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

Ana-Maria Vranceanu,Mira Reichman,James Doorley,A Rani Elwy,Mitchel Harris,Ryan A Mace,David Ring,Cale Jacobs,Kristin R Archer,Jafar Bakhshaie

doi:10.1186/s43058-021-00208-8

Abstract

BackgroundPsychosocial 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.MethodsWe 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.ResultsStakeholders 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.ConclusionsResults provide a blueprint for successful implementation of psychosocial care in orthopedic trauma settings, with important implications for prevention of persistent pain and disability.

Highlights

Psychosocial factors are pivotal in recovery after acute orthopedic traumatic injuries
In this multi-site qualitative study of orthopedic trauma providers, we identified key strategies to facilitate implementation of psychosocial care into orthopedic trauma practices
We integrate the Consolidated Framework for Implementation Research with Proctor’s implementation outcomes as a novel approach to comprehensively characterize the barriers and facilitators among implementation determinants that could impact implementation outcomes. These data serve as a blueprint for maximizing successful implementation of psychosocial care and aligning orthopedic trauma practices with evidence-based biopsychosocial models of care

Summary

Introduction

Psychosocial factors are pivotal in recovery after acute orthopedic traumatic injuries. Mounting evidence shows that misconceptions and distress (e.g., catastrophic thinking, fear of movement, depression, and posttraumatic stress) are important modifiable risk factors for persistent pain and functional limitations after traumatic musculoskeletal injuries, regardless of the injury severity [3, 7, 8], location [9, 10], and type [11, 12] Recognizing these modifiable risk factors early creates an opportunity to intervene with patients who are at risk for persistent pain and disability in the acute post-injury phase, when psychosocial treatments are most effective [13, 14]

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