Hiểu biết về các rào cản và yếu tố thúc đẩy việc thực hiện chăm sóc tâm lý xã hội trong các trung tâm chấn thương chỉnh hình: một nghiên cứu định tính với các bên liên quan đa ngành từ các bối cảnh địa lý khác nhau

Implementation Science Communications - 2021
Ana‐Maria Vranceanu1, Jafar Bakhshaie1, Mira Reichman1, James Doorley1, Ryan A. Mace2, Cale A. Jacobs3, Mitchel B. Harris4, Kristin R. Archer5, David Ring6, A. Rani Elwy7
1Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Boston, MA, USA
2Harvard Medical School, Boston, MA, USA
3Department of Orthopaedic Surgery & Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
4Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
5Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
6Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
7Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA

Tóm tắt

Tóm tắt Đặt vấn đề

Các yếu tố tâm lý xã hội đóng một vai trò thiết yếu trong việc phục hồi sau những chấn thương chấn thương chỉnh hình cấp tính. Việc giải quyết các yếu tố tâm lý xã hội là một cơ hội quan trọng để ngăn ngừa tình trạng đau mãn tính và khuyết tật. Mục tiêu của chúng tôi là xác định những rào cản và yếu tố thúc đẩy việc triển khai chăm sóc tâm lý xã hội trong các cơ sở điều trị ngoại trú chấn thương chỉnh hình, sử dụng Khung Tổng hợp cho Nghiên cứu Triển khai (CFIR) và phân loại của Proctor về các kết quả triển khai, đồng thời cung cấp các chiến lược triển khai được rút ra từ dữ liệu định tính và bổ sung bởi các Khuyến nghị của Chuyên gia để Thực hiện Thay đổi.

 Phương pháp

Chúng tôi đã tiến hành các nhóm tập trung định tính trực tuyến qua video, phỏng vấn ra về và phỏng vấn cá nhân với các bên liên quan trong 3 cơ sở chấn thương cấp 1 đa dạng về địa lý (N = 79; 20 bác sĩ điều trị, 28 bác sĩ nội trú, 10 y tá, 13 trợ lý y tế, 5 nhà vật lý trị liệu/nhà công tác xã hội, và 3 cộng tác viên) tại 3 trung tâm chấn thương ở Texas, Kentucky và Massachusetts. Chúng tôi đã sử dụng phân tích nội dung chỉ đạo và nội dung thông thường để rút ra thông tin về các rào cản, yếu tố thúc đẩy và chiến lược triển khai trong 26 khái niệm của CFIR nằm trong 3 kết quả Proctor có liên quan về tính chấp nhận, tính thích hợp và tính khả thi.

Từ khóa

#Chăm sóc tâm lý xã hội #chấn thương chỉnh hình #phương pháp định tính #chiến lược triển khai #khung tổng hợp nghiên cứu triển khai.

Tài liệu tham khảo

Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Injury Prevention. 2016;22(1):3–18. https://doi.org/10.1136/injuryprev-2015-041616.

Morris S, Lenihan B, Duddy L, O’Sullivan M. Outcome after musculoskeletal trauma treated in a regional hospital. J Trauma. 2000;49(3):461–9. https://doi.org/10.1097/00005373-200009000-00013.

Doornberg JN, Ring D, Fabian LM, Malhotra L, Zurakowski D, Jupiter JB. Pain dominates measurements of elbow function and health status. J Bone Joint Surg Am. 2005;87(8):1725–31. https://doi.org/10.2106/JBJS.D.02745.

Proctor TJ, Mayer TG, Gatchel RJ, McGeary DD. Unremitting health-care-utilization outcomes of tertiary rehabilitation of patients with chronic musculoskeletal disorders. J Bone Joint Surg Am. 2004;86(1):62–9. https://doi.org/10.2106/00004623-200401000-00011.

Baldwin ML. Reducing the costs of work-related musculoskeletal disorders: targeting strategies to chronic disability cases. J Electromyogr Kinesiol. 2004;14(1):33–41. https://doi.org/10.1016/j.jelekin.2003.09.013.

Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry. 1980;137(5):535–44. https://doi.org/10.1176/ajp.137.5.535.

