Service needs and barriers to care five or more years after moderate to severe TBI among Veterans

ABSTRACT

Primary objective: The objective of this paper is to identify the most frequent service needs, factors associated with needs, and barriers to care among Veterans and service members five or more years after moderate to severe traumatic brain injury (TBI). Research design: Survey administered via telephone 5–16 years after injury (median eight years) and subsequent acute inpatient rehabilitation at a regional Veterans Affairs (VA) medical centre. Methods and procedures: Participants were 119 Veterans and military personnel, aged 23–70 (median 35), 90% male. Demographics, injury characteristics, service needs, whether needs were addressed, barriers to care, health and general functioning were assessed. Main outcomes and results: The most frequent needs were for help with memory, information about available services and managing stress. Obtaining information about services was the most consistently un-addressed need; managing stress was the most consistently addressed need. Cognitive and psychiatric symptoms and alienation from community were associated with needs going un-addressed. Participants treated after an expansion of TBI services at the study site reported fewer un-addressed needs. Not knowing where to get help was the most common barrier to care. Conclusion: Repeated outreach, assessment of needs and education about available services are needed throughout Veterans’ lifespan after moderate to severe TBI.

KEYWORDS:

• Traumatic brain injury
• polytrauma
• military personnel
• health services accessibility
• health services needs and demand
• long-term follow-up
• rehabilitation

Declaration of Interest

This material is based upon work supported in part by the Defense and Veterans Brain Injury Center, US Army Medical Research and Materiel Command (USAMRMC), and by a Clayman Institute Fellowship. All authors report no declarations of interest.

Disclaimer

The views, opinions, and/or findings contained in this article are those of the authors and should not be construed as an official Department of Defense position, policy or decision unless so designated by other official documentation.

Preliminary findings were presented at the Association of Academic Physiatrists in San Juan, Puerto Rico (2009) and at the 49th Annual Convention of the Association for Behavioral and Cognitive Therapies in Chicago, IL (November 2015).