Clinical management following self-harm in a UK-wide primary care cohort
Clinical management following self-harm in a UK-wide primary care cohort
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DOI：
10.1016/j.jad.2016.03.013
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发表时间：
2016-06-01
影响因子：
6.6
通讯作者：
Webb, Roger T.
中科院分区：
文献类型：
--
作者：
Carr, Matthew J.;Ashcroft, Darren M.;Webb, Roger T.
背景资料：鲜为人知的是，在初级保健自我harm.Methods的患者的临床管理：一个描述性队列研究，使用数据从684英国一般的做法，有助于临床实践研究数据链（CPRD）在2001-2013年。我们确定了49，970例有自我伤害事件的患者，其中41，500例有一年的随访。62.8%（62.3-63.3）的患者使用精神药物，6318（15.2%，14.9-15.6）被转介到精神卫生服务机构; 4105（9.9%，CI 9.6-10.2）在没有预先精神病诊断或转诊的情况下接受药物治疗，（10.9%，CI 10.6-11.2）有诊断，但随后未接受药物治疗或转诊。在最贫困地区登记的患者比最贫困地区的患者转诊的可能性低27.1%（CI 21.5-32.2）。尽管2011年NICE特别标记了“不要做”的建议，反对在自残后开三环类抗抑郁药，因为它们在过量时可能具有致命毒性，但8.8%（CI 7.8-9.8）的人在随后的一年中开了处方。在2011年药品和保健品管理局（MHRA）发布安全警报后，2012/2013年期间，处方西酞普兰（一种过量使用时毒性更高的SSRI抗抑郁药）的百分比急剧下降。在这些脆弱的病人中，被转介到精神卫生服务机构的比例相对较小，在较贫困地区，转诊的可能性减少，反映出明显的健康不平等。国家临床指南尚未有效地降低这一高危人群的三环类抗抑郁药处方率。(C)2016爱思唯尔B. V.保留所有权利。
Background: Little is known about the clinical management of patients in primary care following self harm.Methods: A descriptive cohort study using data from 684 UK general practices that contributed to the Clinical Practice Research Datalink (CPRD) during 2001-2013. We identified 49,970 patients with a self harm episode, 41,500 of whom had one complete year of follow-up.Results: Among those with complete follow-up, 26,065 (62.8%, 62.3-63.3) were prescribed psychotropic medication and 6318 (15.2%, 14.9-15.6) were referred to mental health services; 4105 (9.9%, CI 9.6-10.2) were medicated without an antecedent psychiatric diagnosis or referral, and 4,506 (10.9%, CI 10.6-11.2) had a diagnosis but were not subsequently medicated or referred. Patients registered at practices in the most deprived localities were 27.1% (CI 21.5-32.2) less likely to be referred than those in the least deprived. Despite a specifically flagged NICE 'Do not do' recommendation in 2011 against prescribing tricyclic antidepressants following self-harm because of their potentially lethal toxicity in overdose, 8.8% (CI 7.8-9.8) of individuals were issued a prescription in the subsequent year. The percentage prescribed Citalopram, an SSRI antidepressant with higher toxicity in overdose, fell sharply during 2012/2013 in the aftermath of a Medicines and Healthcare products Regulatory Agency (MHRA) safety alert issued in 2011.Conclusions: A relatively small percentage of these vulnerable patients are referred to mental health services, and reduced likelihood of referral in more deprived localities reflects a marked health inequality. National clinical guidelines have not yet been effective in reducing rates of tricyclic antidepressant prescribing for this high-risk group. (C) 2016 Elsevier B.V. All rights reserved.