Sixteen years on: Has quality of care for rural and non-compensable traumatic brain injury clients improved?

Caring for people with serious injuries in urban and regional communities: a qualitative investigation of healthcare providers' perceptions

Purpose: To understand the factors that affect the management of people after serious injury in urban and regional settings, beyond hospital discharge from the perspectives of allied health professionals (AHPs).Materials and methods: An exploratory qualitative study of AHPs caring for people with serious injuries post-hospital discharge in urban and regional areas of Victoria, Australia was completed. Twenty-five semi-structured interviews were undertaken with AHPs and thematically analysed.Results: Allied health professionals in urban and regional settings reported the benefits of a multi-disciplinary team to deliver high-quality care. However, a number of barriers to service delivery were identified that impacted on their ability to meet the needs of patients. These included insufficient psychological services, a shortage of available carers and an unmet need for external clinical support in regional areas. Communication between AHPs and other services, and care co-ordination of post-discharge services, was also highlighted as key areas to improve for optimal patient care.Conclusions: Factors that influenced optimal patient management included the availability of psychological and carer services, communication between health professionals and coordination of post-discharge care. The experiences of AHPs can offer practical suggestions to optimise service delivery and post-discharge care for people with serious injuries.Implications for RehabilitationAllied health professionals (AHPs) face a number of challenges in the provision of optimal care to people with serious injuries.Improving the availability of psychological support and attendant carers is needed in regional areas.A designated care coordinator role may assist people with serious injuries transitioning between hospital and home to engage with necessary services and reduce administrative burden for AHPs.Telehealth may provide facilitate improved communication between health professionals and support regional clinicians caring for people with complex injuries.

Utilization and Cost of Health Services in Individuals With Traumatic Brain Injury

Traumatic Brain Injury (TBI) has gained attention in the past decade as a "signature injury" in the conflicts in Iraq and Afghanistan. TBI is a major burden for both the military and civilian population in the US and worldwide. It is a leading cause of death and disability in the US and a major health services resource burden. We seek to answer two questions. What is the evidence regarding the association of TBI with health services utilization and costs in the US and worldwide? What is the evidence regarding racial/ethnic, gender, geographic, socio-economic and other disparities in health services utilization and cost in the US and worldwide? To attain this goal we searched several databases using key words to perform a systematic review of the literature since 2000. We found 36 articles to be eligible for inclusion in the review. The evidence demonstrates a wide variation in health services utilization and costs depending on population of study and severity of TBI. The evidence also supports the existence of racial/ethnic, gender, insurance, geographic disparities in the US as well as other unique disparities worldwide.

We Finally Learnt to Demand: Consumers’ Access to Rehabilitation Following Traumatic Brain Injury

Clinical care guidelines exist internationally recommending the appropriate standards of care for adults following brain injury. These guidelines recommend a care pathway including acute, inpatient and outpatient rehabilitation and community-based care. However, if and how these guidelines are implemented is largely unknown. The aim of this study was to explore the recollected continuum of care experienced by 202 adults with moderate to severe traumatic brain injury (TBI) in Victoria, Australia. The experiences of participants in this study were investigated using a mixed methods research approach (surveys and in-depth interviews). The results indicated that only 20% of participants in this study recollected receiving care in line with recommendations made in clinical care guidelines. Reasons they identified for their problematic access to services included: a lack of information about the services available, the absence of an advocate and services being restricted by limited funding. The findings of this study indicate that while guidelines provide recommendations regarding standards of care and can serve as a benchmark to improve the quality of services, they do not ensure the equitable delivery of services. Clinicians using these guidelines need to be aware of the factors that restrict clients’ access to services and take these into account when planning the delivery of services.

Which Factors Determine Who is Referred for Community Rehabilitation Following Traumatic Brain Injury?

Primary objective: To investigate which variables predict referral for rehabilitation in the participants of the Tasmanian Neurotrauma Register (TNTR), a large (N = 1226) prospective population-based study of adult traumatic brain injury (TBI) in southern Tasmania.

