Primary Care and Brain Injury Physician Utilization for Individuals Living With Chronic Brain Injury.

OBJECTIVE

To examine the use of primary care (PCP) and brain injury physicians in the years after a traumatic brain injury (TBI) and the perceived reasons for lack of utilization.

DESIGN

Prospective, observational cohort study of persons who received inpatient brain injury rehabilitation under the care of a brain injury rehabilitation physician.

SETTING

Fifteen TBI Model System centers.

PARTICIPANTS

Participants in the TBI Model Systems (N=1520) cohort who experienced TBI 1-35 years previously.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: The proportion of participants under the care of a PCP and/or a brain injury physician, and if applicable, the reasons not cared for by a physician; and what type of physician the participant would see if they had 8 common brain injury conditions.

RESULTS

Most participants (85%) reported having a PCP, and 35% reported active care from a brain injury physician. More than 90% have visited their physician in the past 1-2 years. Factors independently associated with not having either a PCP or a brain injury physician were being younger, men, black, unmarried, having fewer health conditions, and having a more rapid initial recovery from their TBI. The most frequent reasons for not having a specific type of physician were a lack of perceived need or their physician taking care of most of their health care problems. The PCP was most often the first contact for 8 common health conditions.

CONCLUSIONS

Most individuals in this longitudinal cohort of TBI survivors report having a PCP. Demographic and clinical characteristics identified subgroups who may lack regular contact with primary care or brain injury specialty care. While all participants were cared for by a brain injury physician during their initial rehabilitation, only a minority had ongoing care from a brain injury physician years later.