General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial
General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial
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基于一般实践的干预措施，以防止故意自残的重复发作：整群随机对照试验
DOI：
10.1136/bmj.324.7348.1254
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发表时间：
2002
期刊：
影响因子：
--
通讯作者：
D. Sharp
中科院分区：
文献类型：
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作者：
Olive Bennewith;N. Stocks;D. Gunnell;T. Peters;M. Evans;D. Sharp
摘要 目的：评估基于一般实践的干预措施对故意自残重复发作的发生率的影响。设计：整群随机对照试验，其中 98 个全科医生被同等数量地分配到干预组或对照组。干预措施包括全科医生邀请患者咨询的一封信，以及全科医生在咨询时使用的评估和管理故意自残的指南。对照患者接受常规全科医生护理。地点：雅芳、威尔特郡和萨默塞特卫生当局的一般医疗机构，其患者居住在布里斯托尔和巴斯的四家综合医院的服务范围内。参与者：1932 名在研究实践中注册的患者，他们在发生故意自残事件后前往四家医院之一的急诊科就诊。主要结局指标：主要结局是在首次发作后 12 个月内重复发生故意自残。次要结果是重复发作的次数和首次重复的时间。结果：与对照组相比，干预组患者故意自残重复发作的发生率没有显着差异（比值比 1.2，95% 置信区间 0.9 至 1.5）。对于重复发作次数和首次重复时间也获得了类似的结果。亚组分析表明，根据患者性别（P=0.51）或造成故意自残的方法（P=0.64），干预措施没有差异。该治疗似乎对有故意自残史的人有益，但对于首次发作的人来说，它会产生不良影响（交互作用 P=0.017）。结论：全科医生向故意伤害自己的患者发出咨询邀请，以及在随后的咨询中使用管理指南并没有减少重复自残的发生率。一项亚组分析表明，之前曾伤害过自己的患者从干预中受益，这与之前的证据不一致，应谨慎对待。需要更多的研究来了解如何管理故意伤害自己的患者，以减少重复发作的发生率。关于这个主题的已知信息 大约三分之二的患者在故意自残事件发生后的三个月内咨询其全科医生 之前没有针对旨在减少故意自残重复发作发生率的全科医学干预措施进行大规模随机对照试验 本研究补充的内容 包括邀请患者全科医生会诊以及在随后的咨询中使用评估和管理故意自残指南的干预措施不会降低故意自残重复发作的发生率
Abstract Objectives: To evaluate the impact of an intervention based in general practice on the incidence of repeat episodes of deliberate self harm. Design: Cluster randomised controlled trial in which 98 general practices were assigned in equal numbers to an intervention or a control group. The intervention comprised a letter from the general practitioner inviting the patient to consult, and guidelines on assessment and management of deliberate self harm for the general practitioner to use in consultations. Control patients received usual general practitioner care. Setting: General practices within Avon, Wiltshire, and Somerset Health Authorities, whose patients lived within the catchment area of four general hospitals in Bristol and Bath. Participants: 1932 patients registered with the study practices who had attended accident and emergency departments at one of the four hospitals after an episode of deliberate self harm. Main outcome measures: Primary outcome was occurrence of a repeat episode of deliberate self harm in the 12 months after the index episode. Secondary outcomes were number of repeat episodes and time to first repeat. Results: The incidence of repeat episodes of deliberate self harm was not significantly different for patients in the intervention group compared with the control group (odds ratio 1.2, 95% confidence interval 0.9 to 1.5). Similar findings were obtained for the number of repeat episodes and time to first repeat. Subgroup analyses indicated that there was no differential effect of the intervention according to patient's sex (P=0.51) or method used to cause deliberate self harm (P=0.64). The treatment seemed to be beneficial for people with a history of deliberate self harm, but it was associated with an adverse effect in people for whom the index episode was their first episode (interaction P=0.017). Conclusions: An invitation to consult, sent by the general practitioner of patients who have deliberately harmed themselves, and the use of management guidelines during any subsequent consultation did not reduce the incidence of repeat self harm. A subgroup analysis that indicated that patients who had previously harmed themselves benefited from the intervention was inconsistent with previous evidence and should be treated with caution. More research is needed on how to manage patients who deliberately harm themselves, to reduce the incidence of repeat episodes. What is already known on this topic About two thirds of patients consult their general practitioner in the three months after an episode of deliberate self harm There have been no previous large scale randomised controlled trials of general practice based interventions aimed at reducing the incidence of repeat episodes of deliberate self harm What this study adds An intervention comprising an invitation to consult from a patient's general practitioner and by the use of guidelines for the assessment and management of deliberate self harm in a subsequent consultation does not reduce the incidence of repeat episodes of deliberate self harm