Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC.
Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC.
J Am Coll Surg. 2020 Aug;231(2):223-230. doi: 10.1016/j.jamcollsurg.2020.03.037. Epub 2020 Apr 23.
Annually, post-traumatic stress disorder, depression, or both, develop in the first year after injury in more than 400,000 adults treated in US trauma centers (≥20%). Yet, few trauma centers monitor and address mental health recovery, and there is limited evaluation and high structural variability across existing programs. More research is needed to guide efforts to establish such programs and to inform national standards and recommendations.
This article describes patient engagement in a stepped-care service to address patients' mental health needs. Trauma-activation patients admitted to our Level I trauma center for at least 24 hours were approached before discharge. Patients were provided education in person at the bedside (step 1), symptom monitoring via a 30-day text-messaging tool (step 2), telephone screening approximately 30 days post injury (step 3), and, when appropriate, mental health treatment referrals and treatment (step 4).
We approached and educated 1,122 patients (56%) on the floor during a 33-month period. Of these, 1,096 patients (98%) enrolled in our program and agreed to 30-day follow-up mental health screening. We reached 676 patients for the 30-day screen, 243 (36%) of these patients screened positive for post-traumatic stress disorder and/or depression. Most of the 243 patients who graduated to step 4 accepted treatment referrals (68%) or were already receiving services from a provider (7%). Home-based telemental health was preferred by 66% of patients who accepted referrals.
This work demonstrates the feasibility of an evidence-based, technology-enhanced, stepped-care intervention to address the mental health needs of trauma center patients. Strategies to reach a higher percentage of patients in follow-up are needed. We recommend trauma centers test and adopt broad-based approaches to ensure optimal long-term patient outcomes.
在美国创伤中心接受治疗的超过 40 万名成年人（≥20%）中，每年有超过 40 万人在受伤后的第一年出现创伤后应激障碍、抑郁症或两者兼有。然而，很少有创伤中心监测和解决心理健康康复问题，并且现有方案的评估和结构差异很大。需要更多的研究来指导建立这些方案的努力，并为国家标准和建议提供信息。
本文描述了患者参与阶梯式护理服务以满足其心理健康需求的情况。创伤激活患者在我们的一级创伤中心至少住院 24 小时后，在出院前进行了接触。患者在床边接受了个人教育（第 1 步），通过 30 天的短信工具进行了症状监测（第 2 步），大约在受伤后 30 天进行了电话筛查（第 3 步），并且在适当的情况下，提供了心理健康治疗转诊和治疗（第 4 步）。
在 33 个月期间，我们在病房接触并教育了 1122 名患者（56%）。其中，1096 名患者（98%）参加了我们的项目并同意进行 30 天的心理健康随访筛查。我们对 676 名患者进行了 30 天的筛查，其中 243 名（36%）筛查出创伤后应激障碍和/或抑郁症阳性。在进入第 4 步的 243 名患者中，大多数（68%）接受了治疗转诊或已经接受了提供者的服务（7%）。接受转诊的患者中有 66%更喜欢家庭为基础的远程心理健康服务。
这项工作证明了一种基于证据的、增强技术的、阶梯式护理干预措施的可行性，以满足创伤中心患者的心理健康需求。需要采取策略来提高更多患者的随访率。我们建议创伤中心测试并采用广泛的方法，以确保患者获得最佳的长期预后。
