Delphi consensus on aftercare resources and processes to support burn survivors transitioning to community living

Remarkable improvements in burn care in recent decades have improved survival rates; however, these accomplishments have not been matched by efforts to address long-term health care needs and community reintegration following burn injury. The multiple sequelae of burn injury have a profound impact on most aspects of a person’s life. There is an urgent need to provide resources and support to manage the complex array of physical and psychosocial issues experienced by persons living with burn injury. Several studies indicate that effective follow-up interventions can help mitigate these complex issues. A recent qualitative study by Dr. Kazis compared post-acute physical rehabilitation and mental health care across thirteen countries on six continents and findings support investing in a range of low-cost interventions to improve follow-up burn care. Study findings acknowledge the need to upgrade and standardize clinical practice to address burn survivors’ unmet post-discharge needs and recommend training in post-acute rehabilitation and mental health. A study investigating the effects of a post-discharge intervention comprised of home visits, telenursing, and referral to specialists or health education centers demonstrated significant improvements in health status, psychological status, and scar management, with continued care required for pain, psychological health, and itching problems. Burn survivors report interest in receiving support services but have trouble accessing resources. Approximately one-third of burn survivors want to be involved in a support program; however, only one-half of interested survivors participated in a program noting that distance and awareness of available programs were primary barriers to participation. Studies also demonstrate disparities in long-term physical and psychosocial outcomes of burn survivors related to geography and insurance status, which was also confirmed in pilot focus group discussions conducted by our team. Uninsured patients were less likely to receive post-discharge resources, resulting in poor long-term outcomes status. A qualitative study of ‘blind spots’ in burn aftercare noted variability of care, lack of structurally embedded processes and failure to implement best-practices. Improving resources and support provided to persons with burn injury as they transition to living in the community is critically important. The overarching aim of this study is to improve resources and support provided to persons with burn injury as they re-enter their communities. The study aims to engage stakeholders to reach consensus on recommended resources and optimal processes to support burn survivors after discharge as they reintegrate into their community.