Zazzali James L, Marshall Grant N, Shetty Vivek, Yamashita Dennis-Duke R, Sinha Uttam K, Rayburn Nadine R
RAND Corporation, Santa Monica, CA 90407, USA.
J Oral Maxillofac Surg. 2007 Aug;65(8):1584-9. doi: 10.1016/j.joms.2006.09.028.
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.
We 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).
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.
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.
弱势群体在经历口腔颌面部损伤后，尤其容易出现心理社会后遗症。为了增进对相关心理社会问题的认知、观点和信念的理解，我们对为贫困患者提供口腔颌面部损伤治疗的外科医生进行了调查。
我们在一家大型城市一级创伤中心对26名口腔颌面外科医生和15名耳鼻喉科医生进行了调查。该调查基于对15名口腔颌面外科医生的半结构化访谈，测量了提供者对攻击性口腔颌面部损伤后相关背景因素和患者心理社会需求的看法。总体调查回复率为85.4%（41人中的35人）。
受访者将人际暴力列为患者口腔颌面部损伤的主要原因。焦虑（如创伤后应激）、抑郁和法律问题是受访者确定的最显著的心理社会后遗症。酗酒、药物滥用和无家可归被确定为口腔颌面部再次受伤和患者不遵守术后医嘱的最重要因素。不到一半的受访者（44.7%）认为医院目前对患者的抑郁、焦虑或药物滥用问题处理得当。绝大多数（94.7%）认为需要一个心理社会后续护理项目，大多数人同意这样一个项目将降低再次受伤的风险，并促进患者遵守后续护理医嘱并按时返回进行定期随访。受访者将他们医院的专科心理健康服务或社区环境确定为该项目的首选地点，他们表示缺乏财政资源和训练有素的人员是在创伤服务环境中实施此类项目的最重大障碍。
为贫困口腔颌面部损伤患者提供护理的外科医生认为，患者非常需要心理社会后续护理项目，他们相信此类项目可以降低再次受伤的风险并促进患者遵守医嘱。
