Transforming Health Care through Innovative and Impactful Research

Kelley Brix, M.D., M.PH. (Text Version)

2024 TBIPHRP Vignette

Title: Breaking Down Barriers to Health Care

I'm a physician, epidemiologist, and I spent my entire career focusing on issues related to the active-duty service members and veterans. I have been involved with overseeing several large traumatic brain injury and psychological health programs since 2012. And when Dr. Taliaferro invited me to serve on the programmatic panel for the TBI psych health research program, I brought that wealth of experience overseeing and managing these national research programs.

There's a very high burden of disease in the active duty and veterans related to TBI and psychological health problems. They're very prevalent and they can be quite disabling. These are complex and heterogeneous conditions. So it's very hard to develop treatments that are effective since the patients are diverse and have different presentations.

Comorbidity is more the rule than the exception in this population. It's very common for an individual who has PTSD to also have depression [or] have alcohol abuse or chronic pain. And that makes it really hard to treat either condition. You might be able to give them a medicine that will help their PTSD symptoms but they're still drinking a 12 pack of beer every day. And the medicine with PTSD does nothing for the alcohol abuse. So these are some of the issues that are really pervasive.

Clearly, there is a need for more effective treatments, immediate treatments, for traumatic brain injury, both mild traumatic brain injury and moderate severe TBI that can be given right away. There's also a need to develop more effective treatments for chronic mild TBI. That is, people who had a concussion but have still have symptoms six months later or longer. So this CDMRP program needs to look for good applications that address these issues. I am excited about that.

The other thing that I'm excited about is that there is a mechanism included in this program that looks at how to deliver health care better. For example, you might have an effective treatment for PTSD, but it requires someone to go to a treatment session once a week for ten weeks. And there’s a number of reasons they can't finish. They only go to two sessions. They never go back. That's not enough. And they don't get well. Is there some way to take that effective treatment that is that strung out over ten weeks? Could you compress it? Could you compress it all into one week, and the person would go for the sessions twice a day for five days, and then they get the ten sessions total in one week. If you tried that, what's the result? Do they do they improve at the same rate as when it’s strung out for ten weeks? Or is it better or worse?

So one of the things that's really important is to try to figure out ways to deliver the health care more effectively, and higher acceptability to patients, and break down barriers to care. And I'm glad that this program has a mechanism specifically for inviting applications that look at improvement in delivery of care, increasing access. So I think that's very exciting because even if you have an effective treatment, if the person can't finish the treatment, they don't get better. So, there are ways that that will improve that.

I have met a lot of patients over the years who had psychological problems, such as major depression or PTSD and they suffered for a long time. Either they were not in any kind of treatment at all, or they were getting suboptimal treatment of some sort. And finally, those individuals found a health care provider that gave them the right kind of treatment that was effective for them, and it alleviated their symptoms. And I can't tell you how grateful those patients were that they were receiving treatment that was effective. And what a huge difference it made for them, for their ability to go back to work properly, for them to carry out their normal daily activities and really improve their quality of life. Basically, their brains are working normally again, and they are happier. They're more productive. I've seen patients express such gratitude that they really can resume their lives again.