Method: Over a 3-year period, only 54 TBI patients were referred by hospital or local health services for public community rehabilitation, with 121 referred by TNTR research assistants. A further 247 accessed private rehabilitation and 804 received no rehabilitation. These four groups were compared on a range of variables to identify which factors determine referral.

Results: Those referred by hospital or community services and those receiving private rehabilitation had more severe TBI (p < .001), greater disability (p < .001) and were more likely to have been hospitalised post-injury (p < .001). The TNTR-referred group reported more post-concussion symptoms (PCS; p < .001), anxiety (p < .001) and depression (p < .001). TNTR-referral was more likely (p < .001) following assault, compared with other causes of injury. Sixteen per cent of those not referred for rehabilitation had suffered moderate or severe TBI.

Conclusions: These results indicate that no recognised pathway existed for non-hospitalised TBI patients to access public rehabilitation, even if they were reporting high levels of PCS and psychological distress. Furthermore, routine follow-up to assess rehabilitation needs was not occurring in Tasmania, even for some with moderate and severe TBI.

The World Report on Disability as a blueprint for international, national, and local aphasia services

This commentary aims to extend the debate of the lead article authors (Wylie, McAllister, Davidson, and Marshall, 2013) by translating the nine recommendations of the World Report on Disability into a plan of action for the aphasia community. Solutions for the advancement of aphasia science and services are presented at international (macro), national (meso), and local (micro) levels. Implications for speech-language pathologists and aphasia service delivery are discussed. An overarching call to action is the need for speech-language pathologists to support a strong and vibrant aphasia community at all levels, so that the voices of people with aphasia can be heard.

Healthcare Consumers' Need for Brain-injury Services: The Critical Importance of Timing in Planning Future Services

Developing an awareness of the preferences of healthcare consumers is essential in determining the ‘reality’ of service provision, in planning the provision of brain-injury services and in service evaluation. Consumers should be given the opportunity to express satisfaction or dissatisfaction with the services they receive, offering their perceptions of barriers to service access, which could be removed once known. This article presents narratives of the healthcare journeys of three adults with a moderate to severe brain injury. The experiences of these participants were elicited through in-depth interviews. The aim of this article is to convey how the needs and experiences of adults with brain injury change throughout time, affecting their ability to access care over time. Previous research by the authors of this paper identified five factors that affect consumers’ experiences of care: acceptance and readiness, support, advocacy, the right service at the right time and mismatched expectations. The fluidity and interaction of these factors through time is demonstrated in this article as facilitating and impeding access to services. The implications for clinicians in considering these factors when planning services for adults with moderate to severe brain injuries are explored.

Improving the care of people with traumatic brain injury through the Neurotrauma Evidence Translation (NET) program: protocol for a program of research

The Neurotrauma Evidence Translation (NET) program was funded in 2009 to increase the uptake of research evidence in the clinical care of patients who have sustained traumatic brain injury. This paper reports the rationale and plan for this five-year knowledge translation research program. The overarching aims of the program are threefold: to improve outcomes for people with traumatic brain injury; to create a network of neurotrauma clinicians and researchers with expertise in knowledge translation and evidence-based practice; and to contribute knowledge to the field of knowledge translation research. The program comprises a series of interlinked projects spanning varying clinical environments and disciplines relevant to neurotrauma, anchored within four themes representing core knowledge translation activities: reviewing research evidence; understanding practice; developing and testing interventions for practice change; and building capacity for knowledge translation in neurotrauma. The program uses a range of different methods and study designs, including: an evidence fellowship program; conduct of and training in systematic reviews; mixed method study designs to describe and understand factors that influence current practices (e.g., semi-structured interviews and surveys); theory-based methods to develop targeted interventions aiming to change practice; a cluster randomised trial to test the effectiveness of a targeted theory-informed intervention; stakeholder involvement activities; and knowledge translation events such as consensus conferences.