TY - JOUR
T1 - Provider Perspectives of Facilitators and Barriers to Reaching and Utilizing Chronic Pain Healthcare for Persons With Traumatic Brain Injury
T2 - A Qualitative NIDILRR and VA TBI Model Systems Collaborative Project
AU - Nakase-Richardson, Risa
AU - Cotner, Bridget A.
AU - Martin, Aaron M.
AU - Agtarap, Stephanie D.
AU - Tweed, Amanda
AU - Esterov, Dmitry
AU - O'Connor, Danielle R.
AU - Ching, Deveney
AU - Haun, Jolie N.
AU - Hanks, Robin A.
AU - Bergquist, Thomas F.
AU - Hammond, Flora M.
AU - Zafonte, Ross D.
AU - Hoffman, Jeanne M.
N1 - Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Objective: To identify facilitators and barriers to reaching and utilizing chronic pain treatments for persons with traumatic brain injury (TBI) organized around an Access to Care framework, which includes dimensions of access to healthcare as a function of supply (ie, provider/system) and demand (ie, patient) factors for a specified patient population. Setting: Community. Participants: Clinicians (n = 63) with experience treating persons with TBI were interviewed between October 2020 and November 2021. Design: Descriptive, qualitative study. Main Measures: Semistructured open-ended interview of chronic pain management for persons with TBI. Informed by the Access to Care framework, responses were coded by and categorized within the core domains (reaching care, utilizing care) and relevant subdimensions from the supply (affordability of providing care, quality, coordination/continuity, adequacy) and demand (ability to pay, adherence, empowerment, caregiver support) perspective. Results: Themes from provider interviews focused on healthcare reaching and healthcare utilization resulted in 19 facilitators and 9 barriers reaching saturation. The most themes fell under the utilization core domain, with themes identified that impact the technical and interpersonal quality of care and care coordination/continuity. Accessibility and availability of specialty care and use of interdisciplinary team that permitted matching patients to treatments were leading thematic facilitators. The leading thematic barrier identified primarily by medical providers was cognitive disability, which is likely directly linked with other leading barriers including high rates of noncompliance and poor follow-up in health care. Medical and behavioral health complexity was also a leading barrier to care and potentially interrelated to other themes identified. Conclusion: This is the first evidence-based study to inform policy and planning for this complex population to improve access to high-quality chronic pain treatment. Further research is needed to gain a better understanding of the perspectives of individuals with TBI/caregivers to inform interventions to improve access to chronic pain treatment for persons with TBI.
AB - Objective: To identify facilitators and barriers to reaching and utilizing chronic pain treatments for persons with traumatic brain injury (TBI) organized around an Access to Care framework, which includes dimensions of access to healthcare as a function of supply (ie, provider/system) and demand (ie, patient) factors for a specified patient population. Setting: Community. Participants: Clinicians (n = 63) with experience treating persons with TBI were interviewed between October 2020 and November 2021. Design: Descriptive, qualitative study. Main Measures: Semistructured open-ended interview of chronic pain management for persons with TBI. Informed by the Access to Care framework, responses were coded by and categorized within the core domains (reaching care, utilizing care) and relevant subdimensions from the supply (affordability of providing care, quality, coordination/continuity, adequacy) and demand (ability to pay, adherence, empowerment, caregiver support) perspective. Results: Themes from provider interviews focused on healthcare reaching and healthcare utilization resulted in 19 facilitators and 9 barriers reaching saturation. The most themes fell under the utilization core domain, with themes identified that impact the technical and interpersonal quality of care and care coordination/continuity. Accessibility and availability of specialty care and use of interdisciplinary team that permitted matching patients to treatments were leading thematic facilitators. The leading thematic barrier identified primarily by medical providers was cognitive disability, which is likely directly linked with other leading barriers including high rates of noncompliance and poor follow-up in health care. Medical and behavioral health complexity was also a leading barrier to care and potentially interrelated to other themes identified. Conclusion: This is the first evidence-based study to inform policy and planning for this complex population to improve access to high-quality chronic pain treatment. Further research is needed to gain a better understanding of the perspectives of individuals with TBI/caregivers to inform interventions to improve access to chronic pain treatment for persons with TBI.
KW - brain injuries
KW - chronic pain
KW - cognitive dysfunction
KW - health services accessibility
KW - healthcare disparities
KW - implementation science
KW - policy
KW - traumatic
UR - http://www.scopus.com/inward/record.url?scp=85181571911&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85181571911&partnerID=8YFLogxK
U2 - 10.1097/HTR.0000000000000923
DO - 10.1097/HTR.0000000000000923
M3 - Article
C2 - 38167719
AN - SCOPUS:85181571911
SN - 0885-9701
VL - 39
SP - E15-E28
JO - Journal of Head Trauma Rehabilitation
JF - Journal of Head Trauma Rehabilitation
IS - 1
ER -