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Barriers and Facilitators to Accessing Rehabilitation Health Care: A Veterans Affairs Traumatic Brain Injury Model Systems Qualitative Study

Published:October 17, 2022DOI:https://doi.org/10.1016/j.apmr.2022.09.020

      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)
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