Obey and Miller, “Resources for Patient Mental Health and Well-Being after Orthopaedic Trauma.”
- Problem: Addresses the impact of psychiatric disorders, such as depression, anxiety, and PTSD, on patient outcomes following orthopaedic trauma and emphasizes the need for comprehensive mental health support alongside physical rehabilitation.
- Focus: To highlight and discuss the various resources available to support the mental health and well-being of patients recovering from orthopaedic trauma.
- Study / Data Population: Reviewed literature and resources available nationally and locally for psychiatric illness management in orthopaedic trauma patients.
- Parameters measured: Outlined various types of resources including psychological treatments (CBT, mindfulness), spiritual support, trauma-informed care, support groups, and referral options.
- Key results: Outlined the effectiveness of psychological treatments, patient satisfaction with spiritual support, and the impact of trauma-informed care on patient outcomes.
- Psychological treatments: CBT was found effective in reducing symptoms of depression and anxiety.
- Spiritual support: Showed positive impacts on coping mechanisms and patient satisfaction.
- Trauma-informed care: Improved patient trust and engagement in treatment.
- Support groups: Provided peer support and shared experiences.
- Referral options: Varied by effectiveness based on patient engagement and follow-through.
- Limitations: Under-recognition and undertreatment of psychiatric disorders by non-specialist providers, systemic and financial barriers to accessing mental health care, and variability in the utilization of trauma-informed care programs like the Trauma Survivors Network. Specific barriers to resource utilization such as financial constraints, geographical limitations, and the need for better integration of these resources into orthopaedic care pathways were also mentioned.
Zdziarski-Horodyski et al., “An Integrated-Delivery-of-Care Approach to Improve Patient Reported Physical Function and Mental Wellbeing after Orthopedic Trauma
- Problem: Despite available psychosocial support, acute trauma care often neglects ongoing emotional and physical needs of orthopedic trauma patients, potentially leading to poorer outcomes. This study addresses whether an integrated care (IntCare) approach, which combines physical rehabilitation with structured psychosocial support, can improve functional quality of life (QOL) and emotional wellbeing compared to standard care (UsCare).
- Focus: The study evaluates the effectiveness of IntCare in improving patient outcomes, including physical function, emotional wellbeing, medical complications, and hospital readmissions, in comparison to UsCare.
- Study/Data Population:
- Inclusion Criteria: Orthopedic trauma patients.
- Sample Size: 100 participants, randomized into IntCare or UsCare groups.
- Parameters Measured:
- Primary Outcomes: Lower Extremity Gain Scale (LEGS), handgrip strength, and active range of motion (AROM).
- Secondary Outcomes: Patient-reported outcomes (PROMIS™ measures), medical complications, readmissions, and onset of new co-morbid diseases.
- Psychosocial Measures: PTSD Checklist, BDI-II, STAI, and Tampa Scale of Kinesiophobia-11.
- Key Results:
- IntCare vs. UsCare: IntCare is hypothesized to improve functional QOL and emotional wellbeing, reduce medical complications, hospital readmissions, and incidence of psychological illness more than UsCare.
- Primary Findings: The use of integrated care is expected to provide a holistic approach to patient recovery, combining physical rehabilitation with psychosocial support, potentially leading to better overall outcomes.
- Limitations:
- Potential positive bias due to the control group's perception of receiving additional care.
- Strict adherence to the intervention may be challenging without compensation for participants.
- Possible interference with the control group’s outcomes due to frequent interactions for data collection.
Stinner, Hendrickson, and Vallier, “Trauma System Support to Facilitate Recovery.”
- Problem: Trauma, a leading cause of death and disability, imposes substantial healthcare costs and impacts recovery beyond physical injury. Despite advances in acute trauma care, psychosocial factors influencing recovery are under-addressed.
- Focus: Reviews trauma centers' programs and resources aimed at promoting psychosocial recovery and identifies barriers to implementing such programs.
- Study/Data Population: Examines existing trauma recovery programs including the Trauma Survivors Network (TSN), Trauma Collaborative Care Study (TCCS), Center for Trauma Survivorship (CTS), and Trauma Recovery Services (TRS). It also considers barriers to implementation.
- Parameters Measured: Programs were assessed on their ability to provide psychosocial support, improve mental health outcomes, enhance patient satisfaction, and reduce healthcare utilization. Metrics included adherence to treatment, patient satisfaction, mental illness screening, and emergency department utilization.
- Key Results: Trauma recovery programs have shown potential benefits including improved patient self-efficacy, reduced emergency department visits, better adherence to treatment, and increased satisfaction. However, variability in resource use and implementation affected the consistency of results. Recent updates to trauma center requirements by the American College of Surgeons (ACS) are expected to drive further integration of psychosocial support.
- Limitations: Barriers to effective implementation include lack of formal support within trauma systems, limited provider education, and resource constraints. The variability in program effectiveness and engagement also poses challenges.
- Conclusion: Addressing psychological and social factors in trauma recovery is crucial for optimizing long-term outcomes. Enhancing trauma center resources and education on psychosocial support will benefit patients and improve overall recovery efficiency.
Brahmbhatt D, Schpero WL. Access to Psychiatric Appointments for Medicaid Enrollees in 4 Large US Cities. JAMA. Published online July 31, 2024. doi:10.1001/jama.2024.13074
- Problem: Medicaid enrollees face a disproportionate burden of severe mental illness yet psychiatrists are less likely than other physicians to accept insurance especially medicaid- this limits access to mental health resources for some of those that need it most
- Focus: Limited availability and wait times for adult appts with psychiatric prescribing clinicians- particularly among medicaid enrollees
- Study/ Data population: Randomly selected 80 prescribing clinicians among 4 major cities of New York City, Los Angeles, Chicago and Phoenix (total of 3220 clinicians)- called as medicaid enrollees seeking soonest avail appointment
- Parameters measured: examined appointment availability, wait times and reasons an appt could not be make with the sampled clinician
- Key results:
- Of 320 clinician offices called, 87 (27.2%) had appts available
- Median wait times were 11 days in Phoenix, 23 days in Chicago, 28 days in New York, and 64 days in LA
- On largest medicaid managed care plans across 4 of largest US cities, only 17.8% of clinicians listed as in-network for medicaid were reachable, accepted medicaid and could provide a new patient appt—when access did exist, was often not timely w wait times up to 6 months
- Limitations:
- Lack of comparison group of enrollees with commercial health insurance
- Calls were placed only to practices in urban areas and diagnosis for appt request when prompted was depression
- Results may not generalize to rural areas or patients seeking for other conditions