Primary care clinical management following self-harm during the first wave of COVID-19 in the UK: population-based cohort study.
Primary care clinical management following self-harm during the first wave of COVID-19 in the UK: population-based cohort study.
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DOI：
10.1136/bmjopen-2021-052613
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发表时间：
2022-02-14
期刊：
影响因子：
2.9
通讯作者：
Webb R
中科院分区：
文献类型：
--
作者：
Steeg S;Carr M;Trefan L;Ashcroft D;Kapur N;Nielsen E;McMillan B;Webb R
在第一波COVID-19期间，初级保健中记录的自我伤害大幅减少，但对初级保健自我伤害管理的影响尚不清楚。我们的目标是在自残事件发生后3个月内研究COVID-19对临床管理的影响。回顾性队列研究。英国初级保健在COVID-19第一波期间（2020年3月10日至2020年6月10日），英国初级保健记录了4238例发生自我伤害指数事件的患者，而在大流行前的比较期间（2010年3月10日至2019年6月10日），这一数字为48739例。使用英国临床实践研究数据链的数据，我们比较了在大流行前时期与COVID-19第一波时期记录的指数自我伤害事件的患者队列。患者随访3个月，以获取随后的全科医生（GP）/执业护士咨询，转介到精神卫生服务和精神药物处方。我们研究了性别，年龄组和多重残疾五分位数指数的差异。至少有一次GP/执业护士咨询的可能性大致相似（83.2% vs COVID-19队列中的80.3%）。COVID-19队列中转介到精神卫生服务的患者比例（4.2%）约为大流行前队列（6.1%）的三分之二。在大流行前（54.0%）和COVID-19第一波（54.9%）队列中，在3个月内处方精神药物的比例相似。尽管基层医疗团队在最初的COVID-19浪潮中经历了挑战，但自我伤害后的处方和咨询模式与大流行前的水平大致相似。我们没有发现任何证据表明在获得远程咨询方面数字排斥的扩大。然而，转介到精神卫生服务机构的可能性降低，值得关注。随着2019冠状病毒病危机的消退，人们面临着心理健康的新挑战，需要为自残者提供可接受的门诊和社区服务。
A substantial reduction in self-harm recorded in primary care occurred during the first wave of COVID-19 but effects on primary care management of self-harm are unknown. Our objectives were to examine the impact of COVID-19 on clinical management within 3 months of an episode of self-harm. Retrospective cohort study. UK primary care. 4238 patients with an index episode of self-harm recorded in UK primary care during the COVID-19 first-wave period (10 March 2020–10 June 2020) compared with 48 739 patients in a prepandemic comparison period (10 March-10 June, 2010-2019). Using data from the UK Clinical Practice Research Datalink, we compared cohorts of patients with an index self-harm episode recorded during the prepandemic period versus the COVID-19 first-wave period. Patients were followed up for 3 months to capture subsequent general practitioner (GP)/practice nurse consultation, referral to mental health services and psychotropic medication prescribing. We examined differences by gender, age group and Index of Multiple Deprivation quintile. Likelihood of having at least one GP/practice nurse consultation was broadly similar (83.2% vs 80.3% in the COVID-19 cohort). The proportion of patients referred to mental health services in the COVID-19 cohort (4.2%) was around two-thirds of that in the prepandemic cohort (6.1%). Similar proportions were prescribed psychotropic medication within 3 months in the prepandemic (54.0%) and COVID-19 first-wave (54.9%) cohorts. Despite the challenges experienced by primary healthcare teams during the initial COVID-19 wave, prescribing and consultation patterns following self-harm were broadly similar to prepandemic levels. We found no evidence of widening of digital exclusion in terms of access to remote consultations. However, the reduced likelihood of referral to mental health services warrants attention. Accessible outpatient and community services for people who have self-harmed are required as the COVID-19 crisis recedes and the population faces new challenges to mental health.
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影响因子：
13.6
作者：
Padmanabhan, Shivani;Carty, Lucy;Strongman, Helen
通讯作者：
Strongman, Helen
影响因子：
6.6
作者：
Carr, Matthew J.;Ashcroft, Darren M.;Webb, Roger T.
通讯作者：
Webb, Roger T.
影响因子：
5.9
作者：
Mroz, Gilly;Papoutsi, Chrysanthi;Greenhalgh, Trisha
通讯作者：
Greenhalgh, Trisha
DOI：
10.1016/s2468-2667(20)30201-2
发表时间：
2020-10
期刊：
The Lancet. Public health
影响因子：
--
作者：
Williams R;Jenkins DA;Ashcroft DM;Brown B;Campbell S;Carr MJ;Cheraghi-Sohi S;Kapur N;Thomas O;Webb RT;Peek N
通讯作者：
Peek N
DOI：
10.1016/s2468-2667(20)30288-7
发表时间：
2021-03
期刊：
The Lancet. Public health
影响因子：
--
作者：
Carr MJ;Steeg S;Webb RT;Kapur N;Chew-Graham CA;Abel KM;Hope H;Pierce M;Ashcroft DM
通讯作者：
Ashcroft DM