Understanding barriers and facilitators to implementation of psychosocial care within orthopedic trauma centers: a qualitative study with multidisciplinary stakeholders from geographically diverse settings

Implementation Science Communications

Cale Jacobs¹  Kristin R. Archer²  Mitchel Harris³  A. Rani Elwy⁴  David Ring⁵  Ryan A. Mace⁶  Jafar Bakhshaie⁶  James Doorley⁶  Mira Reichman⁶  Ana-Maria Vranceanu⁶ 

[1] Department of Orthopaedic Surgery & Sports Medicine, College of Medicine, University of Kentucky;Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center;Department of Orthopaedic Surgery, Massachusetts General Hospital;Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University;Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin;Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital;

关键词: Orthopedic;    Orthopaedic;    Musculoskeletal;    Traumatic injury;    Surgeons;    Medical provider;   

DOI  :  10.1186/s43058-021-00208-8

来源: DOAJ

【 摘 要 】

Abstract Background Psychosocial factors are pivotal in recovery after acute orthopedic traumatic injuries. Addressing psychosocial factors is an important opportunity for preventing persistent pain and disability. We aim to identify barriers and facilitators to the implementation of psychosocial care within outpatient orthopedic trauma settings using the Consolidated Framework for Implementation Research (CFIR) and Proctor’s taxonomy of implementation outcomes, and to provide implementation strategies derived from qualitative data and supplemented by the Expert Recommendations for Implementing Change. Methods We conducted live video qualitative focus groups, exit interviews and individual interviews with stakeholders within 3 geographically diverse level 1 trauma settings (N = 79; 20 attendings, 28 residents, 10 nurses, 13 medical assistants, 5 physical therapists/social workers, and 3 fellows) at 3 trauma centers in Texas, Kentucky, and Massachusetts. We used directed and conventional content analyses to derive information on barriers, facilitators, and implementation strategies within 26 CFIR constructs nested within 3 relevant Proctor outcomes of acceptability, appropriateness, and feasibility. Results Stakeholders noted that implementing psychosocial care within their practice can be acceptable, appropriate, and feasible. Many perceived integrated psychosocial care as crucial for preventing persistent pain and reducing provider burden, noting they lack the time and specialized training to address patients’ psychosocial needs. Providers suggested strategies for integrating psychosocial care within orthopedic settings, including obtaining buy-in from leadership, providing concise and data-driven education to providers, bypassing stigma, and flexibly adapting to fast-paced clinics. Conclusions Results provide a blueprint for successful implementation of psychosocial care in orthopedic trauma settings, with important implications for prevention of persistent pain and disability.

【 授权许可】

Unknown