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

Bridget A. Cotner; Risa Nakase-Richardson; Danielle R. O'Connor; Marc A. Silva; Flora M. Hammond; Noelle E. Carlozzi; Jacob A. Finn; Joyce Chung; Jeanne M. Hoffman

doi:10.1016/j.apmr.2022.09.020

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

Bridget A. Cotner, Risa Nakase-Richardson, Danielle R. O'Connor, Marc A. Silva, Flora M. Hammond, Noelle E. Carlozzi, Jacob A. Finn, Joyce Chung, Jeanne M. Hoffman

Psychiatry & Behavioral Sciences

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

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.

Original language	English (US)
Pages (from-to)	380-389
Number of pages	10
Journal	Archives of Physical Medicine and Rehabilitation
Volume	104
Issue number	3
DOIs	https://doi.org/10.1016/j.apmr.2022.09.020
State	Published - Mar 2023

Bibliographical note

Funding Information:
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.

Funding Information:
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.

Publisher Copyright:
© 2022

Keywords

Brain injuries
Caregivers
Health services accessibility
Military personnel
Qualitative research
Rehabilitation
Veterans

PubMed: MeSH publication types

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.apmr.2022.09.020

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Cite this

Cotner, B. A., Nakase-Richardson, R., O'Connor, D. R., Silva, M. A., Hammond, F. M., Carlozzi, N. E., Finn, J. A., Chung, J., & Hoffman, J. M. (2023). Barriers and Facilitators to Accessing Rehabilitation Health Care: A Veterans Affairs Traumatic Brain Injury Model Systems Qualitative Study. Archives of Physical Medicine and Rehabilitation, 104(3), 380-389. https://doi.org/10.1016/j.apmr.2022.09.020

Barriers and Facilitators to Accessing Rehabilitation Health Care: A Veterans Affairs Traumatic Brain Injury Model Systems Qualitative Study. / Cotner, Bridget A.; Nakase-Richardson, Risa; O'Connor, Danielle R. et al.
In: Archives of Physical Medicine and Rehabilitation, Vol. 104, No. 3, 03.2023, p. 380-389.

Research output: Contribution to journal › Article › peer-review

Cotner, BA, Nakase-Richardson, R, O'Connor, DR, Silva, MA, Hammond, FM, Carlozzi, NE, Finn, JA, Chung, J & Hoffman, JM 2023, 'Barriers and Facilitators to Accessing Rehabilitation Health Care: A Veterans Affairs Traumatic Brain Injury Model Systems Qualitative Study', Archives of Physical Medicine and Rehabilitation, vol. 104, no. 3, pp. 380-389. https://doi.org/10.1016/j.apmr.2022.09.020

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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 = "Brain injuries, Caregivers, Health services accessibility, Military personnel, Qualitative research, Rehabilitation, Veterans",

author = "Cotner, {Bridget A.} and Risa Nakase-Richardson and O'Connor, {Danielle R.} and Silva, {Marc A.} and Hammond, {Flora M.} and Carlozzi, {Noelle E.} and Finn, {Jacob A.} and Joyce Chung and Hoffman, {Jeanne M.}",

note = "Funding Information: 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{\textquoteright} Hospital, Minneapolis VA Health Care System, and Palo Alto VA Health Care System facilities. Funding Information: 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{\textquoteright} Hospital, Minneapolis VA Health Care System, and Palo Alto VA Health Care System facilities. Publisher Copyright: {\textcopyright} 2022",

year = "2023",

month = mar,

doi = "10.1016/j.apmr.2022.09.020",

language = "English (US)",

volume = "104",

pages = "380--389",

journal = "Archives of Physical Medicine and Rehabilitation",

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T1 - Barriers and Facilitators to Accessing Rehabilitation Health Care

T2 - A Veterans Affairs Traumatic Brain Injury Model Systems Qualitative Study

AU - Cotner, Bridget A.

AU - Nakase-Richardson, Risa

AU - O'Connor, Danielle R.

AU - Silva, Marc A.

AU - Hammond, Flora M.

AU - Carlozzi, Noelle E.

AU - Finn, Jacob A.

AU - Chung, Joyce

AU - Hoffman, Jeanne M.

N1 - Funding Information: 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. Funding Information: 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. Publisher Copyright: © 2022

PY - 2023/3

Y1 - 2023/3

N2 - 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.

AB - 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.

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KW - Caregivers

KW - Health services accessibility

KW - Military personnel

KW - Qualitative research

KW - Rehabilitation

KW - Veterans

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

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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