Department of Orthopaedics and Rehabilitation, School of Medicine, Vanderbilt University, Nashville, TN, USA.
Arch Phys Med Rehabil. 2010 May;91(5):774-80. doi: 10.1016/j.apmr.2010.01.006.
To examine the perceived need and unmet need for support services, the reasons for not obtaining services, and the factors contributing to unmet need for vocational and mental health services in patients with traumatic lower-extremity injury.
Multicenter, prospective observational study.
Eight level I trauma centers.
Patients (N=545) undergoing lower-extremity reconstruction or amputation from March 1994 to June 1997.
Not applicable.
Perceived need and unmet need for support services at 3, 6, and 12 months after hospitalization.
Eighty-five percent of patients reported a need for at least 1 support service, and 32% reported an unmet need over the 12 months. The highest perceived need was for home nursing and legal, and for unmet need was vocational and mental health services. The main reason for patients not trying to obtain mental health assistance was thinking they would get better on their own, and for other support services was not knowing where to go. Patients treated by reconstruction compared with amputation, and being nonwhite were statistically associated with unmet needs for vocational and mental health services.
The results suggest a significant amount of unmet need for vocational and mental health services during the first year after hospitalization in the severe lower-extremity trauma population with perceived need. Areas for future research are to objectively measure need and unmet need, and further investigate the disparities in unmet need by race and treatment type in this patient population. Recommendations for trauma centers include education and screening for mental health conditions and the need for support services during hospitalization and clinic visits, and increasing communication between surgeons and providers specializing in vocational, psychological, and socioeconomic issues.
调查创伤性下肢损伤患者对职业和心理健康服务的支持服务需求和未满足需求、未获得服务的原因，以及导致未满足需求的因素。
多中心、前瞻性观察研究。
8 个一级创伤中心。
1994 年 3 月至 1997 年 6 月下肢重建或截肢的患者（N=545）。
无。
住院后 3、6 和 12 个月的支持服务需求和未满足需求。
85%的患者报告至少需要 1 种支持服务，32%的患者在 12 个月内报告存在未满足需求。感知需求最高的是家庭护理和法律，未满足需求最高的是职业和心理健康服务。患者未尝试寻求心理健康帮助的主要原因是认为自己会自行好转，而对于其他支持服务，原因是不知道去哪里寻求帮助。与截肢相比，接受重建治疗的患者和非白人患者在职业和心理健康服务的未满足需求方面存在统计学差异。
结果表明，在严重下肢创伤人群中，住院后第一年存在大量职业和心理健康服务的未满足需求，同时存在需求感知。未来的研究领域包括客观测量需求和未满足需求，并进一步调查该患者群体中种族和治疗类型差异导致的未满足需求。创伤中心的建议包括在住院和就诊期间对心理健康状况和支持服务需求进行教育和筛查，并增加外科医生与专门从事职业、心理和社会经济问题的提供者之间的沟通。
