title: Provider perceptions of patient psychosocial needs after orofacial injury.
abstract: OBJECTIVE
  Vulnerable populations are at particular risk for developing psychosocial sequelae after they experience orofacial injury. To enhance understanding of awareness, perspectives, and beliefs regarding attendant psychosocial issues, surgeons who provide orofacial injury care to indigent patients were surveyed.
  
  
  METHODS
  We surveyed 26 oral and maxillofacial surgeons and 15 otolaryngology surgeons at a large, urban, Level 1 trauma center. The survey, which measured providers' perceptions of pertinent contextual elements and patients' psychosocial needs after assaultive orofacial injury, was based on semistructured interviews with 15 oral and maxillofacial surgeons. The overall survey response rate was 85.4% (35 of 41).
  
  
  RESULTS
  Respondents ranked interpersonal violence as the dominant cause of orofacial injury among patients. Anxiety (eg, post-traumatic stress), depression, and legal issues were the most significant psychosocial sequelae identified by respondents. Alcohol abuse, drug abuse, and homelessness were identified as the most important contributors to orofacial reinjury and patient noncompliance with postsurgical instructions. Less than half of respondents (44.7%) believed that patients' problems with depression, anxiety, or substance abuse were currently addressed in an adequate way in the hospital. The vast majority (94.7%) believed that a psychosocial aftercare program was needed, and most agreed that such a program would decrease the risk of reinjury and would promote patient compliance with aftercare instructions and return for scheduled follow-up care. Respondents identified the specialty mental health service in their hospital or a community-based setting as the preferred locations for such a program, and they indicated that lack of financial resources and trained personnel were the most significant barriers to implementation of such a program within the setting of trauma services.
  
  
  CONCLUSIONS
  Surgeons who provide care to indigent patients with orofacial injury perceive a great need for psychosocial aftercare programs for patients, and they believe that such programs could reduce the risk of reinjury and promote patient compliance.
authors.affiliation: RAND Corporation, Santa Monica, CA 90407, USA. zazzali@rand.org
authors.forename: James L
authors.initials: JL
authors.lastname: Zazzali
authors.forename: Grant N
authors.initials: GN
authors.lastname: Marshall
authors.forename: Vivek
authors.initials: V
authors.lastname: Shetty
authors.forename: Dennis-Duke R
authors.initials: DD
authors.lastname: Yamashita
authors.forename: Uttam K
authors.initials: UK
authors.lastname: Sinha
authors.forename: Nadine R
authors.initials: NR
authors.lastname: Rayburn
mesh_terms: D001291:Attitude of Health Personnel; D003625:Data Collection; D003866:Depressive Disorder / Q000209:etiology / Q000628:therapy; D006297:Health Services Accessibility; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D008446:Maxillofacial Injuries / Q000150:complications / Q000523:psychology* / Q000601:surgery; D008489:Medical Indigency; D008605:Mental Health Services; D020380:Needs Assessment; D019647:Oral Surgical Procedures; D010036:Otolaryngology; D010347:Patient Care Planning; D018570:Risk Assessment; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000628:therapy; D014193:Trauma Centers; D014754:Violence; D035862:Vulnerable Populations