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Bernardo C, Hoon E, Gonzalez-Chica DA, Frank O, Black-Tiong S, Stocks N. Management of physical and psychological trauma resulting from motor vehicle crashes in Australian general practice: a mixed-methods approach. BMC PRIMARY CARE 2024; 25:167. [PMID: 38755534 PMCID: PMC11100075 DOI: 10.1186/s12875-024-02421-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND In Australia, motor vehicle crashes (MVC)-related health data are available from insurance claims and hospitals but not from primary care settings. This study aimed to identify the frequency of MVC-related consultations in Australian general practices, explore the pharmacological management of health conditions related to those crashes, and investigate general practitioners' (GPs) perceived barriers and enablers in managing these patients. METHODS Mixed-methods study. The quantitative component explored annual MVC-related consultation rates over seven years, the frequency of chronic pain, depression, anxiety or sleep issues after MVC, and management with opioids, antidepressants, anxiolytics or sedatives in a sample of 1,438,864 patients aged 16 + years attending 402 Australian general practices (MedicineInsight). Subsequently, we used content analysis of 81 GPs' qualitative responses to an online survey that included some of our quantitative findings to explore their experiences and attitudes to managing patients after MVC. RESULTS MVC-related consultation rates remained stable between 2012 and 2018 at around 9.0 per 10,000 consultations. In 2017/2018 compared to their peers, those experiencing a MVC had a higher frequency of chronic pain (48% vs. 26%), depression/anxiety (20% vs. 13%) and sleep issues (7% vs. 4%). In general, medications were prescribed more after MVC. Opioid prescribing was much higher among patients after MVC than their peers, whether they consulted for chronic pain (23.8% 95%CI 21.6;26.0 vs. 15.2%, 95%CI 14.5;15.8 in 2017/2018, respectively) or not (15.8%, 95%CI 13.9;17.6 vs. 6.7%, 95% CI 6.4;7.0 in 2017/2018). Qualitative analyses identified a lack of guidelines, local referral pathways and decision frameworks as critical barriers for GPs to manage patients after MVC. GPs also expressed interest in having better access to management tools for specific MVC-related consequences (e.g., whiplash/seatbelt injuries, acute/chronic pain management, mental health issues). CONCLUSION Chronic pain, mental health issues and the prescription of opioids were more frequent among patients experiencing MVC. This reinforces the relevance of appropriate management to limit the physical and psychological impact of MVC. GPs identified a lack of available resources (e.g. education, checklists and management support tools) for managing MVC-related consequences, and the need for local referral pathways and specific guidelines to escalate treatments.
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Affiliation(s)
- Carla Bernardo
- Adelaide Medical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 817.01, Adelaide, SA, 5000, Australia.
| | - Elizabeth Hoon
- Adelaide Medical School, School of Public Health, The University of Adelaide, 115 Grenfell St, Level 8, Room 818.01, Adelaide, SA, 5000, Australia
| | - David Alejandro Gonzalez-Chica
- Adelaide Medical School, Adelaide Rural Clinical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 811C.02, Adelaide, SA, 5000, Australia
| | - Oliver Frank
- Adelaide Medical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 817.09, Adelaide, SA, 5000, Australia
| | - Sean Black-Tiong
- Adelaide Medical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 817, Adelaide, SA, 5000, Australia
| | - Nigel Stocks
- Adelaide Medical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 823.01, Adelaide, SA, 5000, Australia
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The 12-Month Effects of the Trauma Collaborative Care Intervention: A Nonrandomized Controlled Trial. J Bone Joint Surg Am 2022; 104:1796-1804. [PMID: 36000769 DOI: 10.2106/jbjs.22.00475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Studies have suggested that patient-centered collaborative care in the early phases of recovery may assist providers and patients in managing the multifactorial consequences of injury and may lead to better outcomes. This cluster-controlled trial, conducted at 12 U.S. Level-I trauma centers, was designed to evaluate the impact of the Trauma Collaborative Care (TCC) program on 1-year outcomes following severe musculoskeletal injury. METHODS Patients with high-energy orthopaedic trauma requiring surgical fixation were prospectively enrolled. Six sites implemented the TCC intervention as well as the Trauma Survivors Network (TSN), and