Citation

Benavides L, Shie V, Yee B, Yelvington M, Simko LC, Wolfe AE, McMullen K, Epp J, Parry I, Shon R, Holavanahalli R, Herndon D, Rosenberg M, Rosenberg L, Meyer W, Gibran NS, Wiechman S, Ryan CM, Schneider JC. J. Burn Care Res. 2019; ePub(ePub): ePub.

Affiliation

Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.

Copyright

(Copyright © 2019, American Burn Association, Publisher Lippincott Williams and Wilkins)

DOI

10.1093/jbcr/irz185

PMID

31710682

Abstract

While disparities in health care outcomes and services for vulnerable populations have been documented, the extent to which vulnerable burn populations demonstrate disparities in long-term care is relatively underexplored. This study's goal was to assess for differences in long-term occupational or physical therapy (OT/PT) and psychological service use after burn injury in vulnerable populations. Data from the Burn Model System National Database (2006-2015) were analyzed. The vulnerable group included participants in one or more of these categories: 65 years of age or older, non-white, no insurance or Medicaid insurance, pre-injury receipt of psychological therapy or counseling, pre-injury alcohol and/or drug misuse, or with a pre-existing disability. Primary outcomes investigated were receipt of OT/PT and psychological services. Secondary outcomes included nine OT/PT subcategories. Outcomes were examined at 6, 12, and 24 months post-injury. 1,136 burn survivors (692 vulnerable; 444 non-vulnerable) were included. The vulnerable group was mostly female, unemployed at time of injury, and with smaller burns. Both groups received similar OT/PT and psychological services at all timepoints. Adjusted regression analyses found that while the groups received similar amounts services, some vulnerable subgroups received significantly more services. Participants 65 years of age or older, who received psychological therapy or counseling prior to injury, and with a pre-existing disability received more OT/PT and psychological or peer support services at follow-up. Overall, vulnerable and non-vulnerable groups received comparable OT/PT and psychological services. The importance of long-term care among vulnerable subgroups of the burn population is highlighted by this study. Future work is needed to determine adequate levels of follow up services.

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Language: en

Keywords

burn injury; disparities; follow-up care; psychological services; rehabilitation; therapy