Fortin Gabrielle, Ligier Fabienne, Van Haaster Ian, Doyon Claude, Daneau Diane, Lesage Alain
Institut universitaire en santé mentale de Montréal Research Centre, Montreal, Quebec, Canada (Mss Fortin and Daneau, Mr Doyon, and Dr Lesage); Centre Psychothérapique de Nancy, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Laxou, Lorraine, France (Dr Ligier); Université de Lorraine, EA 4360 APEMAC, Nancy, Lorraine, France (Dr Ligier); CIUSSS de l'Est-de-l'Île-de-Montréal, CLSC St-Michel, Montreal, Quebec, Canada (Dr Van Haaster); and Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada (Dr Lesage).
Qual Manag Health Care. 2021;30(2):97-103. doi: 10.1097/QMH.0000000000000302.
In Quebec, Canada, several independent processes are in place to investigate cases of death by suicide. An enhanced multidisciplinary audit process was developed to analyze these cases more thoroughly, with the aim of generating recommendations for suicide prevention. A study was undertaken to evaluate the feasibility and implementability of this process.
The life trajectories of 14 people who died by suicide in Montreal, Canada, in 2016 were reconstructed on the basis of information retrieved by interviewing bereaved relatives and examining coroner investigation files and other records. A multidisciplinary panel that included a representative of families bereaved by suicide then reviewed case summaries to determine unmet needs and service gaps at 3 levels: individual intervention, regional programs, and the provincial health and social services system.
The feasibility of the audit process was demonstrated in the context of a public health care system. Thirty-one distinct recommendations were made variably across 13 of the 14 cases reviewed, whereas none had originally been made by the coroner. The recommendations that recurred most often were (1) improve training for professionals and educate the general public regarding depression and substance-related disorders; (2) deploy mobile crisis intervention teams from emergency departments; and (3) provide access to a family physician to all, especially men.
Although the audit produced novel recommendations and is implementable, there was resistance from physicians and their hospital mortality review committee against this multidisciplinary audit involving families. These concerns could be alleviated by having the process endorsed by provincial authorities.
在加拿大魁北克省，有多个独立程序对自杀死亡案例进行调查。为更全面地分析这些案例，制定了强化的多学科审核程序，旨在生成预防自杀的建议。开展了一项研究以评估该程序的可行性和可实施性。
根据对遗属的访谈以及对验尸官调查档案和其他记录的审查所获取的信息，重构了2016年在加拿大蒙特利尔自杀身亡的14人的生命轨迹。一个多学科小组，其中包括一名自杀遗属家庭的代表，随后审查了案例摘要，以确定在三个层面上未满足的需求和服务差距：个体干预、区域项目以及省级卫生和社会服务系统。
在公共卫生保健系统的背景下证明了审核程序的可行性。在审查的14个案例中的13个案例中，不同程度地提出了31条不同的建议，而验尸官最初均未提出这些建议。最常出现的建议是：（1）改善专业人员培训并就抑郁症和物质相关障碍对公众进行教育；（2）从急诊科部署流动危机干预小组；（3）让所有人，尤其是男性都能获得家庭医生服务。
尽管审核产生了新的建议且具有可实施性，但医生及其医院死亡率审查委员会对涉及家庭的这种多学科审核存在抵触。省级当局认可该程序可缓解这些担忧。
