Horrocks Matthew, Michail Maria, Aubeeluck Aimee, Wright Nicola, Morriss Richard
Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.
JMIR Res Protoc. 2018 Dec 7;7(12):e11135. doi: 10.2196/11135.
Suicide is a global public health concern, but it is preventable. Increased contact with primary care before the suicide or attempted suicide raises opportunities for intervention and prevention. However, suicide assessment and management are areas that many general practitioners (GPs) find particularly challenging. Previous research has indicated significant variability in how GPs understand, operationalize, and assess suicide risk, which subsequently has an impact on clinical decision making. Clinical decision support systems (CDSS) have been widely implemented across different health care settings, including primary care to support practitioners in clinical decision making. A CDSS may reduce inconsistencies in the identification, assessment, and management of suicide risk by GPs by guiding them through the consultation and generating a risk assessment plan that can be shared with a service user or with specialized mental health services.
Our aim is to co-develop and test with end users (eg, GPs, primary care attendees, mental health professionals) an electronic clinical decision support system (e-CDSS) to support GPs in the identification, assessment, and management of suicidality in primary care.
Ours is an ongoing embedded mixed-methods study with four phases: (1) qualitative interviews with GPs to explore their views on the content, format, and use of the e-CDSS, as well as consultation with two service-user advisory groups (people aged ≤25 and people aged ≥25) to inform the content of the e-CDSS including phrasing of items and clarity; (2) participatory co-production workshops with GPs, service users, and clinical experts in suicidality to determine the content and format of the e-CDDS; gain consensus of the relevance of items; establish content validity and identify pathways to implementation, using the Consolidated Framework for Implementation Research; (3) building the e-CDSS so that it guides the GP through a consultation; and (4) usability testing of the e-CDSS with GPs and service users in one primary care practice involving a nonlive and a live stage.
The study was funded for four years, to take place between 2015 and 2019, and is currently completing phase 4 data collection. The first results are expected to be submitted for publication in June 2019. The findings will enable us to evaluate the feasibility, acceptability, and usability of a suicide-specific, electronic, guided decision support system in primary care.
This study will be the first to explore the feasibility, acceptability, and usability of an electronic, guided decision support system for use in primary care consultations for the improved assessment and management of suicidality.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/11135.
自杀是一个全球公共卫生问题，但它是可以预防的。在自杀或自杀未遂之前增加与初级保健的接触会增加干预和预防的机会。然而，自杀评估和管理是许多全科医生（GP）认为特别具有挑战性的领域。先前的研究表明，全科医生在理解、实施和评估自杀风险方面存在显著差异，这随后会影响临床决策。临床决策支持系统（CDSS）已在包括初级保健在内的不同医疗环境中广泛实施，以支持从业者进行临床决策。CDSS可以通过在会诊过程中指导全科医生并生成可与服务使用者或专业心理健康服务机构共享的风险评估计划，减少全科医生在自杀风险识别、评估和管理方面的不一致性。
我们的目标是与最终用户（如全科医生、初级保健就诊者、心理健康专业人员）共同开发并测试一个电子临床决策支持系统（e-CDSS），以支持全科医生在初级保健中识别、评估和管理自杀倾向。
我们正在进行一项嵌入式混合方法研究，分为四个阶段：（1）对全科医生进行定性访谈，以探讨他们对e-CDSS的内容、格式和使用的看法，并与两个服务使用者咨询小组（年龄≤25岁的人和年龄≥25岁的人）进行协商，以确定e-CDSS的内容，包括项目措辞和清晰度；（2）与全科医生、服务使用者和自杀倾向临床专家共同参与制作研讨会，以确定e-CDDS的内容和格式；就项目的相关性达成共识；利用实施研究综合框架建立内容效度并确定实施途径；（3）构建e-CDSS，使其在会诊过程中指导全科医生；（4）在一个初级保健机构中，与全科医生和服务使用者对e-CDSS进行可用性测试，包括非实时和实时阶段。
该研究获得了为期四年的资助，于2015年至2019年进行，目前正在完成第4阶段的数据收集。预计第一批结果将于2019年6月提交发表。这些发现将使我们能够评估一个针对自杀的电子引导决策支持系统在初级保健中的可行性、可接受性和可用性。
本研究将首次探索一种电子引导决策支持系统在初级保健会诊中用于改善自杀倾向评估和管理的可行性、可接受性和可用性。
国际注册报告识别号（IRRID）：RR1-10.2196/11135。
