一般实践患者在自杀尝试前后的护理：佛兰芒一般实践中的观察性研究。

Care of general practice patients preceding and following a suicide attempt: observational study in Flemish general practices.

机构信息

Epidemiology and Public Health, Sciensano, Brussels, Belgium.

出版信息

BMJ Open. 2019 May 5;9(5):e028546. doi: 10.1136/bmjopen-2018-028546.

DOI:10.1136/bmjopen-2018-028546

PMID:31061060

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6501981/

Abstract

OBJECTIVES

First, to examine general practitioner (GP) knowledge about the care (needs) of their patients; second, to examine the quality of GP follow-up care; third, to examine the transmission of patient care information from hospitals/emergency services (ES) to GPs.

SETTING

105 general practices from the representative Belgian Network of Sentinel General Practices (SGP) in Flanders, the largest region of Belgium, during 2013-2016.

PARTICIPANTS

245 suicide attempts by regular patients.

OUTCOMES MEASURES

Ten care-related measures, including three indicators of quality of follow-up care, were based on data reported by the SGP on structured forms at baseline and at two follow-up points in time.

RESULTS

As for GP knowledge, 10.5% of SGP failed to report whether suicidal risk was noticed in patients seen in the month preceding the attempt; 9.0% whether there were previous attempts; 22.5% whether the patient was receiving mental health treatment at follow-up and 22.0% whether suicidal behaviour was repeated at follow-up. Relatively more patients≥65 years had no suicide risk evaluation (OR 3.54; 95% CI 1.11 to 11.26). As for quality of follow-up care, there was a GP-patient contact following 90.5% of the attempts, follow-up appointments were planned following 43.4% of the attempts and there was a GP contact with patient proxies following 62.8% of the attempts. Patient age ≥65 years (OR 4.09; 95% CI 1.79 to 9.33), a recent GP-patient contact preceding the attempt (OR 1.97; 95% CI 1.13 to 3.43), depression of patient (OR 1.96; 95% CI 1.14 to 3.37) and a suburban SGP area (OR 2.34; 95% CI 1.13 to 4.82) were determinants of an increased quality of care sum. GPs received patient care information from a hospital (ES) for 67.8% of eligible attempts, with SGP practice location being a determinant.

CONCLUSIONS

GPs are highly involved in the care of suicide attempters but there is room for improvement, also in informational continuity from hospital (ES) to GPs.

摘要

目的

首先，调查全科医生（GP）对患者护理（需求）的了解情况；其次，调查 GP 后续护理的质量；第三，调查从医院/急诊服务（ES）向全科医生传递患者护理信息的情况。

背景

2013 年至 2016 年，在代表比利时佛兰德斯的比利时网络哨兵全科医生（SGP）的 105 家全科医生诊所中，对 245 名常规患者的自杀未遂事件进行了调查。

参与者

245 名自杀未遂的常规患者。

结果

关于 GP 知识，有 10.5%的 SGP 未能报告在尝试前一个月是否注意到患者存在自杀风险；9.0%的 SGP 未能报告是否有过自杀尝试；22.5%的 SGP 未能报告患者在随访时是否正在接受心理健康治疗，22.0%的 SGP 未能报告自杀行为在随访时是否重复。年龄≥65 岁的患者中，自杀风险评估未做的比例相对较高（OR3.54；95%CI1.11 至 11.26）。在后续护理质量方面，90.5%的自杀未遂事件后有 GP-患者接触，43.4%的自杀未遂事件后有后续预约，62.8%的自杀未遂事件后有 GP 与患者代理人接触。患者年龄≥65 岁（OR4.09；95%CI1.79 至 9.33）、尝试前最近一次 GP-患者接触（OR1.97；95%CI1.13 至 3.43）、患者抑郁（OR1.96；95%CI1.14 至 3.37）和郊区 SGP 地区（OR2.34；95%CI1.13 至 4.82）是护理质量总分增加的决定因素。全科医生从医院（ES）收到了 67.8%符合条件的尝试的患者护理信息，SGP 诊所位置是一个决定因素。