Highlights
- •Those with more severe traumatic brain injury described more barriers to accessing care.
- •Ease of communication with providers was the most common facilitator.
- •Distance from facilities was the most common barrier.
- •Tailored approaches for those with greater disability are needed to improve access.
Abstract
Objective
To compare barriers and facilitators to accessing health care services among service
members and veterans (SMVs) by traumatic brain injury (TBI) severity groups.
Design
Qualitative descriptive study guided by an access to health care services conceptual
framework.
Setting
Five Veterans Affairs (VA) polytrauma rehabilitation centers.
Participants
SMVs (N=55, including 10 caregivers as proxies) ≥2 years post-TBI recruited from the
VA TBI Model Systems and grouped by TBI severity (mild/moderate, severe).
Main Outcome Measures
Barriers and facilitators accessing care.
Results
The main facilitators included ease of communicating with providers to help SMVs identify
and utilize appropriate health care, family advocates who promoted engagement in health
care, ability to use government and community facilities, and online resources or
equipment. Distance to services was uniformly identified as a main barrier for both
patient groups. However, facilitators and barriers to health care access differed
by TBI severity. SMVs with severe TBI highlighted the role of nonprofit organizations
in promoting health care engagement and the availability of VA specialty residential
programs in meeting health care needs. Having unrecognized health care needs in chronic
stages and communication difficulties with providers were more commonplace for those
with greater TBI severity and affected quality of care. Those with mild/moderate TBI
highlighted challenges associated with paying for services in the community and scheduling
of services.
Conclusions
Barriers and facilitators exist across multiple dimensions of a health care access
framework and vary by TBI severity. Results suggest possible mechanistic links between
health care access and SMV health outcomes. Findings support current policy and practice
efforts to facilitate health care access for SMVs with TBI but highlight the need
for tailored approaches for those with greater disability.
Keywords
List of abbreviations:
DoD (Department of Defense), PRC (polytrauma rehabilitation center), SMV (service members and veterans), TBI (traumatic brain injury), TBIMS (TBI Model Systems), VA (Veterans Affairs)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Health.mil. The official website of the military health system. Available at: https://www.health.mil/. Accessed February 23, 2021.
- Caregivers of veterans—serving on the homefront.National Alliance for Caregiving, Bethesda, MD2010
- Unmet rehabilitation needs indirectly influence life satisfaction 5 years after traumatic brain injury: a Veterans Affairs TBI Model Systems study.Arch Phys Med Rehabil. 2021; 102: 58-67
- Rehabilitation needs at 5 years post-traumatic brain injury: a VA TBI Model Systems study.J Head Trauma Rehabil. 2021; 36: 175-185
- Unmet rehabilitation needs after traumatic brain injury across Europe: results from the CENTER-TBI study.J Clin Med. 2021; 10: 1035
- Perception of barriers to the diagnosis and receipt of treatment for neuropsychiatric disturbances after traumatic brain injury. Arch of.Phys Med Rehabil. 2017; 98: 2548-2552
- A latent content analysis of barriers and supports to healthcare: perspectives from caregivers of service members and veterans with military-related traumatic brain injury.J Head Trauma Rehabil. 2018; 33: 342-353
- Patient perspectives on quality and access to healthcare after brain injury.Brain Inj. 2018; 32: 431-441
- Access to health services for moderate to severe TBI in Indiana: patient and caregiver perspectives.Brain Inj. 2018; 32: 1510-1517
- Traumatic brain injury caregivers: a qualitative analysis of spouse and parent perspectives on quality of life.Neuropsychol Rehab. 2017; 27: 16-37
- Action ethnography of community reintegration for veterans and military service members with traumatic brain injury: protocol for a mixed methods study.JMIR Res Protoc. 2019; 8: e14170
- A needs review of caregivers for adults with traumatic brain injury.Fed Pract. 2017; 34: 42-49
- Service needs and barriers to care five or more years after moderate to severe TBI among veterans.Brain Inj. 2017; 31: 1287-1293
- Service onceptuali in a public post-acute rehabilitation unit following traumatic brain injury.Neuropsychol Rehab. 2015; 25: 841-863
- Health status, difficulties, and desired health information and services for veterans with traumatic brain injuries and their caregivers: a qualitative investigation.PloS ONE. 2018; 13e020304
- Barriers and strategies for coordinating care among veterans with traumatic brain injury: a mixed methods study of VA polytrauma care team members.Brain Inj. 2018; 32: 755-762
- Aligning for heroes: partnership for veteran care in New Hampshire.Nurs Adm Q. 2015; 39: E17-E25