the other 6 sites provided the standard of care. Participants were followed for 1 year, and a composite primary outcome measure composed of the Short Musculoskeletal Function Assessment (SMFA) Dysfunction Index, Patient Health Questionnaire-9 (PHQ-9), and Posttraumatic Stress Disorder Checklist (PCL) was assessed. A 2-stage, Bayesian hierarchical statistical procedure was used to characterize treatment effects. Sensitivity analyses were conducted to account for an error in the delivery of the intervention. RESULTS There were 378 patients enrolled at 6 trauma centers implementing the TCC program, and 344 patients enrolled at 6 trauma centers providing usual care. Patient utilization of treatment components varied across the intervention sites: 29% of patients in the intervention group received all 5 key components (TSN handbook education, peer visits, recovery assessment, and calls before and after recovery assessment). Posterior estimates of the intention-to-treat effect suggested that the intervention did not have an appreciable effect: the odds of the composite outcome for the TCC group increased by 5% (95% credible interval, -40% to 63%). The estimates of the effect of receiving all 5 key intervention components were similar. CONCLUSIONS Despite prior work showing early positive effects, this analysis suggests that the TCC program as delivered did not have positive effects on patient outcomes at 1 year. It is not known whether programs that improve compliance or target specific subgroups would better meet the psychosocial needs of trauma survivors. LEVEL OF EVIDENCE Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
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AAOS/Major Extremity Trauma and Rehabilitation Consortium Clinical Practice Guideline Summary for Evaluation of Psychosocial Factors Influencing Recovery From Orthopaedic Trauma. J Am Acad Orthop Surg 2022; 30:e307-e312. [PMID: 34714783 DOI: 10.5435/jaaos-d-21-00777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/02/2021] [Indexed: 02/01/2023] Open
Abstract
The Clinical Practice Guideline for Evaluation of Psychosocial Factors Influencing Recovery from Adult Orthopaedic Trauma is based on a systematic review of current scientific and clinical research. The purpose of this clinical practice guideline is to improve outcomes after adult orthopaedic trauma by evaluating, and addressing, the psychosocial factors that affect recovery. This guideline contains one recommendation to address eight psychosocial factors after military and civilian adult orthopaedic trauma that may influence clinical, functional, and quality of life recovery. Furthermore, it addresses additional factors that may be associated with greater biopsychosocial symptom intensity, limitations, and/or diminished health-related quality of life. However, this guideline did not evaluate effective treatment strategies for the treatment or prevention of psychosocial factors. This guideline cannot be fully extrapolated to the treatment of children or adolescents. In addition, the work group highlighted the need for additional research because studies of general traumatic injuries do not always generalize to specific orthopaedic populations.
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Abstract
BACKGROUND Following hospital discharge after traumatic injuries, many patients' rehabilitation is inhibited by poor health-related quality of life (HRQoL). OBJECTIVE The purpose of this review is to identify factors that influence the HRQoL of polytrauma patients after hospital discharge. METHODS A systematic literature search was performed in CINAHL and PubMed databases for English-language articles published between January 2015 and January 2020. Articles that dealt with pediatric or narrow adult populations, exclusively considered brain and spinal cord injuries, burn injuries, or isolated fractures were excluded. In total, 22 nonexperimental cohort studies were eligible for inclusion. RESULTS Based on these studies, with minor disagreements explainable by deficient sampling, variables that impacted HRQoL fell into 11 categories: demographics, preinjury HRQoL, preexisting conditions, mental health status, injury type and location, injury severity, course of hospitalization, time after injury, financial and employment status, functional capacity, and pain. CONCLUSION The finding with the greatest implications was that mental health, positive coping, self-efficacy, and perception of physical state significantly influence HRQoL after injury and, along with other modifiable variables, can be optimized by directed treatment. Additionally, targeted assessments and interventions can be utilized to improve quality of life for patients with nonmodifiable risk factors.
