Self-perceived health care needs and delivery of health care services 5 years after moderate-to-severe traumatic brain injury.
OBJECTIVE
To describe the self-perceived health care needs of patients with moderate-to-severe traumatic brain injury (TBI) and to assess the impact of the functional level at 1 year after injury on patients' unmet needs at the 5-year follow-up.


METHODS
A prospective follow-up study.


METHODS
Clinical research.


METHODS
A total of 93 patients participated in the 5-year follow-up.


METHODS
We registered demographic and injury-related data at the time of admission and the scores for the Disability Rating Scale, Glasgow Outcome Scale-Extended, and Short Form 36 subscales for physical functioning and mental health at 1 and 5 years. The patients' self-perceived health care needs and use of health care services at 5 years were the main outcome measurements.


RESULTS
At the 5-year follow-up, 70% of patients reported at least 1 perceived need. The self-perceived health care needs were met for 39% of the patients. The patients with unmet needs (n = 29 [31%]) reported frequent needs in emotional (65%), vocational (62%), and cognitive (58%) domains. These patients were significantly more likely to present a less severe disability on the Disability Rating Scale at the 1-year follow-up (odds ratio [OR] 0.11 [95% confidence interval {CI}, 0.02-0.7]; P = .02). Worse mental health at the 1-year follow-up and a younger age (16-29 years) largely predicted unmet needs at the 5-year follow-up (OR 3.28 [95% CI, 1.1-10.04], P = .04; and OR 4.93 [95% CI, 0.16-15.2], P = .005, respectively).


CONCLUSIONS
Gaps between self-perceived health care needs and health care services received at the 5-year follow-up were found. An important message to clinicians who provide health care services in the late TBI phase is that they should be aware of patients' long-term needs regarding cognitive and emotional difficulties. Of equal importance is an emphasis on long-term vocational rehabilitation services. To ensure the appropriateness of health care service delivery, health care services after TBI should be better targeted at less-severe TBI population as well.
Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway.∗; Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway†. Electronic address: nandelic@online.no.
Nada
N
Andelic
Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway.∗; Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway†
Helene L
HL
Soberg
Department of Physical Medicine and Rehabilitation, Sørlandet Hospital, Kristiansand, Norway‡
Svein
S
Berntsen
Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway†; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway§
Solrun
S
Sigurdardottir
Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services, Faculty of Medicine, University of Oslo, Oslo, Norway.∗; Division of Surgery and Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway||
Cecilie
C
Roe
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008603:Mental Health; D011446:Prospective Studies; D011788:Quality of Life; D012649:Self Concept; D013997:Time Factors; D015599:Trauma Severity Indices; D055815:Young Adult