Suicide Screening in Primary Care: Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents
Suicide Screening in Primary Care: Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents
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DOI：
10.1016/j.jadohealth.2017.08.026
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发表时间：
2018-02-01
影响因子：
7.6
通讯作者：
Aalsma, Matthew C.
中科院分区：
文献类型：
--
作者：
Etter, Dillon J.;McCord, Allison;Aalsma, Matthew C.
目的：本研究的目的是评估使用现有的计算机决策支持系统来筛选青少年患者自杀倾向的可行性，并在初级保健环境中为临床医生提供随访指导。预测患者认可的自杀和供应商文件的后续checked.Methods：前瞻性队列研究进行了检查的实施CDSS筛选青少年患者自杀，并提供后续建议，以供应商。干预实施的患者年龄在12-20岁，在两个初级保健诊所在印第安纳波利斯，印第安纳州。结果：样本包括2,134名青少年患者（51%女性，60%黑人，平均年龄= 14.6岁[标准差= 2.1]）。超过6%的患者自杀倾向筛查呈阳性。对自杀倾向的积极认可在女性、抑郁症患者中更常见，并且由经医学委员会认证的提供者而不是一般的儿科提供者看到。提供者记录了83%的自杀倾向筛查阳性患者的后续行动。随访行动的记录与临床试验机构和西班牙裔人种相关。大多数的病人谁赞同自杀（71%）被认为是不积极自杀后，他们的provider.Conclusions评估：将青少年自杀筛查和供应商的后续指导到现有的计算机决策支持系统在初级保健是可行的，并充分利用供应商。女性性别和抑郁症状与青少年自杀倾向相关，尽管并非所有自杀青少年都抑郁。普遍使用多项目自杀筛查评估近可能更有效地识别自杀青少年。(C)2017年青少年健康和医学协会。All rights reserved.
Purpose: The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. Predictors of patient endorsement of suicidality and provider documentation of follow-up were examined.Methods: A prospective cohort study was conducted to examine the implementation of a CDSS that screened adolescent patients for suicidality and provided follow-up recommendations to providers. The intervention was implemented for patients aged 12-20 years in two primary care clinics in Indianapolis, Indiana.Results: The sample included 2,134 adolescent patients (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Just over 6% of patients screened positive for suicidality. A positive endorsement of suicidality was more common among patients who were female, depressed, and seen by an adolescent-medicine board-certified provider as opposed to general pediatric provider. Providers documented follow-up action for 83% of patients who screened positive for suicidality. Documentation of follow-up action was correlated with clinic site and Hispanic race. The majority of patients who endorsed suicidality (71%) were deemed not actively suicidal after assessment by their provider.Conclusions: Incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care is feasible and well utilized by providers. Female gender and depressive symptoms are consistently associated with suicidality among adolescents, although not all suicidal adolescents are depressed. Universal use of a multi-item suicide screener that assesses recency might more effectively identify suicidal adolescents. (C) 2017 Society for Adolescent Health and Medicine. All rights reserved.