- Olson-Madden JH. Barriers and facilitators in providing community mental health care to returning veterans with a history of traumatic brain injury and co-occurring mental health symptoms.Community Ment Health J. 2016; 52 (19): 158-164
- Descriptive findings of the VA polytrauma rehabilitation centers TBI Model Systems national database.Arch Phys Med Rehabil. 2018; 99: 952-959
- Patient-centered access to health care: conceptualizing access at the interface of health systems and populations.Int J Equity Health. 2013; 12: 18
- Straight talk about communication research methods.Kendall-Hunt Publishing, Dubuque, IA2010
- Qualitative communication research methods.Sage Publications, Thousand Oaks2002
- Qualitative research and evaluation methods.Sage Publications, Thousand Oaks2002
- Characteristics of qualitative studies in influential journals of general medicine: A critical review.Biosci Trends. 2009; 3: 202-209
- Characteristics of qualitative descriptive studies: a systematic review.Res Nurs Health. 2017; 40: 23-42
- Content analysis and thematic analysis: implications for conducting a qualitative descriptive study.Nurs Health Sci. 2013; 15: 398-405
- Development of a traumatic brain injury model system within the Department of Veterans Affairs Polytrauma System of Care.J Head Trauma Rehabil. 2014; 29: E1-E7
- The Glasgow Coma Scale at 40 years: standing the test of time.Lancet Neurol. 2014; 13: 844-854
- Utility of post-traumatic amnesia in predicting 1-year productivity following traumatic brain injury: comparison of the Russell and Mississippi PTA classification intervals.J Neurol Neurosurg Psychiatry. 2011; 82: 494-499
- Prevalence and predictors of tobacco smoking in veterans and service members following traumatic brain injury rehabilitation: a VA TBIMS study.Brain Inj. 2018; 32: 994-999
- Traumatic brain injury—practice based evidence study: Design and patients, centers, treatments, and outcomes.Arch Phys Med Rehabil. 2015; 96 (e15): S178-S196
- A general inductive approach for analyzing qualitative evaluation data.Am J Eval. 2016; 27: 237-246
- Qualitative data analysis: an expanded sourcebook.2nd ed. Sage Publications, Thousand Oaks1994
- Intercoder reliability in qualitative research.Int J Qual Methods. 2020; 19: 1-13
- The qualitative researcher’s companion.1st ed. Sage Publications, Thousand Oaks2002
- Sample sizes for saturation in qualitative research: a systematic review of empirical tests.Soc Sci Med. 2022; 292114523
- Mild TBI in interdisciplinary neurorehabilitation: treatment challenges and insights.NeuroRehabilitation. 2020; 46: 227-241
- A systematic review of chronic disease management. Research Centre for Primary Health Care and Equity, School of Public Health and Community Medicine.Sydney, Australia: University of New South Wales School of Public Health & Community Medicine. 2006;
- Expanding access through virtual care: the VA’s early experience with COVID-19.N Engl J Med. 2020; : 1-11
- A family's affair: caring for veterans with penetrating traumatic brain injury.Mil Med. 2018; 183: 379-385
Article info
Publication history
Published online: October 17, 2022
Accepted:
September 26,
2022
Received in revised form:
September 21,
2022
Received:
August 16,
2022
Footnotes
Portions of this research were presented at the 95th annual American Congress for Rehabilitation Medicine, Dallas, TX, September 30-October 3, 2018, and the 97th American Congress for Rehabilitation Medicine, Atlanta, GA, October 21-24, 2020.
This work was prepared under Contract W91YTZ-13-C-0015 and HT0014-19-C-0004 DHA Contracting Office (CO-NCR) HT0014 and, therefore, is defined as U.S. Government work under Title 17 U.S.C.§101. Per Title 17 U.S.C.§105, copyright protection is not available for any work of the U.S. Government. For more information, please contact [email protected] This material is also based upon work supported by: (1) the U.S. Army Medical Research and Material Command and from the U.S. Department of Veterans Affairs Chronic Effects of Neurotrauma Consortium under Award No. W81XWH-13-2-0095, [The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office.]; (2) VHA Central Office VA TBI Model Systems Program of Research; (3) 9Line LLC; (4) grants from National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems program: Indiana University School of Medicine/Rehabilitation Hospital of Indiana (Grant #90DRTB0002) and University of Washington (Grant #90DRTB0008). Lastly, this material is the result of work supported with resources and the use of James A. Haley Veterans’ Hospital, Minneapolis VA Health Care System, and Palo Alto VA Health Care System facilities.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense (DOD), Department of Army/Navy/Air Force, Veterans Health Administration (VHA), U.S. Government, or any other U.S. government agency. No official endorsement should be inferred.
Disclosures: None.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine.
