Provider Perceptions of Patient Psychosocial Needs After Orofacial Injury

Published In: Journal of Oral and Maxillofacial Surgery, v. 65, no. 8, Aug. 2007, p. 1584-1589

Posted on RAND.org on January 01, 2007

by James Zazzali, Grant N. Marshall, Vivek Shetty, Dennis-Duke R. Yamashita, Uttam K. Sinha, Nadine Rayburn

PURPOSE: Vulnerable populations are at particular risk for developing psychosocial sequelae after they experience orofacial injury. To enhance understanding of awareness, perspectives, and beliefs regarding attendant psychosocial issues, surgeons who provide orofacial injury care to indigent patients were surveyed. MATERIALS AND METHODS: The authors surveyed 26 oral and maxillofacial surgeons and 15 otolaryngology surgeons at a large, urban, Level 1 trauma center. The survey, which measured providers' perceptions of pertinent contextual elements and patients' psychosocial needs after assaultive orofacial injury, was based on semistructured interviews with 15 oral and maxillofacial surgeons. The overall survey response rate was 85.4% (35 of 41). RESULTS: Respondents ranked interpersonal violence as the dominant cause of orofacial injury among patients. Anxiety (eg, post-traumatic stress), depression, and legal issues were the most significant psychosocial sequelae identified by respondents. Alcohol abuse, drug abuse, and homelessness were identified as the most important contributors to orofacial reinjury and patient noncompliance with postsurgical instructions. Less than half of respondents (44.7%) believed that patients' problems with depression, anxiety, or substance abuse were currently addressed in an adequate way in the hospital. The vast majority (94.7%) believed that a psychosocial aftercare program was needed, and most agreed that such a program would decrease the risk of reinjury and would promote patient compliance with aftercare instructions and return for scheduled follow-up care. Respondents identified the specialty mental health service in their hospital or a community-based setting as the preferred locations for such a program, and they indicated that lack of financial resources and trained personnel were the most significant barriers to implementation of such a program within the setting of trauma services. CONCLUSIONS: Surgeons who provide care to indigent patients with orofacial injury perceive a great need for psychosocial aftercare programs for patients, and they believe that such programs could reduce the risk of reinjury and promote patient compliance.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.