Person-Centered Suicide Prevention in Primary Care Settings

2017 ◽  
pp. 213-239
Author(s):  
Paul R. Duberstein ◽  
Marsha Wittink ◽  
Wilfred R. Pigeon
Keyword(s):  
Primary Care ◽  
Human Resources ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Care Physician ◽  
Self Determination ◽  
Positive Development ◽  
Supply Side ◽  
Policy Initiatives ◽  
Primary Care Settings

The increase in the availability of mental health services in primary care settings in large health systems is a positive development for suicide prevention, but challenges remain. Unhelpful power asymmetries in the patient–primary care physician (PCP) relationship, supply-side economic factors, and the disease-centered (biomedical) model make it difficult for PCPs to elicit patient priorities. Thus many of the drivers of suicide risk are marginalized if not ignored in the patient–PCP encounter. Drawing from self-determination theory and systems theory, this chapter offers a person-centered vision of suicide prevention in primary care. It calls for policy initiatives to that accommodate PCPs’ needs for self-determination and outfit primary care settings with the technological and human resources needed to improve the way PCPs and patients communicate about difficult issues. These initiatives are expected to mitigate suicide risk and improve other patient outcomes as well as PCP job satisfaction.

scholarly journals Nurturing the Student, Sustaining the Mission: 20 Years of the International/Inner-City/Rural Preceptorship Program

2019 ◽  
Vol 51 (10) ◽  
pp. 823-829
Author(s):  
Yeri Park ◽  
Mark H. Ryan ◽  
Sally A. Santen ◽  
Roy Sabo ◽  
Courtney Blondino ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Inner City ◽  
Rural Areas ◽  
Self Determination Theory ◽  
Care Physician ◽  
Self Determination ◽  
Medically Underserved ◽  
Medically Underserved Areas ◽  
Virginia Commonwealth University

Background and Objectives: Specialized medical school educational tracks aim to increase the primary care workforce. The International/Inner-City/Rural Preceptorship (I2CRP) Program is unique in addressing multiple communities, a large cohort and applying the Self Determination Theory framework. This study examined program impact by analyzing the numbers of graduates matched into primary care and practicing in medically underserved communities. Methods: We compared the match list of I2CRP graduates between 2000 and 2017 (n=204) to non-I2CRP Virginia Commonwealth University School of Medicine (VCU SOM) graduates (n=3,037). We analyzed the matches into primary care, National Health Service Corps (NHSC) priority specialties, and NHSC priority plus general surgery. We searched a federal database to determine which graduates are practicing in workforce shortage areas. Results: Many more I2CRP graduates matched to primary care (71.1%), compared to non-I2CRP graduates (38.2%; P<.001). Within primary care, I2CRP graduates matched to family medicine more frequently than non-I2CRP graduates (36.3% vs 8.4%). Eighteen percent of posttraining I2CRP graduates work in rural areas and 41% work in medically underserved areas. Conclusions: I2CRP graduates are more likely to match to family medicine and primary care. I2CRP curriculum nurtures new medical students’ interest in primary care, and self-determination theory provides a framework to organize the program curriculum. The program’s impact endures as evidenced by participants’ continued work in underserved areas after residency. Increasing support for such programs may help address the primary care physician shortage in medically underserved areas.

Practical Suicide Risk Management for the Busy Primary Care Physician

SciVee ◽  
2011 ◽  
Author(s):  
Anna k. Mcdowell ◽  
Timothy w. Lineberry ◽  
J. michael Bostwick
Keyword(s):  
Primary Care ◽  
Risk Management ◽  
Primary Care Physician ◽  
Suicide Risk ◽  
Care Physician

scholarly journals Association between a national primary care pay-for-performance scheme and suicide rates in England: spatial cohort study

2018 ◽  
Vol 213 (4) ◽  
pp. 600-608
Author(s):  
Christos Grigoroglou ◽  
Luke Munford ◽  
Roger T. Webb ◽  
Nav Kapur ◽  
Tim Doran ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Quality Of Care ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Pay For Performance ◽  
Social Fragmentation ◽  
Practice Performance ◽  
The Relationship

BackgroundPay-for-performance policies aim to improve population health by incentivising improvements in quality of care.AimsTo assess the relationship between general practice performance on severe mental illness (SMI) and depression indicators under a national incentivisation scheme and suicide risk in England for the period 2006–2014.MethodLongitudinal spatial analysis for 32 844 small-area geographical units (lower super output areas, LSOAs), using population-structure adjusted numbers of suicide as the outcome variable. Negative binomial models were fitted to investigate the relationship between spatially estimated recorded quality of care and suicide risk at the LSOA level. Incidence rate ratios (IRRs) were adjusted for deprivation, social fragmentation, prevalence of depression and SMI as well as other 2011 Census variables.ResultsNo association was found between practice performance on the mental health indicators and suicide incidence in practice localities (IRR=1.000, 95% CI 0.998–1.002). IRRs indicated elevated suicide risks linked with area-level social fragmentation (1.030; 95% CI 1.027–1.034), deprivation (1.013, 95% CI 1.012–1.014) and rurality (1.059, 95% CI 1.027–1.092).ConclusionsPrimary care has an important role to play in suicide prevention, but we did not observe a link between practices' higher reported quality of care on incentivised mental health activities and lower suicide rates in the local population. It is likely that effective suicide prevention needs a more concerted, multiagency approach. Better training in suicide prevention for general practitioners is also essential. These findings pertain to the UK but have relevance to other countries considering similar programmes.Declaration of interestNone.

