Clinicians' perceptions of factors contributing to complexity and intensity of care of outpatients with traumatic brain injury.
OBJECTIVE
This study investigated clinicians' perceptions on factors linked to patient complexity in traumatic brain injury (TBI) outpatient rehabilitation.


METHODS
Twelve clinicians from various disciplines, working in TBI outpatient programmes from three rehabilitation institutions in Montreal, Quebec, were recruited using convenience and snowball sampling. Data was collected through focus groups and individual interviews and thematic analysis was used to identify themes.


RESULTS
Participants identified complexity factors falling under the following themes: sequelae of TBI (cognitive/behavioural/psychological impacts), personal factors (personality traits, pre-medical state, lifestyle and age), patients' environment (architectural, social, language, cultural and financial) and therapeutic relationship (mismatch, misunderstanding and personality clashes). Clinicians also reported facilitators to optimal treatment delivery such as quality of services and working in an interdisciplinary team. Limited time, training and resources were identified as barriers to treatment.


CONCLUSIONS
A substantial proportion of patients in outpatient TBI programmes seem to follow an atypical evolution and exhibit added complexity. In order to optimize quality of care, clinicians recommended increased community awareness about TBI, increased resources for rehabilitation clinicians and specialized services post-discharge. These findings are insightful for stakeholders; providing a basis for discussions on policy changes that can better meet this population's needs.
School of Physical and Occupational Therapy, McGill University , Montreal , Canada.
Jerine Anton
JA
Jeyaraj
Audrey
A
Clendenning
Valérie
V
Bellemare-Lapierre
Shabeena
S
Iqbal
Marie-Christine
MC
Lemoine
Dominique
D
Edwards
Nicol
N
Korner-Bitensky
D001930:Brain Injuries / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy; D005260:Female; D017144:Focus Groups; D006282:Health Personnel; D006301:Health Services Needs and Demand; D006801:Humans; D008019:Life Style; D008297:Male; D010045:Outpatients; D010552:Personality Assessment; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D058996:Quality Improvement; D011792:Quebec / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012931:Social Environment; D012938:Social Perception