Rebecca Musgrove, Matthew J Carr, Nav Kapur, Carolyn A Chew-Graham, Faraz Mughal, Darren M Ashcroft, Roger T Webb
{"title":"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。","authors":"Rebecca Musgrove, Matthew J Carr, Nav Kapur, Carolyn A Chew-Graham, Faraz Mughal, Darren M Ashcroft, Roger T Webb","doi":"10.3399/BJGPO.2023.0165","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Evidence is sparse regarding service usage and the clinical management of people recently discharged from inpatient psychiatric care who die by suicide.</p><p><strong>Aim: </strong>To improve understanding of how people discharged from inpatient mental health care are supported by primary care during this high-risk transition.</p><p><strong>Design & setting: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>Over 40% of patients who died within 2 weeks and 80% who died later had at least one primary care consultation. 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 two weeks of discharge, AOR 0.61 (0.42-0.89), more likely to consult in the week before death, AOR 1.71 (1.36-2.15), to be prescribed multiple types of psychotropic medication, (AOR 1.73, 1.28-2.33), to experience readmission and have a diagnosis outside of the 'Severe Mental Illness' definition.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5000,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Primary care contact, clinical management and suicide risk following discharge from inpatient mental health care.\",\"authors\":\"Rebecca Musgrove, Matthew J Carr, Nav Kapur, Carolyn A Chew-Graham, Faraz Mughal, Darren M Ashcroft, Roger T Webb\",\"doi\":\"10.3399/BJGPO.2023.0165\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Evidence is sparse regarding service usage and the clinical management of people recently discharged from inpatient psychiatric care who die by suicide.</p><p><strong>Aim: </strong>To improve understanding of how people discharged from inpatient mental health care are supported by primary care during this high-risk transition.</p><p><strong>Design & setting: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>Over 40% of patients who died within 2 weeks and 80% who died later had at least one primary care consultation. 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 two weeks of discharge, AOR 0.61 (0.42-0.89), more likely to consult in the week before death, AOR 1.71 (1.36-2.15), to be prescribed multiple types of psychotropic medication, (AOR 1.73, 1.28-2.33), to experience readmission and have a diagnosis outside of the 'Severe Mental Illness' definition.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":36541,\"journal\":{\"name\":\"BJGP Open\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2024-06-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BJGP Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3399/BJGPO.2023.0165\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PRIMARY HEALTH CARE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJGP Open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3399/BJGPO.2023.0165","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PRIMARY HEALTH CARE","Score":null,"Total":0}
Primary care contact, clinical management and suicide risk following discharge from inpatient mental health care.
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: Over 40% of patients who died within 2 weeks and 80% who died later had at least one primary care consultation. 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 two weeks of discharge, AOR 0.61 (0.42-0.89), more likely to consult in the week before death, AOR 1.71 (1.36-2.15), to be prescribed multiple types of psychotropic medication, (AOR 1.73, 1.28-2.33), to 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.