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Primary Care for Patients with Brain Injury Courage Center Physicians Clinic. Teresa Kiresuk, DNP Michelle Ullery, FNP Korinne Novak, ANP. Brain Injury Incidence. MN TBI: 154,933 Estimated that 10,00 progress to long term disability (MN, Department of health, 2010)
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Primary Care for Patients with Brain InjuryCourage Center Physicians Clinic Teresa Kiresuk, DNP Michelle Ullery, FNP Korinne Novak, ANP
Brain Injury Incidence • MN TBI: 154,933 • Estimated that 10,00 progress to long term disability (MN, Department of health, 2010) • Nationwide TBI: 1.4 million annually • 100,000 develop long term sequale (CDC, 2010) • Currently estimates of 5.3 million individuals have disability due to TBI (CDC, 2009) • cdc.gov/traumaticbraininjury/tbi_report_to_congress.html#6 • health.state.mn.us/injury/midas/ub92/index.cfm
Post Brain Injury Problems • Physical Symptoms • Psychological Symptoms • Social Symptoms
Physical Symptoms • Headache Dizziness • Tinnitus Visual Disturbances • Insomnia Fatigue • Chronic Pain Impaired Cognition • Neurogenic Bladder Neurogenic Bowel • Spasticity and Dystonias
Psychological Symptoms • Personality Changes • Mood Disorders • Depression • Mania • Anxiety • Substance Abuse
Social Symptoms • Relationship Difficulties • Vocational Concerns • Sexuality Issues • Driving Safety
Health Maintenance Needs • USPSTF Preventive healthcare and health maintenance • General recommendations based on age and gender for • -Screening, -Immunization • - Counseling -Chemoprophylaxis
Health Maintenance NeedsFollowing TBI • Screening: Headache, fatigue, dizziness, visual changes, bowel and bladder management, spasticity, mood disorders, personality changes, vocational concerns and status, relationship concerns, and substance use • Counseling: injury prevention, family planning, health concerns • Immunization: pneumovax, influenza, hep b, TD, • Chemoprophylaxis: asa, vit d, calcium, bisphosphonates • Secondary Prevention Measures: injury, skin integrity,
Health Maintenance Challenges • Inadequate comprehensive primary care and preventive health services • Appointment time limitations • Physical access to clinic and exam techniques • Provider knowledge regarding Post TBI needs • Provider knowledge regarding Health Maintenance Needs • Focus on a Few Chronic Problems
Interdisciplinary Approach • Primary Care, Psychiatry and PM&R in same clinic • HCH Model • Co-Visits, Back to Back Visits • Specialty Services within Clinic Organization • Rehabilitative Services in Organization • Specialty Referrals Available • Adaptive Clinic Equipment
References • Bockenek, W., Currie, D. (1994). Physical medicine and rehabilitation as a primary care specialty, Commentary. American Journal of Physical Medicine and Rehabilitation. 73(1) 58-60. • Bushnik, T., Englander, J., & Wright, J. (2008). The experience of fatigue in the first 2 years after moderate-to-severe traumatic brain injury: a preliminary report. Journal of Head Trauma Rehabilitation. 23(1)17-2 • Castriotta, R,& Murthy, J. (2011). Sleep disorders in patients with traumatic brain injury: a review. CNS Drugs 25(3): 175-85. • Hoffman, J., Lucan, S., Dikmen, S., Braden, C., Brown, A., Brunner, R., Diaz-Arrastia, R., Walker, W., Watanabe, T., and Bell, K. (2011). Natural history of headache after traumatic brain injury. Journal of Neurotrauma, 28(9) 1719-1725. • Iverson, G., Zasler, N., & Lange, R. (2007). Post-concussive disorder. In Zasler, N., Katz, D., & Zafonte, R. (Eds.), Brain Injury Medicine (pp373-406). New York: Demos Medical Publishing • Klein, M., (2011). Sexuality and Dysfunction. Medscape Reference: Drugs, Diseases, and Procedures. Retrieved from http://emedicine.medscape.com/article/319119-overview#a30. • Kroll, T., Jones, G., Kehn, M., and Neri, M. (2006). Barriers and strategies affecting the utilization of primary preventive services for people with physical disabilities: a qualitative inquiry. Health and Social Care in the Community, 144284-293.
References • Morrison, E., George, V., & Mosqueda, L., (2008). Primary care for adults with physical disabilities: perceptions from consumer and provider focus groups. Family Medicine, 40(9)645-651. • Orff, H, Ayalon, L., & Drummond, S. (2009). Traumatic brain injury and sleep disturbance: a review of current research. Journal of Head Trauma Rehabilitation, 24(3): 155-65. • Radice-Neumann D, Zupan B, Tomita M, Willer B (2009). Training emotional processing in persons with brain injury. Journal of Head Trauma and Rehabilitation, 24(5): 313–323. • Slomine, B., McCarthy, M., Ding, R., MacKenzie, E., Jaffe, K., Aitken, M., Durbin, D., Christensen, J., Dorsch, A., and Paidas, C.(2006). Health care utilization and needs after pediatric traumatic brain injury. Pediatrics, 117(4)663-674. • Sutton, J., and DeJong, G. (1998). Managed care and people with disabilities. Archives of Physical Medicine and Rehabilitation, 79: 1312-1316. • US Department of Health and Human Services (2010). Agency for Heath Care Research and Quality. The guide to clinical preventive services 2010-2011. Electronic Publication of the US Preventive Ser