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Singichetti B, Naumann RB, Sauber-Schatz E, Proescholdbell S, Marshall SW. Potential injuries and costs averted by increased use of evidence-based behavioral road safety policies in North Carolina. TRAFFIC INJURY PREVENTION 2020; 21:545-551. [PMID: 33095063 PMCID: PMC8126265 DOI: 10.1080/15389588.2020.1824066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/28/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The purpose of this study was to estimate the potential injuries and costs that could be averted by implementing evidence-based road safety policies and interventions not currently utilized in one U.S. state, North Carolina (NC). NC consistently has annual motor vehicle-related death rates above the national average. METHODS We used the Centers for Disease Control and Prevention's Motor Vehicle Prioritizing Interventions and Cost Calculator for States (MV PICCS) tool as a foundation for examining the potential injuries and costs that could be averted from underutilized evidence-based policies, assuming a $1.5 million implementation budget and that income generated from policy-related fines and fees would help offset costs. We further examined costs by payer source. RESULTS Model results indicated that seven interventions should be prioritized for implementation in NC: increased alcohol ignition interlock use, increased seat belt fines, in-person license renewal for ages 70 and older, license plate impoundment, seat belt enforcement campaigns, saturation patrols, and speed cameras. Increasing the seat belt fine had the potential to avert the greatest number of fatal (n = 70) and non-fatal (n = 6,597) injuries annually, along with being the most cost-effective of the recommended interventions. Collectively, the seven recommended evidence-based policies/interventions have the potential to avert 302 fatal injuries, 16,607 non-fatal injuries, and $839 million annually in NC with the greatest costs averted for insurers. CONCLUSIONS This study demonstrates the utility of the MV PICCS tool as a foundation for exploring state-specific impacts that could be realized through increased evidence-based road safety policy and intervention implementation. For NC, we found that increasing the seat belt fine would avert the most injuries, and had the greatest financial benefits for the state, and the lowest implementation costs. Incorporating fines and fees into policy implementation can create important financial feedbacks that allow for implementation of additional evidence-based and cost-effective policies/interventions. Given the recent uptick in U.S. motor vehicle-related deaths, analyses informed by the MV PICCS tool can help researchers and policy makers initiate discussions about successful state-specific strategies for reducing the burden of crashes.
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Affiliation(s)
- Bhavna Singichetti
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill; 521 South Greensboro Street, Campus Box 7505, Carrboro NC 27510, United States
| | - Rebecca B. Naumann
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill; 521 South Greensboro Street, Campus Box 7505, Carrboro NC 27510, United States
| | - Erin Sauber-Schatz
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention; United States Public Health Service; 4770 Buford Highway, N.E., Mailstop S106-9, Atlanta, GA 30341, United States
| | - Scott Proescholdbell
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services; 5505 Six Forks Rd, Raleigh, NC 27609, United States
| | - Stephen W. Marshall
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina at Chapel Hill; 521 South Greensboro Street, Campus Box 7505, Carrboro NC 27510, United States
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Factors Associated With Long-term Outcomes After Injury: Results of the Functional Outcomes and Recovery After Trauma Emergencies (FORTE) Multicenter Cohort Study. Ann Surg 2020; 271:1165-1173. [PMID: 30550382 DOI: 10.1097/sla.0000000000003101] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine factors associated with patient-reported outcomes, 6 to 12 months after moderate to severe injury. SUMMARY OF BACKGROUND DATA Due to limitations of trauma registries, we have an incomplete understanding of factors that impact long-term patient-reported outcomes after injury. As 96% of patients survive their injuries, several entities including the National Academies of Science, Engineering and Medicine have called for a mechanism to routinely follow trauma patients and determine factors associated with survival, patient-reported outcomes, and reintegration into society after trauma. METHODS Over 30 months, major trauma patients [Injury Severity Score (ISS) ≥9] admitted to 3 Level-I trauma centers in Boston were assessed via telephone between 6 and 12 months after injury. Outcome measures evaluated long-term functional, physical, and mental-health outcomes. Multiple regression models were utilized to identify patient and injury factors associated with outcomes. RESULTS We successfully followed 1736 patients (65% of patients contacted). More than half (62%) reported current physical limitations, 37% needed help for at least 1 activity of daily living, 20% screened positive for posttraumatic stress disorder (PTSD), all SF-12 physical health subdomain scores were significantly below US norms, and 41% of patients who were working previously were unable to return to work. Age, sex, and education were associated with long-term outcomes, while almost none of the traditional measures of injury severity were. CONCLUSION The long-term sequelae of trauma are more significant than previously expected. Collection of postdischarge outcomes identified patient factors, such as female sex and low education, associated with worse recovery. This suggests that social support systems are potentially at the core of recovery rather than traditional measures of injury severity.
