Development of a guidance to improve allied primary healthcare after acquired brain injury in the Netherlands – a mixed-methods study

The organisation of primary care for individuals with acquired brain injury (ABI) and collaboration in primary care rehabilitation requires improvement. Based on previous research, aimed at improving post-stroke care pathways, this study focuses on the development of guidance for the Netherlands that addresses three key areas: (1) the knowledge and skills of occupational therapists, physiotherapists, and speech and language therapists working in primary care rehabilitation for people with ABI; (2) collaboration in regional primary care networks to deliver appropriate care at the right time and in the right place; and (3) strategies to enhance the visibility and accessibility of suitable therapists for patients with ABI and their professional care providers within primary care. A mixed-methods design was employed, guided by the principles of improvement science and in accordance with the Advisory and Expert Group on Quality Standards (AQUA) guideline. The process was structured in three phases: preparation, research, and development. The data were collected through a combination of methods, including interviews and a narrative review. The results of the interviews and narrative review were used to create items for the Delphi study, which were then discussed with expert groups and led to the development of the guidance. Furthermore, input from multiple expert groups was sought throughout the entire process. Twenty-three interviews were conducted and subsequently analysed. The narrative review was based on 23 relevant articles. The Delphi study reached 95% consensus in two rounds. The need for expertise in ABI treatment, interdisciplinary collaboration, transparent communication, and enhanced accessibility to specialised care, particularly in rural areas, were identified as the most important topics. A Dutch national guidance aimed at improving primary care rehabilitation for people with ABI was developed successfully through an iterative process. The guidance contains practical tips and advice for allied health professionals.