Perception of Barriers to Diagnosis and Receipt of Treatment for Neuropsychiatric Disturbances Following Traumatic Brain Injury

Publication date: Available online 5 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jennifer S. Albrecht, Lyndsay M. O'Hara, Kara A. Moser, C. Daniel Mullins, Vani Rao
ObjectiveTo explore perceptions of barriers and facilitators to diagnosis and receipt of treatment for neuropsychiatric disturbances (NPD) following traumatic brain injury (TBI).DesignQualitative study employing semi-structured interviews and focus groupsSettingA clinic specializing in the treatment of TBI NPD, an urban trauma center, and a large urban academic hospitalParticipantsTen health care providers who treat individuals with TBI, 18 persons with TBI and 5 caregiversMain Outcome MeasuresTopic guides for the interviews and focus groups were guided by prior literature, clinical experience, and the goals of the project and focused on the three most common TBI NPD: depression, anxiety, and post-traumatic stress disorder. Interviews and focus groups were audio-recorded and transcribed. We performed a conventional content analysis on the transcripts and grouped concepts into overall themes, incorporating feedback from stakeholders.ResultsPatient education, insurance, provider type, time since TBI, caregiver support, and recognition or screening for TBI NPD were the most frequently mentioned barriers or facilitators to diagnosis and treatment of TBI NPD by both interview and focus group participants. We grouped these and other frequently mentioned concepts into three broad themes: education, access, and support. Each of these themes is explored in depth and supported with direct quotations.ConclusionsThis study explored patient, caregiver and health care provider – identified barriers and facilitators to the diagnosis and receipt of treatment for TBI NPD. Barriers included poor provider education on TBI NPD and limited access to care due to lack of insurance, transportation, and income. Facilitators included patient education on TBI NPD and strong caregiver support. Future studies should develop and pilot interventions aimed at quality of care that address the identified barriers and facilitators.



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