Discharge from the trauma centre: exposure to opioids, unmet information needs and lack of follow up—a qualitative study among physical trauma survivors

Abstract

Background Physical trauma is associated with mortality, long-term pain and morbidity. Effective pain management is fundamental in trauma care and opioids are indispensable for treating acute pain; however, the use and misuse of prescribed opioids is an escalating problem. Despite this, few studies have been directed towards trauma patients in an early phase of rehabilitation with focusing on experiences and perspectives of health and recovery including pain and persistent use of prescribed opioids with abuse potential. To explore pre- and post-discharge trauma care experiences, including exposure to opioids, physical trauma survivors were recruited from a major trauma centre in Norway that provides the highest level of surgical trauma care. Method Qualitative exploratory study. Individual semi-structured interviews were conducted among 13 trauma patients with orthopedic injuries, known to be associated with severe pain, six weeks post-discharge. The interviews were recorded, transcribed verbatim, and thematically analyzed with an interdisciplinary approach. Results The overarching theme was that discharge from the trauma centre and the period that immediately followed were associated with feelings of insecurity. The three main themes that were identified as contributing to this was (a) unmet information needs about the injury, (b) exposure to opioids, and (c) lack of follow-up after discharge from the hospital. Participants experienced to be discharged with prescribed opioids, but without information about their addictive properties or tapering plans. This, and lack of attention to mental health and psychological impact of trauma, gave rise to unmet treatment needs of pain management and mental health problems during hospitalization and following discharge. Conclusion The findings from this study suggest that in addition to delivery of high-quality biomedical trauma care, health professionals should direct more attention to psychosocial health and safe pain management, including post-discharge opioid tapering and individually tailored follow-up plans for physical trauma survivors.

Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization

“…A recent study interviewing 13 patients with orthopedic trauma identified the theme of insecurity after discharge due to unmet information needs about their injury and its expected effect on their physical function, about the psychological reaction to trauma, and about opioid side effects and tapering. 26 These patients also noted lack of follow-up after discharge from the trauma center as a concern. Zatzick et al tested two models of care seeking to improve the postdischarge experience of patients with trauma—identification of patient concerns prior to discharge followed by either a care management program or nurse notification of the concerns.…”

“…These findings contribute to a scarce literature about the experience of patients with trauma in the inpatient to outpatient care transition. A recent study interviewing 13 patients with orthopedic trauma identified the theme of insecurity after discharge due to unmet information needs about their injury and its expected effect on their physical function, about the psychological reaction to trauma, and about opioid side effects and tapering 26. These patients also noted lack of follow-up after discharge from the trauma center as a concern.…”

A qualitative longitudinal study of traumatic orthopaedic injury survivors’ experiences with pain and the long-term recovery trajectory

“…While nearly 1.3 million people suffer a fatal outcome from road traffic accidents every year, between 20 and 50 million individuals survive and live with permanent or temporary disabilities 3. Furthermore, as medical technology and trauma system improvements have reduced trauma-related mortality,4 5 an increased interest has been directed towards injury survivors and the challenges they experience following hospital discharge 6–9…”

Outpatient mental health service use in major trauma survivors: A population-based cohort study from Ontario, Canada

“…Major trauma survivors face many challenges as they recover, including persisting pain, disability, financial stress, social difficulties, and poor mental health. [1][2][3][4][5][6][7] While many patients eventually retain a near baseline level of function, other patients are plagued by ongoing and complex psychosocial and physical challenges that can disrupt their life for years after injury, leading some to suggest that major trauma be considered a chronic disease. 8,9 Little is known about the psychosocial recovery trajectories of major trauma survivors.…”

“…Although nearly 87% of patients who experience a major injury survive, the patient's recovery is often far from over at hospital discharge. Major trauma survivors face many challenges as they recover, including persisting pain, disability, financial stress, social difficulties, and poor mental health 1–7 . While many patients eventually retain a near baseline level of function, other patients are plagued by ongoing and complex psychosocial and physical challenges that can disrupt their life for years after injury, leading some to suggest that major trauma be considered a chronic disease 8,9 …”