Transcript Document

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)
• 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
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Post Brain Injury Problems
Physical Symptoms
Psychological Symptoms
Social Symptoms
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Physical Symptoms
Headache
Dizziness
Tinnitus
Visual Disturbances
Insomnia
Fatigue
Chronic Pain
Impaired Cognition
Neurogenic Bladder
Neurogenic Bowel
Spasticity and Dystonias
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Psychological Symptoms
Personality Changes
Mood Disorders
• Depression
• Mania
• Anxiety
• Substance Abuse
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Social Symptoms
Relationship Difficulties
Vocational Concerns
Sexuality Issues
Driving Safety
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Health Maintenance Needs
USPSTF Preventive healthcare and health
maintenance
General recommendations based on age and gender
for
-Screening,
-Immunization
- Counseling
-Chemoprophylaxis
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Health Maintenance Needs
Following 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,
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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
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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
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References
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References
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