Patient Facilitators and Barriers to Accessing Chronic Pain Treatments for Persons with TBI: Provider Perspectives

Research Objectives: To examine patient-focused facilitators and barriers to accessing chronic pain care for individuals with TBI from a national sample of providers

Design: A descriptive, qualitative study guided by a conceptual framework of access to health care services

Setting: Medical facilities representing Veteran Affairs, Department of Defense, and civilian health care systems

Participants: 63 providers representing VA, DoD, and Civilian sites across the United States

Interventions: NA

Main Outcome Measures: Facilitators and barriers to chronic pain treatment

Results: Several facilitators were identified by providers, including providing education to ensure comprehension of diagnosis and treatment; patient motivation and buy-in; patients having functional and realistic goals; insurance covering the costs of care and referrals; and patients seeing positive changes in themselves. Providers identified many barriers to care, including patient lack of participation such as no-showing to appointments or not participating in treatments; patients being unsure of telehealth; patient work schedules; lack of transportation; and no caregivers or visitors permitted due to Covid restrictions.

Conclusions: Barriers and facilitators to chronic pain treatment exist across multiple dimensions of a healthcare access framework. Given importance of patient motivation and buy-in and engagement in treatment, provider training and experience in motivational enhancement and addressing health beliefs may help facilitate access to chronic pain care when adapted for persons with TBI. Targeted patient education that ensures rationale for treatment and patient acceptance of the treatment was the most discussed facilitator to care. Findings support multiple points of intervention to promote equitable access to chronic pain care for persons with TBI.

Author(s) Disclosures: None