BackgroundIn the UK, studies suggest that the transition from hospital to home after an injury can be a difficult time and many patients report feeling inadequately prepared. Patients often use primary care services after hospital discharge. These consultations provide opportunities to consider problems that patients experience and to facilitate recovery. Little is known, however, about how patients and service providers view care after hospital discharge and the role played by primary care services, specifically GPs. AimTo identify good practice and unmet needs in respect of post-discharge support for injured patients. Design and settingQualitative study using semi-structured interviews at four sites (Bristol, Leicester/ Loughborough, Nottingham, and Surrey). MethodQualitative interviews with 40 service providers and 45 hospitalised injured patients. ResultsAlthough there were examples of wellmanaged hospital discharges, many patients felt they were not provided with the information they needed about their injury, what to expect in terms of recovery, pain control, return to work, psychological problems, and services to help meet their needs. They also described difficulty accessing services such as physiotherapy or counselling. Service providers identified problems with communication between secondary and primary care, lack of access to physiotherapy, poor communication about other services that may help patients, GP service and resource constraints, and difficulties in providing information to patients concerning likely prognosis. ConclusionDischarge from hospital after an injury can be problematic for patients. Changes in both secondary and primary care are required to resolve this problem.

PurposeUnintentional injuries have a significant long-term health impact in working age adults. Depression, anxiety and post-traumatic stress disorder are common post-injury, but their impact on self-reported recovery has not been investigated in general injury populations. This study investigated the role of psychological predictors 1 month post-injury in subsequent self-reported recovery from injury in working-aged adults.MethodsA multicentre cohort study was conducted of 668 unintentionally injured adults admitted to five UK hospitals followed up at 1, 2, 4 and 12 months post-injury. Logistic regression explored relationships between psychological morbidity 1 month post-injury and self-reported recovery 12 months post-injury, adjusting for health, demographic, injury and socio-legal factors. Multiple imputations were used to impute missing values.ResultsA total of 668 adults participated at baseline, 77% followed up at 1 month and 63% at 12 months, of whom 383 (57%) were included in the main analysis. Multiple imputation analysis included all 668 participants. Increasing levels of depression scores and increasing levels of pain at 1 month and an increasing number of nights in hospital were associated with significantly reduced odds of recovery at 12 months, adjusting for age, sex, centre, employment and deprivation. The findings were similar in the multiple imputation analysis, except that pain had borderline statistical significance.ConclusionsDepression 1 month post-injury is an important predictor of recovery, but other factors, especially pain and nights spent in hospital, also predict recovery. Identifying and managing depression and providing adequate pain control are essential in clinical care post-injury.Electronic supplementary materialThe online version of this article (doi:10.1007/s00127-016-1299-z) contains supplementary material, which is available to authorized users.

Abstract:OBJECTIVE: To explore information needs of unintentional injury patients and their carers over time, across services, and how such needs are met from the perspectives of patients, carers and service providers.METHODS: Qualitative nested study within a multi-centre longitudinal study quantifying psychosocial, physical, occupational outcomes and service use and costs following a range of unintentional injuries. Semi-structured interviews conducted with 45 patients during the first year post injury, 18 of their carers and 40 providers of services.RESULTS: Patients and carers needed information about the nature and severity of injury, prognosis, self-management and further services. Information needs changed over time with the biggest difficulties being during transfer from primary to secondary care. Barriers to information provision included service providers' time limitations and uncertainty around information provision, and patients' reluctance to ask for information or inability to process it. Suggested improvements included provision of reassurance as well as factual information, information about further services, earlier follow-up, increased appointment times and greater involvement of families where appropriate. This is an accepted manuscript of an article published by Elsevier in 'Injury' available online at http://www.sciencedirect.com/science/article/pii/S0020138314006305?via%3Dihub It is not the copy of record. Copyright © 2017, Elsevier 2 CONCLUSIONS: The information needs of patients and carers post injury change with time and there are a number of ways to remove gaps and barriers in current provision to meet such needs.PRACTICE IMPLICATIONS: Providing information on injury management, prognosis and available services and reassurance at each stage of the recovery process in secondary care and when transferring to primary care would be helpful for patients and carers. A follow-up contact soon after discharge and the opportunity to ask questions could be beneficial. Better information about the patient's needs and ways they can help could help carers fulfil their caring role.

Purpose To demonstrate the impact of psychological morbidity 1 month post-injury on subsequent post-injury quality of life (HRQoL) in a general injury population in the UK to inform development of trauma care and rehabilitation services.Methods Multicentre cohort study of 16–70-year-olds admitted to 4 UK hospitals following injury. Psychological morbidity and HRQoL (EQ-5D-3L) were measured at recruitment and 1, 2, 4 and 12 months post-injury. A reduction in EQ-5D compared to retrospectively assessed pre-injury levels of at least 0.074 was taken as the minimal important difference (MID). Multilevel logistic regression explored relationships between psychological morbidity 1 month post-injury and MID in HRQoL over the 12 months after injury.ResultsA total of 668 adults participated. Follow-up rates were 77% (1 month) and 63% (12 months). Substantial reductions in HRQoL were seen; 93% reported a MID at 1 month and 58% at 12 months. Problems with pain, mobility and usual activities were commonly reported at each time point. Depression and anxiety scores 1 month post-injury were independently associated with subsequent MID in HRQoL. The relationship between depression and HRQoL was partly explained by anxiety and to a lesser extent by pain and social functioning. The relationship between anxiety and HRQoL was not explained by factors measured in our study.ConclusionsHospitalised injuries result in substantial reductions in HRQoL up to 12 months later. Depression and anxiety early in the recovery period are independently associated with lower HRQoL. Identifying and managing these problems, ensuring adequate pain control and facilitating social functioning are key elements in improving HRQoL post-injury.Electronic supplementary materialThe online version of this article (doi:10.1007/s11136-016-1439-7) contains supplementary material, which is available to authorized users.

BackgroundThe benefits of work for physical, psychological, and financial wellbeing are well documented. Return to work (RTW) after unintentional injury is often delayed, and psychological morbidity may contribute to this delay. The impact of psychological morbidity on RTW after a wide range of unintentional injuries in the UK has not been adequately quantified. AimTo quantify the role of psychological factors, including anxiety, depression, and post-traumatic distress, on RTW following unintentional injuries. Design and settingA longitudinal multicentre prospective study was undertaken in Nottingham, Bristol, Leicester, and Guildford, UK. MethodParticipants (n = 273) were 16-69-year-olds admitted to hospital following unintentional injury, who were in paid employment prior to injury. They were surveyed at baseline, then at 1, 2, 4, and 12 months following injury; demographic data were collected along with injury characteristics, psychological morbidity, and RTW status. Associations between demographic, injury and psychological factors, and RTW between 2 and 12 months after injury were quantified using random effects logistic regression.