Clinical management following self-harm in a UK-wide primary care cohort

Autor: Matthew J, Carr, Darren M, Ashcroft, Evangelos, Kontopantelis, David, While, Yvonne, Awenat, Jayne, Cooper, Carolyn, Chew-Graham, Nav, Kapur, Roger T, Webb
Rok vydání: 2016
Předmět:
Male
GP
General Practitioner
Antidepressive Agents
Tricyclic
Citalopram
NHS
National Health Service
Medication
Drug Prescriptions
Vulnerable Populations
MHRA
Medicines and Healthcare products Regulatory Agency
Cohort Studies
FHSA
Family Health Services Authority
Diagnoses
Humans
Self-harm
Healthcare Disparities
Poverty
Referral and Consultation
NICE
National Institute for Health and Clinical Excellence
SSRI
Selective Serotonin Reuptake Inhibitor
YLL
Years of Life Lost
Primary Health Care
LSOA
Lower-Layer Super Output Area
Middle Aged
Referrals
Primary care
Antidepressive Agents
United Kingdom
CI
Confidence Interval
CPRD
Clinical Practice Research Datalink
IMD
Index of Multiple Deprivation
UK
United Kingdom
Female
Self-Injurious Behavior
Selective Serotonin Reuptake Inhibitors
Follow-Up Studies
Research Paper
Zdroj: Journal of Affective Disorders
ISSN: 1573-2517
Popis: Background Little is known about the clinical management of patients in primary care following self-harm. Methods A descriptive cohort study using data from 684 UK general practices that contributed to the Clinical Practice Research Datalink (CPRD) during 2001–2013. We identified 49,970 patients with a self-harm episode, 41,500 of whom had one complete year of follow-up. Results Among those with complete follow-up, 26,065 (62.8%, 62.3–63.3) were prescribed psychotropic medication and 6318 (15.2%, 14.9-15.6) were referred to mental health services; 4105 (9.9%, CI 9.6–10.2) were medicated without an antecedent psychiatric diagnosis or referral, and 4,506 (10.9%, CI 10.6–11.2) had a diagnosis but were not subsequently medicated or referred. Patients registered at practices in the most deprived localities were 27.1% (CI 21.5–32.2) less likely to be referred than those in the least deprived. Despite a specifically flagged NICE 'Do not do’ recommendation in 2011 against prescribing tricyclic antidepressants following self-harm because of their potentially lethal toxicity in overdose, 8.8% (CI 7.8-9.8) of individuals were issued a prescription in the subsequent year. The percentage prescribed Citalopram, an SSRI antidepressant with higher toxicity in overdose, fell sharply during 2012/2013 in the aftermath of a Medicines and Healthcare products Regulatory Agency (MHRA) safety alert issued in 2011. Conclusions A relatively small percentage of these vulnerable patients are referred to mental health services, and reduced likelihood of referral in more deprived localities reflects a marked health inequality. National clinical guidelines have not yet been effective in reducing rates of tricyclic antidepressant prescribing for this high-risk group.
Highlights • The percentage of patients referred to mental health services is low. • Patients in the most deprived localities have the least chance of being referred. • One in ten are prescribed medication without a diagnosis or referral. • Eleven percent have a diagnosis but are not medicated or referred. • Despite guidance, a sizeable proportion were prescribed potentially toxic medication.
Databáze: OpenAIRE
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