scholarly journals Effects of discontinuation of chronic medication in primary care: a systematic review of deprescribing trials

2018 ◽  
Vol 68 (675) ◽  
pp. e663-e672 ◽  
Author(s):  
Sioe Lie Thio ◽  
Joana Nam ◽  
Mieke L van Driel ◽  
Thomas Dirven ◽  
Jeanet W Blom
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Care Physician ◽  
Evidence Based ◽  
Chronic Medication ◽  
Primary Care Settings ◽  
Number Of Patients ◽  
The Mean ◽  
Randomised Controlled

BackgroundPolypharmacy is becoming more prevalent and evaluation of appropriateness of medication use is increasingly important. The primary care physician often conducts the deprescribing process; however, there are several barriers to implementing this.AimTo examine the feasibility and safety of discontinuation of medication, with a focus on studies that have been conducted in the community, that is, primary care (or general practice) and nursing homes.Design and settingThis systematic review included randomised controlled trials published in 2005–2017, which studied withdrawal of long-term drugs prescribed in primary care settings and compared continuing medication with discontinuing.MethodPubMed and EMBASE searches were conducted and the extracted data included the number of patients who successfully stopped medication and the number of patients who experienced relapse of symptoms or restarted medication.ResultsA total of 27 studies reported in 26 papers were included in this review. The number of participants in the studies varied from 20 to 2471 and the mean age of participants ranged from 50.3 years to 89.2 years. The proportion of patients who successfully stopped their medication varied from 20% to 100%, and the range of reported relapse varied from 1.9% to 80%.ConclusionOnly a few studies have examined the success rate and safety of discontinuing medication in primary care, and these studies are very heterogeneous. Most studies show that deprescribing and cessation of long-term use seem safe; however, there is a risk of relapse of symptoms. More research is needed to advise physicians in making evidence-based decisions about deprescribing in primary care settings.

scholarly journals Practical Suicide-Risk Management for the Busy Primary Care Physician

2011 ◽  
Vol 86 (8) ◽  
pp. 792-800 ◽  
Author(s):  
Anna K. McDowell ◽  
Timothy W. Lineberry ◽  
J. Michael Bostwick
Keyword(s):  
Primary Care ◽  
Risk Management ◽  
Primary Care Physician ◽  
Suicide Risk ◽  
Care Physician

Chhattisgarh community mental healthcare tele-mentoring program (CHaMP): Digitally driven initiative to reach the unreached

2021 ◽  
pp. 002076402110111
Author(s):  
Ferose Azeez Ibrahim ◽  
Barikar C Malathesh ◽  
Gopi Gajera ◽  
Praveen Pandey ◽  
Lakshmi Nirisha P ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Human Resources ◽  
Mental Healthcare ◽  
Mentoring Program ◽  
Training Methods ◽  
Medical Assistants ◽  
Primary Care Settings ◽  
Primary Care Doctors ◽  
The Government

Objective: Harnessing technology is one accepted method to leapfrog the barrier of inadequate trained human resources for mental health. The Chhattisgarh Community Mental Healthcare Tele-Mentoring Program (CHaMP) is a collaborative digitally driven initiative of the Government of Chhattisgarh (GOC) and the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru the aim of which is to train the Primary Care Doctors (PCDs) and Rural Medical Assistants (RMA) to identify, screen and treat/refer cases of mental health disorders presenting to the primary care settings ( n = 2150). The objective of this article is to give a brief overview of the initiative Methods: CHaMP consists of the following modules: (a) a brief on-site training (b) eLearning and Skill Development (eLSD) and (c) Collaborative Video Consultation (CVC). The latter two are andragogic training methods delivered digitally. Results and conclusion: From August 2019 to May 2020, 501 PCDs and RMAs have been covered. During this time, they have cared 15,000 patients suffering from mental illness, which hitherto was not the case. Technology that is easily available and usable has the potential to overcome the big hurdle of inadequate mental health human resources in India.

Mental health and medical consultation in primary care settings

1990 ◽  
Vol 20 (3) ◽  
pp. 681-694 ◽  
Author(s):  
J. L. Vázquez-Barquero ◽  
G. Wilkinson ◽  
P. Williams ◽  
J. F. Diez-Manrique ◽  
C. Peña
Keyword(s):  
Primary Care ◽  
Psychiatric Morbidity ◽  
Joint Effect ◽  
Demographic Variables ◽  
Care Physician ◽  
Interactive Effects ◽  
Care Utilization ◽  
Primary Care Settings ◽  
Socio Demographic Factors ◽  
Primary Care Utilization

SynopsisThis paper examines the effect of psychiatric morbidity, as measured by the GHQ-60, on the probability of being in contact with a primary care physician, and the socio-demographic factors which influenced this effect. We found that the presence of psychiatric morbidity emerged as a major determinant of primary care utilization in both sexes, and about one-sixth of consultations in men and one-fifth of consultations in women could be attributed to it. Logistic modelling was used to investigate the joint effect on general practitioner consultation of psychiatric morbidity and seven socio-demographic variables. Sex, age, and psychiatric morbidity exerted independent, but not interactive, effects on consultation.

Sign in / Sign up

Export Citation Format

Share Document