Understanding barriers and facilitators to implementation of psychosocial care within orthopedic trauma centers: a qualitative study with multidisciplinary stakeholders from geographically diverse settings
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 ca...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-09-01
|
| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-021-00208-8 |
| _version_ | 1818670243472474112 |
|---|---|
| author | Ana-Maria Vranceanu Jafar Bakhshaie Mira Reichman James Doorley Ryan A. Mace Cale Jacobs Mitchel Harris Kristin R. Archer David Ring A. Rani Elwy |
| author_facet | Ana-Maria Vranceanu Jafar Bakhshaie Mira Reichman James Doorley Ryan A. Mace Cale Jacobs Mitchel Harris Kristin R. Archer David Ring A. Rani Elwy |
| author_sort | Ana-Maria Vranceanu |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-17T07:05:01Z |
| format | Article |
| id | doaj.art-cf7c49206ca948bcb38e3a22c01b3741 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-12-17T07:05:01Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-cf7c49206ca948bcb38e3a22c01b37412022-12-21T21:59:12ZengBMCImplementation Science Communications2662-22112021-09-012111710.1186/s43058-021-00208-8Understanding barriers and facilitators to implementation of psychosocial care within orthopedic trauma centers: a qualitative study with multidisciplinary stakeholders from geographically diverse settingsAna-Maria Vranceanu0Jafar Bakhshaie1Mira Reichman2James Doorley3Ryan A. Mace4Cale Jacobs5Mitchel Harris6Kristin R. Archer7David Ring8A. Rani Elwy9Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General HospitalIntegrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General HospitalIntegrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General HospitalIntegrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General HospitalIntegrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General HospitalDepartment of Orthopaedic Surgery & Sports Medicine, College of Medicine, University of KentuckyDepartment of Orthopaedic Surgery, Massachusetts General HospitalDepartment of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical CenterDepartment of Surgery and Perioperative Care, Dell Medical School, The University of Texas at AustinDepartment of Psychiatry and Human Behavior, Alpert Medical School, Brown UniversityAbstract 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.https://doi.org/10.1186/s43058-021-00208-8OrthopedicOrthopaedicMusculoskeletalTraumatic injurySurgeonsMedical provider |
| spellingShingle | Ana-Maria Vranceanu Jafar Bakhshaie Mira Reichman James Doorley Ryan A. Mace Cale Jacobs Mitchel Harris Kristin R. Archer David Ring A. Rani Elwy 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 Orthopedic Orthopaedic Musculoskeletal Traumatic injury Surgeons Medical provider |
| title | Understanding barriers and facilitators to implementation of psychosocial care within orthopedic trauma centers: a qualitative study with multidisciplinary stakeholders from geographically diverse settings |
| title_full | Understanding barriers and facilitators to implementation of psychosocial care within orthopedic trauma centers: a qualitative study with multidisciplinary stakeholders from geographically diverse settings |
| title_fullStr | Understanding barriers and facilitators to implementation of psychosocial care within orthopedic trauma centers: a qualitative study with multidisciplinary stakeholders from geographically diverse settings |
| title_full_unstemmed | Understanding barriers and facilitators to implementation of psychosocial care within orthopedic trauma centers: a qualitative study with multidisciplinary stakeholders from geographically diverse settings |
| title_short | Understanding barriers and facilitators to implementation of psychosocial care within orthopedic trauma centers: a qualitative study with multidisciplinary stakeholders from geographically diverse settings |
| title_sort | understanding barriers and facilitators to implementation of psychosocial care within orthopedic trauma centers a qualitative study with multidisciplinary stakeholders from geographically diverse settings |
| topic | Orthopedic Orthopaedic Musculoskeletal Traumatic injury Surgeons Medical provider |
| url | https://doi.org/10.1186/s43058-021-00208-8 |
| work_keys_str_mv | AT anamariavranceanu understandingbarriersandfacilitatorstoimplementationofpsychosocialcarewithinorthopedictraumacentersaqualitativestudywithmultidisciplinarystakeholdersfromgeographicallydiversesettings AT jafarbakhshaie understandingbarriersandfacilitatorstoimplementationofpsychosocialcarewithinorthopedictraumacentersaqualitativestudywithmultidisciplinarystakeholdersfromgeographicallydiversesettings AT mirareichman understandingbarriersandfacilitatorstoimplementationofpsychosocialcarewithinorthopedictraumacentersaqualitativestudywithmultidisciplinarystakeholdersfromgeographicallydiversesettings AT jamesdoorley understandingbarriersandfacilitatorstoimplementationofpsychosocialcarewithinorthopedictraumacentersaqualitativestudywithmultidisciplinarystakeholdersfromgeographicallydiversesettings AT ryanamace understandingbarriersandfacilitatorstoimplementationofpsychosocialcarewithinorthopedictraumacentersaqualitativestudywithmultidisciplinarystakeholdersfromgeographicallydiversesettings AT calejacobs understandingbarriersandfacilitatorstoimplementationofpsychosocialcarewithinorthopedictraumacentersaqualitativestudywithmultidisciplinarystakeholdersfromgeographicallydiversesettings AT mitchelharris understandingbarriersandfacilitatorstoimplementationofpsychosocialcarewithinorthopedictraumacentersaqualitativestudywithmultidisciplinarystakeholdersfromgeographicallydiversesettings AT kristinrarcher understandingbarriersandfacilitatorstoimplementationofpsychosocialcarewithinorthopedictraumacentersaqualitativestudywithmultidisciplinarystakeholdersfromgeographicallydiversesettings AT davidring understandingbarriersandfacilitatorstoimplementationofpsychosocialcarewithinorthopedictraumacentersaqualitativestudywithmultidisciplinarystakeholdersfromgeographicallydiversesettings AT aranielwy understandingbarriersandfacilitatorstoimplementationofpsychosocialcarewithinorthopedictraumacentersaqualitativestudywithmultidisciplinarystakeholdersfromgeographicallydiversesettings |