Article

OBJECTIVES: 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. DESIGN: Multicenter, prospective observational study.
SETTING: Eight level I trauma centers. PARTICIPANTS: Patients (N=545) undergoing
lower-extremity reconstruction or amputation from March 1994 to June 1997.
INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Perceived need and unmet
need for support services at 3, 6, and 12 months after hospitalization. RESULTS:
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. CONCLUSIONS: 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.

Langue : ANGLAIS