Primary care contact, clinical management, and suicide risk following discharge from inpatient mental health care: a case-control study.

IF 2.5 Q2 PRIMARY HEALTH CARE
BJGP Open Pub Date : 2024-10-29 DOI:10.3399/BJGPO.2023.0165
Rebecca Musgrove, Matthew J Carr, Nav Kapur, Carolyn A Chew-Graham, Faraz Mughal, Darren M Ashcroft, Roger T Webb
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Abstract

Background: Evidence is sparse regarding service usage and the clinical management of people recently discharged from inpatient psychiatric care who die by suicide.

Aim: To improve understanding of how people discharged from inpatient mental health care are supported by primary care during this high-risk transition.

Design & setting: A nested case-control study, utilising interlinked primary and secondary care records in England for people who died within a year of discharge between 2001 and 2019, matched on age, sex, practice-level deprivation, and region with up to 20 living discharged people.

Method: We described patterns of consultation, prescription of psychotropic medication, and continuity of care for people who died by suicide and those who survived. Mutually adjusted relative risk estimates were generated for a range of primary care and clinical variables.

Results: More than 40% of patients who died within 2 weeks of discharge and >80% of patients who died within 1 year of discharge had at least one primary care consultation within the respective time periods. Evidence of discharge communication from hospital was infrequent. Within-practice continuity of care was relatively high. Those who died by suicide were less likely to consult within 2 weeks of discharge (adjusted odds ratio [AOR] 0.61 [95% confidence interval {CI} = 0.42 to 0.89]), more likely to consult in the week before death (AOR 1.71 [95% CI = 1.36 to 2.15]), be prescribed multiple types of psychotropic medication (AOR 1.73 [95% CI = 1.28 to 2.33]), experience readmission, and have a diagnosis outside of the 'severe mental illness' definition.

Conclusion: Primary care clinicians have opportunities to intervene and should prioritise patients experiencing transition from inpatient care. Clear communication and liaison between services is essential to provide timely support.

住院精神病患者出院后的初级保健接触、临床管理和自杀风险。
背景:目标:进一步了解在这一高风险过渡时期,从精神疾病住院治疗出院的患者如何获得初级医疗支持:利用英格兰相互关联的初级和二级医疗记录,对2001年至2019年期间出院后一年内死亡的患者进行嵌套病例对照研究,根据年龄、性别、医疗机构贫困程度和地区与最多20名在世的出院患者进行配对:我们描述了自杀死亡者和存活者的就诊模式、精神药物处方以及护理的连续性。结果:超过40%的患者在自杀后2个月内死亡:超过40%在两周内死亡的患者和80%在两周后死亡的患者至少接受过一次初级医疗咨询。出院沟通的证据并不常见。诊所内护理的连续性相对较高。自杀死亡者在出院后两周内就诊的可能性较低,AOR值为0.61(0.42-0.89);在死亡前一周就诊的可能性较高,AOR值为1.71(1.36-2.15);被开具多种类型精神药物的可能性较高(AOR值为1.73,1.28-2.33);再次入院的可能性较高;被诊断为 "严重精神疾病 "以外的疾病的可能性较高:结论:初级保健临床医生有机会进行干预,并应优先考虑从住院治疗转出的患者。服务机构之间的明确沟通和联系对于提供及时的支持至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BJGP Open
BJGP Open Medicine-Family Practice
CiteScore
5.00
自引率
0.00%
发文量
181
审稿时长
22 weeks
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