Team-based suicide prevention: lessons learned from early adopters of collaborative care
Team-based suicide prevention: lessons learned from early adopters of collaborative care
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DOI：
10.1080/13561820.2019.1697213
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发表时间：
2019-12-20
影响因子：
2.7
通讯作者：
Pigeon, Wilfred R.
中科院分区：
文献类型：
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作者：
Wittink, Marsha N.;Levandowski, Brooke A.;Pigeon, Wilfred R.
在临床环境中预防自杀需要多个具有不同学科专业知识的临床医生之间的协调。我们的目的是了解团队方法在初级保健中预防自杀的好处和挑战，特别关注退伍军人。退伍军人健康管理局在预防自杀方面既有既得利益，也迅速而系统地采用了以团队为基础的初级保健干预方法，包括预防自杀。我们对位于美国东北部一个退伍军人管理局集水区的六个地区的初级保健提供者（pcp）、行为健康提供者和护士进行了8个焦点小组和8次深度访谈。转录本分析采用同步演绎和归纳内容分析。研究结果显示，不同的临床医生被认为具有特定的专业知识和角色。护士被认为能够很好地识别病人行为的细微变化，这些变化可能使病人有自杀的危险；行为健康提供者在自杀风险评估方面的技能得到认可；和pcp被认为是所需服务和治疗之间不可或缺的渠道。我们的研究结果表明，临床医生的角色分化可能是VHA设置中以团队为基础的自杀预防工作的重要副产品。我们将我们的研究结果置于过程和关系的跨专业框架中，并讨论了实施团队自杀预防的意义。
Suicide prevention in clinical settings requires coordination among multiple clinicians with expertise in different disciplines. We aimed to understand the benefits and challenges of a team approach to suicide prevention in primary care, with a particular focus on Veterans. The Veterans Health Administration has both a vested interest in preventing suicide and it has rapidly and systematically adopted team-based approaches for primary care interventions, including suicide prevention. We conducted eight focus groups and eight in-depth interviews with primary care providers (PCPs), behavioral health providers and nurses located in six regions within one Veterans Administration Catchment Area in the northeast of the US. Transcripts were analyzed using simultaneous deductive and inductive content analysis. Findings revealed that different clinicians were thought to have particular expertise and roles. Nurses were recognized as being well positioned to identify subtle changes in patient behavior that could put patients at risk for suicide; behavioral health providers were recognized for their skill in suicide risk assessment; and PCPs were felt to be an integral conduit between needed services and treatment. Our findings suggest that clinician role-differentiation may be an important by-product of team-based suicide prevention efforts in VHA settings. We contextualize our findings within both a processual and relational interprofessional framework and discuss implications for the implementation of team-based suicide prevention.