Vranceanu A-M, Bachoura A, Weening A, Vrahas M, Smith RM, Ring D. Psychological factors predict disability and pain intensity after skeletal trauma. J Bone Joint Surg Am. 2014;96(3):e20. https://doi.org/10.2106/JBJS.L.00479.

Webster BS, Verma SK, Gatchel RJ. Relationship between early opioid prescribing for acute occupational low back pain and disability duration, medical costs, subsequent surgery and late opioid use. Spine (Phila Pa 1976). 2007;32(19):2127–32. https://doi.org/10.1097/BRS.0b013e318145a731.

Helmerhorst GTT, Vranceanu A-M, Vrahas M, Smith M, Ring D. Risk factors for continued opioid use one to two months after surgery for musculoskeletal trauma. J Bone Joint Surg Am. 2014;96(6):495–9. https://doi.org/10.2106/JBJS.L.01406.

Rosenbloom BN, Khan S, McCartney C, Katz J. Systematic review of persistent pain and psychological outcomes following traumatic musculoskeletal injury. J Pain Res. 2013;6:39–51. https://doi.org/10.2147/JPR.S38878.

Clay FJ, Watson WL, Newstead SV, McClure RJ. A systematic review of early prognostic factors for persistent pain following acute orthopedic trauma. Pain Res Manag. 2012;17(1):35–44. https://doi.org/10.1155/2012/935194.

Vranceanu A-M, Safren S, Zhao M, Cowan J, Ring D. Disability and psychologic distress in patients with nonspecific and specific arm pain. Clin Orthop Relat Res. 2008;466(11):2820–6. https://doi.org/10.1007/s11999-008-0378-1.

Pray JE. Responding to psychosocial needs: physician perceptions of their referral practices for hospitalized patients. Health Soc Work. 1991;16(3):184–92. https://doi.org/10.1093/hsw/16.3.184.

Sharpe L. Psychosocial management of chronic pain in patients with rheumatoid arthritis: challenges and solutions. J Pain Res. 2016;9:137–46. https://doi.org/10.2147/JPR.S83653.

McCarthy ML, MacKenzie EJ, Edwin D, Bosse MJ, Castillo RC, Starr A, et al. Psychological distress associated with severe lower-limb injury. J Bone Joint Surg Am. 2003 Sep;85(9):1689–97. https://doi.org/10.2106/00004623-200309000-00006.

American Academy of Orthopaedic Surgeons Board of Directors. Early screening for psychosocial risk and and protective factors: appropriate use criteria [Internet]. 2020 Available from: https://www.aaos.org/globalassets/quality-and-practice-resources/dod/prfauc.pdf

DeMario B, Kalina MJ, Truong E, Hendrickson S, Tseng ES, Claridge JA, et al. Downstream hospital system effects of a comprehensive trauma recovery services program. J Trauma Acute Care Surg. 2020;89(6):1177–82. https://doi.org/10.1097/TA.0000000000002872.

Wegener ST, Carroll EA, Gary JL, TO MK, RV OT, Sietsema DL, et al. Trauma Collaborative Care Intervention: effect on surgeon confidence in managing psychosocial complications after orthopaedic trauma. J Orthop Trauma. 2017;31(8):427–33. https://doi.org/10.1097/BOT.0000000000000867.

Nicholls JL, Azam MA, Burns LC, Englesakis M, Sutherland AM, Weinrib AZ, et al. Psychological treatments for the management of postsurgical pain: a systematic review of randomized controlled trials. Patient Relat Outcome Meas. 2018;9:49–64. https://doi.org/10.2147/PROM.S121251.

Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychology. 2015;3(1):32. https://doi.org/10.1186/s40359-015-0089-9.

Duncan EA, Murray J. The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review. BMC Health Services Research. 2012;12(1):96. https://doi.org/10.1186/1472-6963-12-96.

Mutabdzic D, Mylopoulos M, Murnaghan ML, Patel P, Zilbert N, Seemann N, et al. Coaching surgeons: is culture limiting our ability to improve? Ann Surg. 2015;262(2):213–6. https://doi.org/10.1097/SLA.0000000000001247.

