Table 5

Facilitators and challenges the PA interventionist reported in implementing the support program

Facilitators
Patient level
Patient receptivityPatients were receptive and appreciative of post-trauma hospitalization follow-up.
Provider level
Use of provider delegatesAbility to deliver intervention to PCP delegates provided the opportunity to reach PCPs indirectly.
Provider/delegate receptivityProviders and their delegates were generally receptive to the intervention.
Challenges
Patient level
COVID-19

  • PA was not able to develop rapport through a first in-person visit with the patient.

  • Patients were less likely to follow-up with their PCP due to COVID-19 concerns (eg, telehealth only, limited hours).

PA availabilityPA was not available 24/7, so often did not reach patient prior to discharge. Reaching patients after discharge could be challenging.
Many patients did not plan to follow-up with PCP.

  • The intervention was with the PCP, so if the patient did not plan to see their PCP, there would be no opportunity to benefit from the intervention.

  • Patients had various reasons they did not plan to follow-up with the PCP (eg, planning follow-up at trauma center, lack of understanding of PCP role in post-trauma hospitalization care, competing priorities at home such as child with OUD or spouse entering hospice).

Provider level
COVID-19Providers were less available for the intervention due to factors such as the busyness of COVID-19, abbreviated hours, reduced staff.
PA availabilityThe PA interventionist was not always available and could miss provider call back for consultation.
Providers hard to reachThere was often no provider back line, or the provider had left the practice.
PA concerns

  • The PA found it challenging to discuss a different care plan from the one that the provider had already offered the patient (eg, opioid prescribing from more than one provider).

  • The PA was concerned that the providers might think the trauma hospital was trying to provide oversight of patient care.

  • OUD, opioid use disorder; PA, physician assistant; PCP, primary care provider.