Are hospital services for self-harm getting better? An observational study examining management, service provision and temporal trends in England
Are hospital services for self-harm getting better? An observational study examining management, service provision and temporal trends in England
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DOI：
10.1136/bmjopen-2013-003444
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发表时间：
2013-01-01
期刊：
影响因子：
2.9
通讯作者：
Kapur, N.
中科院分区：
文献类型：
--
作者：
Cooper, J.;Steeg, S.;Kapur, N.
目的描述因自残而住院的个人的特征和管理，并评估自2001年早期研究以来管理和服务质量的变化，在此期间已有国家指导。设计观察性研究。设置分层随机抽样英国英格兰32家医院。参与者：在2010年至2011年的3个月审计期间，6442名个人出现了7689次自我伤害事件。结果自我伤害事件，与心理社会评估和随访相关的个人管理的关键方面，以及21项服务质量指标。56%（3583/6442）的人是女性，51%（3274/6442）的人年龄在35岁以下。医院在管理上有很大差异。接受心理健康专业人员心理社会评估的发作比例从22%到88%不等（中位数58%，IQR 48-70%）;导致住院的发作比例从22%到85%不等（中位数54%，IQR 41-63%）;在11-64%的事件中进行了专家心理健康随访的转诊（中位数28%，IQR 22-38%）;在4-62%的事件中转诊到非法定服务（中位数15%，IQR 8-23%）; 0-21%的事件导致精神病住院（中位数7%，QR 4-12%）。专家评估率因伤害方法而异;自我切割的中位率为45%（IQR 28-63%），而自我中毒的中位率为58%（IQR 48-73%）。与2001年的研究相比，接受专家评估的事件比例几乎没有差异;普通医院入院人数显着增加，但转诊接受专家心理健康随访的人数减少。然而，服务质量量表的分数从中位数的11.5-14.5（增加了26%）。结论尽管国家的指导方针和政策措施，医院管理的自我伤害的服务仍然是可变的。我们没有发现随着时间的推移，评估水平提高的证据，但服务质量的标志可能有所改善。本文是研究自我伤害服务提供变化的一部分：一项观察性研究，研究结果和时间趋势。国家卫生研究所临床研究网络（NIHR CRN）组合数据库注册号：HOMASH 2（7333）。NIHR获得NHS许可的协调系统（CSP）注册号：23226。
Objectives To describe the characteristics and management of individuals attending hospital with self-harm and assess changes in management and service quality since an earlier study in 2001, a period in which national guidance has been available.Design Observational study.Setting A stratified random sample of 32 hospitals in England, UK.Participants: 6442 individuals presenting with 7689 episodes of self-harm during a 3-month audit period between 2010 and 2011.Outcome Self-harm episodes, key aspects of individual management relating to psychosocial assessment and follow-up, and a 21-item measure of service quality.Results Overall, 56% (3583/6442) of individuals were women and 51% (3274/6442) were aged under 35years. Hospitals varied markedly in their management. The proportion of episodes that received a psychosocial assessment by a mental health professional ranged from 22% to 88% (median 58%, IQR 48-70%); the proportion of episodes resulting in admission to general hospitals varied from 22% to 85% (median 54%, IQR 41-63%); a referral for specialist mental health follow-up was made in 11-64% of episodes (median 28%, IQR 22-38%); a referral to non-statutory services was made in 4-62% of episodes (median 15%, IQR 8-23%); 0-21% of episodes resulted in psychiatric admission (median 7%, QR 4-12%). The specialist assessment rate varied by method of harm; the median rate for self-cutting was 45% (IQR 28-63%) vs 58% (IQR 48-73%) for self-poisoning. Compared with the 2001 study, there was little difference in the proportion of episodes receiving specialist assessment; there was a significant increase in general hospital admission but a decrease in referrals for specialist mental health follow-up. However, scores on the service quality scale had increased from a median of 11.5-14.5 (a 26% increase).Conclusions Services for the hospital management of self-harm remain variable despite national guidelines and policy initiatives. We found no evidence for increasing levels of assessment over time but markers of service quality may have improved. This paper forms part of the study Variations in self-harm service delivery: an observational study examining outcomes and temporal trends'. The National Institute for Health Research Clinical Research Network (NIHR CRN) Portfolio database registration number: HOMASH 2 (7333). The NIHR Coordinated System for gaining NHS Permission (CSP) registration number: 23226.