一个临床决策支持工具的随机试点,以增加阿片类药物使用障碍的有风险的初级保健患者的自杀查
Rebecca C Rossom1, A Lauren Crain1, Gavin Bart2
1HealthPartners Institute, Minneapolis, Minnesota.
AJPM focus
|November 28, 2024
概括
临床决策支持提示并没有增加阿片类药物使用障碍患者的自杀风险评估. 需要更有效的干预措施来改善对高风险人群的查和护理.
科学领域:
- 主要护理是指初级护理.
- 临床决策支持 临床决策支持
- 心理健康整合精神健康整合
背景情况:
- 患有阿片类药物使用障碍 (OUD) 的人面临明显增加的自杀风险.
- 系统的自杀风险查很少在OUD患者的初级保健中实施.
- 将心理健康评估整合到日常护理中,对于有风险的人群至关重要.
研究的目的:
- 评估针对性临床决策支持 (CDS) 提示对结构化自杀风险评估完成的影响.
- 评估CDS警报的有效性,促使临床医生在患有或有OUD风险的患者中查自杀风险.
- 为了确定增强提示是否有助于使用哥伦比亚自杀严重性评级表 (C-SSRS).
主要方法:
- 采用了一个集群随机控制的实用试点研究设计.
- 成年初级保健患者 (18-75岁) 患有或有OUD,阿片类药物过量服用和自杀风险.
- 干预诊所收到CDS警报和手册,建议高风险患者完成C-SSRS;对照诊所没有收到自杀风险警报.
主要成果:
- 干预组 (20.3%) 和对照组 (17.4%) 的C-SSRS完成率没有显著差异 (p=0.70).
- 平均随访时间为249天.
- 大多数C-SSRS得分 (71%-75%) 表示没有自杀风险.
结论:
- 针对性的CDS提示并没有提高OUD患者在初级保健中完成结构化自杀风险评估.
- 目前的干预措施可能不足以显著增加自杀风险查的采用率.
- 进一步研究更强大的策略是必要的,以改善初级保健机构的自杀风险评估.
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