Research department, 113 Suicide prevention, Amsterdam, The Netherlands.
Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
PLoS One. 2020 Nov 30;15(11):e0242540. doi: 10.1371/journal.pone.0242540. eCollection 2020.
In health systems with strongly developed primary care, such as in the Netherlands, effectively engaging primary care professionals (PCPs) in suicide prevention is a key strategy. As part of the national Suicide Prevention Action Network (SUPRANET), a program was offered to PCPs in six regions in the Netherlands in 2017-2018 to more effectively engage them in suicide prevention. This implementation study aimed to evaluate to what extent SUPRANET was helpful in supporting PCPs to apply suicide prevention practices. From March to May 2018, 21 semi-structured interviews have been carried out with PCPs and other non-clinical professionals from SUPRANET regions in the Netherlands. Verbatim transcripts were analysed using the grounded theory approach. Data was structured using the Consolidated Framework for Implementation Research, which enabled identifying facilitating and challenging factors for PCPs to carry out suicide prevention practices. An important challenge included difficulties in assessing suicide risk (intervention characteristics) due to PCPs' self-perceived incompetence, burdensomeness of suicide and limited time and heavy workload of PCPs. Another important limitation was collaboration with mental health care (outer setting), whereas mental health nurses (inner setting) and SUPRANET (implementation process) were facilitating factors for applying suicide prevention practices. With regard to SUPRANET, especially the training was positively evaluated by PCPs. PCPs expressed a strong need for improving collaboration with specialized mental health care, which was not provided by SUPRANET. Educating PCPs on suicide prevention seems beneficial, but is not sufficient to improve care for suicidal patients. Effective suicide prevention also requires improved liaison between mental health services and primary care, and should therefore be the focus of future suicide prevention strategies aimed at primary care.
在初级保健高度发达的卫生系统中，例如荷兰，有效地让初级保健专业人员（PCP）参与预防自杀是一项关键策略。作为国家预防自杀行动网络（SUPRANET）的一部分，2017-2018 年，荷兰六个地区的 PCP 提供了一个方案，以更有效地让他们参与预防自杀。本实施研究旨在评估 SUPRANET 在多大程度上有助于支持 PCP 应用预防自杀的做法。2018 年 3 月至 5 月，对来自荷兰 SUPRANET 地区的 21 名 PCP 及其他非临床专业人员进行了 21 次半结构化访谈。使用扎根理论方法分析逐字记录。使用实施研究综合框架对数据进行结构化，这使我们能够确定 PCP 实施预防自杀做法的促进和挑战因素。一个重要的挑战包括由于 PCP 自我感知的能力不足、自杀的负担和有限的时间以及 PCP 的工作量繁重，导致评估自杀风险（干预特征）的困难。另一个重要的限制是与精神卫生保健的合作（外部环境），而精神卫生护士（内部环境）和 SUPRANET（实施过程）是实施预防自杀做法的促进因素。就 SUPRANET 而言，PCP 对培训给予了积极评价。PCP 强烈需要改善与专门的精神卫生保健的合作，而这不是 SUPRANET 提供的。对 PCP 进行预防自杀教育似乎是有益的，但不足以改善对自杀患者的护理。有效的预防自杀还需要改善精神卫生服务与初级保健之间的联系，因此，应该成为未来旨在针对初级保健的预防自杀策略的重点。