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Cardoso JP, Mota ELA, Rios PAA, Ferreira LN. Associated factors from loss productivity among people involved in road traffic accident: a prospective study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200015. [PMID: 32159626 DOI: 10.1590/1980-549720200015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/13/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To study associated factors with loss productivity in people involved road traffic accidents (RTA). METHODS The population based cohort study was conducted in Jequié, Brazil between 2013 to 2015. The instrument for interview was used in people involved in RTA and interview in four months. Individuals, occupational, health conditions, injury and support variables were used for bivariate and multivariate analysis. RESULTS The cumulative incidence was loss productivity was 61.1% and density incidence of 7.45 cases/100 person-month. Multivariate analysis showed association for injury (IDR = 4.23; 95%CI = 2.90 - 6.17) and vehicle used with work instrument (IDR = 2.80; 95%CI = 1.62 - 4.85). CONCLUSION Public policies are needed to ensure traffic safety in order to minimize the effects of RTA about productivity and to carry news studies to expand knowledge about loss productivity.
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Early Effects of the Trauma Collaborative Care Intervention: Results From a Prospective Multicenter Cluster Clinical Trial. J Orthop Trauma 2019; 33:538-546. [PMID: 31634286 DOI: 10.1097/bot.0000000000001581] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the impact of the Trauma Collaborative Care (TCC) program's early intervention components on 6-week outcomes. TCC was developed to improve psychosocial sequelae of orthopaedic trauma and includes the Trauma Survivors Network and additional collaborative care services. DESIGN Prospective, multicenter, cluster clinical trial. SETTING Level I Trauma Centers. PATIENTS Individuals with high-energy orthopaedic injuries requiring surgery and hospital admission: 413 patients at 6 trauma centers implementing the TCC program and 374 patients at 6 trauma centers receiving usual care. INTERVENTION TCC early intervention: patient education, peer visits, and coaching calls. MAIN OUTCOME MEASUREMENTS Pain rating scale, Patient Health Questionnaire-9 depression, Post-Traumatic Stress Disorder Checklist, and self-efficacy for return to work and managing finances. For each outcome, a hybrid Bayesian statistical procedure, accounting for clustering within sites and differences in baseline characteristics between sites, was used to estimate the intention-to-treat (ITT) effect and the effect under full receipt of early intervention components. RESULTS Sites varied substantially in utilization of intervention components. The posterior estimates of the ITT (full receipt) effect favor TCC for 4 (5) of the 5 endpoints. The posterior probabilities of a favorable (ITT; full receipt) TCC effect were as follows: depression (89%-93%), pain (84%-74%), post-traumatic stress disorder (68%-68%), self-efficacy for return to work (74%-76%), and self-efficacy for managing finances (47%-61%). CONCLUSIONS Results suggest TCC may have a small positive effect on early outcomes, but use of the services was highly variable among sites. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Duckworth MP, Iezzi T. Motor Vehicle Collisions and Their Consequences—Part II: Predictors of Impairment and Disability. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9334-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Motor Vehicle Collisions and Their Consequences—Part 1: Common Physical, Psychosocial, and Cognitive Outcomes. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9331-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Reduced Quality of Life, Fatigue, and Societal Participation After Polytrauma. Int Surg 2018. [DOI: 10.9738/intsurg-d-17-00104.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective:
This cross-sectional study analyzed associations between and determinants for health-related quality of life (HRQoL), fatigue, and societal participation in polytrauma patients.
Summary of background data:
More polytrauma patients survive their injuries, often resulting in long-term disabilities. HRQoL is therefore an important outcome of trauma care. Fatigue and societal participation may be related to HRQoL. Also, their relation to severe injuries has not been studied to date.
Methods:
A total of 283 polytrauma patients (injury severity score ≥ 16) admitted to the Dutch level 1 Trauma Centre West were analyzed. HRQoL was measured by the physical component summary (PCS) and mental component summary (MCS) scores of the SF-36, fatigue by the multidimensional fatigue inventory, and societal participation by the Utrecht scale for evaluation of rehabilitation-participation. Age, sex, comorbidity, injury pattern, injury severity, and time since trauma were analyzed as potential determinants.
Results:
A total of 122 patients (43%) responded after a median follow-up of 15 (range, 10–23) months after polytrauma; 44% reported reduced physical health (PCS < 45) and 47% reported reduced mental health (MCS < 45). HRQoL was highly correlated with all fatigue and participation subscales. Severe head injury was associated with worse mental health. Female patients reported more general and mental fatigue and were less satisfied with their ability to perform daily activities. Patients with pre-existing comorbidity experienced worse physical health, more fatigue, and reduced societal participation.
Conclusions:
One to 2 years after trauma, polytrauma patients report reduced HRQoL, which is associated with more fatigue and reduced societal participation. Trauma rehabilitation strategies should focus on early recognition of reduced HRQoL, fatigue, and societal participation and facilitate early intervention to improve these outcomes.
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