进因素和障碍：一项定性的美国国家残疾与康复研究所及退伍军人事务部脑外伤模型系统合作项目。
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.
作者信息
Nakase-Richardson Risa, Cotner Bridget A, Agtarap Stephanie D, Martin Aaron M, Ching Deveney, O'Connor Danielle R, Tweed Amanda, Haun Jolie N, Hanks Robin A, Bergquist Thomas F, Hammond Flora M, Zafonte Ross D, Hoffman Jeanne M
机构信息
James A. Haley Veterans' Hospital, Tampa, Florida (Dr Nakase-Richardson); Sleep and Pulmonary Division, Department of Internal Medicine, University of South Florida, Tampa (Drs Nakase-Richardson and Cotner); Traumatic Brain Injury Center of Excellence, Defense Health Agency, Tampa, Florida (Dr Nakase-Richardson and Ms Tweed); Research Service/Polytrauma, James A. Haley Veterans' Hospital, Tampa, Florida (Drs Cotner and Haun and Ms O'Connor); Research Department, Craig Hospital, Englewood, Colorado (Dr Agtarap); Mental Health and Behavioral Sciences/Polytrauma, James A. Haley Veterans' Hospital, Tampa, Florida (Dr Martin); Tampa Veterans Research and Education Foundation, Tampa, Florida (Dr Ching); Department of Child & Family Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa (Dr Ching); 9Line, LLC, Tampa, Florida (Ms Tweed); Department of Physical Medicine and Rehabilitation, School of Medicine, Wayne State University, Detroit, Michigan (Dr Hanks); Mayo Clinic College of Medicine and Science, Rochester, Minnesota (Dr Bergquist); Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine & Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Boston (Dr Zafonte); and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle (Dr Hoffman).
出版信息
J Head Trauma Rehabil. 2024;39(1):E1-E14. doi: 10.1097/HTR.0000000000000922.
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.
目的
依据医疗服务可及性框架，确定创伤性脑损伤（TBI）患者慢性疼痛医疗服务的影响因素。报告与该框架中确定需求、需求认知以及寻求医疗服务等核心领域相关的研究结果。
背景
社区。
参与者
2020年10月至2021年11月期间接受访谈的63名医疗服务提供者，他们均有两年或以上治疗TBI患者的经验。
设计
描述性定性研究。
主要测量方法
针对TBI患者慢性疼痛管理进行开放式问题的半结构化访谈。依据医疗服务可及性框架，对回答进行编码，并从供需角度在确定医疗需求、需求认知以及与寻求医疗服务相关的因素等领域进行分类。
结果
对于整个样本，超过20%的医疗服务提供者群体认可14个促进因素和6个障碍因素。主要促进因素包括所需资源和治疗的现场可及性（94%）、有足够时间和医疗服务提供者能力以确保患者理解诊断和治疗计划（83%），以及确立患者对治疗计划的积极性和认同度（75%）。最受认可的障碍因素包括影响医疗服务可及性的政策（46%）、服务等待时间（41%），以及患者因认知和身体挑战对远程医疗普遍存在的不确定性（37%）。报告了在民用医疗系统与退伍军人事务部（VA）医疗系统以及不同类型医疗服务提供者之间存在的独特影响因素。
结论
这是第一项基于证据的研究，可为改善TBI患者获得高质量慢性疼痛治疗服务的政策和规划提供依据。研究结果将为未来在医疗系统、患者和政策层面的干预措施提供参考，这些干预措施可根据医疗环境（VA、民用）和医疗服务提供者类型（康复治疗师、心理学家和医生）进行调整。基于证据的干预措施可能有助于减少TBI患者所经历的医疗服务差距，并促进其获得高质量、基于证据的慢性疼痛护理。
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