Boggs Jennifer M, Quintana LeeAnn M, Beck Arne, Clinch Samuel, Richardson Laura, Conley Amy, Richards Julie E, Betz Marian E
Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, United States.
Kaiser Permanente Colorado Behavioral Health Department, Denver, CO, United States.
Front Digit Health. 2022 Sep 6;4:974153. doi: 10.3389/fdgth.2022.974153. eCollection 2022.
Few patients with suicide risk are counseled on lethal means safety by health providers. This study tested the feasibility of different delivery methods for Lock to Live (L2L), a web-based decision aid of safe storage options for firearms and medications.
Patients reporting suicide ideation on the PHQ9 depression screener during outpatient health visits were included. Invitation messages to visit L2L were sent combinations of email, text, Electronic Health Record (EHR) message, mailed letter, or provider referral, followed by a survey about storage behavior and acceptability. Provider interviews evaluated logistical considerations and acceptability.
The population-based method reached 2,729 patients and the best method (EHR message plus 2 email reminders) had 11% uptake (L2L visitation rate). Provider referral had small reach (14 patients) and 100% uptake (all visited). Provider interviews identified several strategies to promote uptake including: EHR reminders, provider training, quality metrics with accountability, a clearly communicated lethal means screening/counseling policy, and strong organizational leadership support.
Despite the low uptake for population-based (11%), far more patients with suicide risk were engaged in the L2L tool through population-based outreach than provider-referral over the same time frame.
很少有存在自杀风险的患者会接受医疗服务提供者关于致死手段安全性的咨询。本研究测试了不同交付方式用于“锁护生命”（L2L）的可行性，L2L是一种基于网络的关于枪支和药物安全储存选项的决策辅助工具。
纳入在门诊健康就诊期间通过PHQ9抑郁筛查工具报告有自杀意念的患者。向患者发送访问L2L的邀请信息，采用电子邮件、短信、电子健康记录（EHR）信息、邮寄信件或提供者转诊等组合方式，随后进行关于储存行为和可接受性的调查。对提供者进行访谈以评估后勤方面的考虑因素和可接受性。
基于人群的方法覆盖了2729名患者，最佳方法（EHR信息加2次电子邮件提醒）的使用率为11%（L2L访问率）。提供者转诊的覆盖范围较小（14名患者）且使用率为100%（全部访问）。提供者访谈确定了几种促进使用的策略，包括：EHR提醒、提供者培训、有问责制的质量指标、明确传达的致死手段筛查/咨询政策以及强大的组织领导支持。
尽管基于人群的方法使用率较低（11%），但在同一时间段内，通过基于人群的外展服务参与L2L工具的存在自杀风险的患者比通过提供者转诊的要多得多。