Ferlie E, Fitzgerald L, Wood M. Getting evidence into clinical practice: an organisational behaviour perspective. J Health Serv Res Policy. 2000;5(2):96–102. https://doi.org/10.1177/135581960000500207.

Vranceanu AM, Beks RB, Guitton TG, Janssen SJ, Ring D. How do orthopaedic surgeons address psychological aspects of illness? Arch Bone Jt Surg. 2017;5(1):2–9.

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science. 2009;4(1):50. https://doi.org/10.1186/1748-5908-4-50.

Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76. https://doi.org/10.1007/s10488-010-0319-7.

Waltz TJ, Powell BJ, Chinman MJ, Smith JL, Matthieu MM, Proctor EK, et al. Expert recommendations for implementing change (ERIC): protocol for a mixed methods study. Implementation Science. 2014;9(1):39. https://doi.org/10.1186/1748-5908-9-39.

Waltz TJ, Powell BJ, Matthieu MM, Damschroder LJ, Chinman MJ, Smith JL, et al. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implementation Science. 2015;10(1):109. https://doi.org/10.1186/s13012-015-0295-0.

Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science. 2015;10(1):21. https://doi.org/10.1186/s13012-015-0209-1.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007;19(6):349–57. https://doi.org/10.1093/intqhc/mzm042.

Haun JN, Alman AC, Melillo C, Standifer M, McMahon-Grenz J, Shin M, et al. Using electronic data collection platforms to assess complementary and integrative health patient-reported outcomes: feasibility project. JMIR Medical Informatics. 2020;8(6, e15609). https://doi.org/10.2196/15609.

Weiner BJ, Lewis CC, Stanick C, Powell BJ, Dorsey CN, Clary AS, et al. Psychometric assessment of three newly developed implementation outcome measures. Implementation Science. 2017;12(1):108. https://doi.org/10.1186/s13012-017-0635-3.

Branch-Elliman W, Gupta K, Rani EA. Factors influencing uptake of evidence-based antimicrobial prophylaxis guidelines for electrophysiology procedures. Am J Infect Control. 2020;48(6):668–74. https://doi.org/10.1016/j.ajic.2019.10.020.

Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88. https://doi.org/10.1177/1049732305276687.

Serhal E, Arena A, Sockalingam S, Mohri L, Crawford A. Adapting the consolidated framework for implementation research to create organizational readiness and implementation tools for Project ECHO. J Contin Educ Health Prof. 2018;38(2):145–51. https://doi.org/10.1097/CEH.0000000000000195.

Auvinen J, Kylmä J, Välimäki M, Bweupe M, Suominen T. Midwives’ perspectives on male participation in PMTCT of HIV and how they can support it in Lusaka. Zambia. Midwifery. 2014;30(1):17–27. https://doi.org/10.1016/j.midw.2013.01.010.

Waltz TJ, Powell BJ, Fernández ME, Abadie B, Damschroder LJ. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implementation Science. 2019;14(1):42. https://doi.org/10.1186/s13012-019-0892-4.

Stoop CH, et al. Effectiveness of a stepped care intervention for anxiety and depression in people with diabetes, asthma or COPD in primary care: a randomized controlled trial. J Affect Disord. 2015;184:269–76.

Hayes SC, Hofmann SG. The third wave of cognitive behavioral therapy and the rise of process-based care. World Psychiatry. 2017;16(3):245–6. https://doi.org/10.1002/wps.20442.

Hofmann SG, Hayes SC. The future of intervention science: process-based therapy. Clinical Psychological Science. 2019;7(1):37–50. https://doi.org/10.1177/2167702618772296.

Chad-Friedman E, Talaei-Khoei M, Ring D, Vranceanu A-M. First use of a brief 60-second mindfulness exercise in an orthopedic surgical practice; results from a pilot study. Arch Bone Jt Surg. 2017;5(6):400–5.

Vranceanu A-M, Jacobs C, Lin A, Greenberg J, Funes CJ, Harris MB, et al. Results of a feasibility randomized controlled trial (RCT) of the Toolkit for Optimal Recovery (TOR): a live video program to prevent chronic pain in at-risk adults with orthopedic injuries. Pilot Feasibility Stud. 2019;5(1):30. https://doi.org/10.1186/s40814-019-0416-7.

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