Integrated behavioral health services in pediatric primary care and emergency department utilization for suicide risk.
Integrated behavioral health services in pediatric primary care and emergency department utilization for suicide risk.
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DOI：
10.3389/fpsyt.2023.1241642
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发表时间：
2023
影响因子：
4.7
通讯作者：
Riley, Andrew R.
中科院分区：
文献类型：
--
作者：
Wellen, Brianna C. M.;Wright, Naomi M.;Bickford, Mira A.;Bakken, Eliza Hayes;Riley, Andrew R.
在初级保健环境中普遍进行自杀风险筛查是预防自我伤害和改善健康结果的一个有希望的途径。将青年分流到适当水平的护理，包括将低风险患者从急诊科(ED)分流是一个有意义的目标。先前的研究表明，综合行为健康(IBH)可以防止在自杀风险筛查当天不必要地进入ED。我们假设，在自杀风险筛查的同一天接受ibh会诊的青少年不太可能进入ED，但更有可能在接下来的一个月联系ibh服务和使用初级保健。我们对3,649名10-18岁的年轻人进行了回顾性图表回顾，他们在两个儿科初级保健实践中接受了自杀筛查问题(ASQ)的筛查。我们收集了筛查当天和随后31天的人口学数据、ASQ和患者健康问卷-9(PHQ-9)得分，以及患者在筛查当天和随后31天与IBH、急诊和医疗初级保健的接触情况。我们进行了一系列Logistic回归和卡方分析，以确定与自杀风险筛查阳性的同一天接触IBH是否预示着同一天进入急诊室、IBH接触和医疗初级保健利用。在7,982个ASQ得分中，1,380个(18%)为非急性，87个ASQ(1%)筛选为急性阳性。无论是否接触IBH，超过90%的阳性筛查都被从ED转移。没有一名患者死于自杀。对于所有阳性筛查(急性筛查和非急性筛查)，同一天的IBH与普通急诊的可能性较高。在接受筛查的同一天接受IBH会诊的阳性筛查患者，没有一人在随后的一个月内被送往教育署。在筛查的同一天接触国际保健机构，积极地预测了在接下来的一个月中国际保健机构和医疗初级保健服务的利用情况，特别是对于具有少数族裔和民族身份的年轻人。在设有独立健康中心和有系统风险评估程序的诊所的情况下，大部分自杀风险筛查呈阳性的青少年都被教育署分流了。然而，与我们的假设相反，我们的研究表明，与没有接受ibh咨询的同龄人相比，接受当天ibh咨询的年轻人更有可能被ED接纳。这些发现表明，在儿科初级保健中，系统的自杀筛查结合IBH会诊可以有效地识别风险水平，并将患者分流到适当的护理。
Universal screening for suicide risk in primary care settings is a promising avenue for preventing self-harm and improving health outcomes. Triaging youth to an appropriate level of care, including diverting lower-risk patients from the emergency department (ED) is a meaningful goal. Previous research indicates integrated behavioral health (IBH) may prevent unnecessary admission to the ED on the day of suicide risk screening. We hypothesized that youth who received an IBH consultation the same day as suicide risk screening would be less likely to be admitted to the ED, but more likely to contact IBH services and utilize primary care in the following month. We conducted a retrospective chart review of 3,649 youth aged 10-18 years who were screened with the Ask Suicide-Screening Questions (ASQ) in two pediatric primary care practices. We collected demographic data, ASQ and Patient Health Questionnaire-9 (PHQ-9) scores, as well as patient contacts with IBH, the ED, and medical primary care the day of screening and the following 31 days. We conducted a series of logistic regressions and chi-square analyses to determine whether contact with IBH on the same day as positive suicide risk screenings predicted same-day admission to the ED, IBH contact, and medical primary care utilization. Among the 7,982 ASQ scores, 1,380 (18%) were non-acute and 87 ASQs (1%) screened acutely positive. Over 90% of positive screens were diverted from the ED regardless of IBH contact. None of the patients died from suicide. Same-day IBH was associated with higher likelihood of general ED visits for all positive screens (acute and non-acute together). None of the positive screens that received an IBH consultation on the same day as screening were admitted to the ED in the subsequent month. Contact with IBH the same day as screening positively predicted utilization of IBH and medical primary care services in the subsequent month, especially for youth with minority race and ethnicity identities. In the context of clinics with IBH and systematic risk assessment processes, most youth who screen positive for suicide risk are diverted from the ED. However, contrary to our hypothesis, our study showed that youth who received same-day IBH consultations were more likely to be admitted to the ED compared to peers who did not receive IBH consultations. These findings suggest that systematic suicide screening combined with IBH consultations in pediatric primary care can effectively identify risk levels and triage patients to appropriate care.
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DOI：
10.1016/j.chc.2017.05.002
发表时间：
2017-10
影响因子：
2.4
作者：
Asarnow JR;Babeva K;Horstmann E
通讯作者：
Horstmann E
影响因子：
--
作者：
Bursac, Zoran;Gauss, C Heath;Williams, David Keith;Hosmer, David W
通讯作者：
Hosmer, David W
验证在门诊专科和初级保健诊所向年轻人询问自杀筛查问题（ASQ）。
影响因子：
7
作者：
Aguinaldo LD;Sullivant S;Lanzillo EC;Ross A;He JP;Bradley-Ewing A;Bridge JA;Horowitz LM;Wharff EA
通讯作者：
Wharff EA
影响因子：
5.9
作者：
Aarons, Gregory A.;Sommerfeld, David H.;Hecht, Debra B.;Silovsky, Jane F.;Chaffin, Mark J.
通讯作者：
Chaffin, Mark J.
影响因子：
4.7
作者：
Brodsky BS;Spruch-Feiner A;Stanley B
通讯作者：
Stanley B