Primary care contact, clinical management, and suicide risk following discharge from inpatient mental health care: a case–control study
Background: Evidence is sparse regarding service usage and the clinical management of people recently discharged from inpatient psychiatric care who die by suicide. Aim: To improve understanding of how people discharged from inpatient mental health care are supported by primary care during this hi...
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| Format: | Article |
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Royal College of General Practitioners
2024-12-01
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| Series: | BJGP Open |
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| Online Access: | https://bjgpopen.org/content/8/4/BJGPO.2023.0165 |
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| author | Rebecca Musgrove Matthew J Carr Nav Kapur Carolyn A Chew-Graham Faraz Mughal Darren M Ashcroft Roger T Webb |
| author_facet | Rebecca Musgrove Matthew J Carr Nav Kapur Carolyn A Chew-Graham Faraz Mughal Darren M Ashcroft Roger T Webb |
| author_sort | Rebecca Musgrove |
| collection | DOAJ |
| description | Background: Evidence is sparse regarding service usage and the clinical management of people recently discharged from inpatient psychiatric care who die by suicide. Aim: To improve understanding of how people discharged from inpatient mental health care are supported by primary care during this high-risk transition. Design & setting: A nested case–control study, utilising interlinked primary and secondary care records in England for people who died within a year of discharge between 2001 and 2019, matched on age, sex, practice-level deprivation, and region with up to 20 living discharged people. Method: We described patterns of consultation, prescription of psychotropic medication, and continuity of care for people who died by suicide and those who survived. Mutually adjusted relative risk estimates were generated for a range of primary care and clinical variables. Results: More than 40% of patients who died within 2 weeks of discharge and >80% of patients who died within 1 year of discharge had at least one primary care consultation within the respective time periods. Evidence of discharge communication from hospital was infrequent. Within-practice continuity of care was relatively high. Those who died by suicide were less likely to consult within 2 weeks of discharge (adjusted odds ratio [AOR] 0.61 [95% confidence interval {CI} = 0.42 to 0.89]), more likely to consult in the week before death (AOR 1.71 [95% CI = 1.36 to 2.15]), be prescribed multiple types of psychotropic medication (AOR 1.73 [95% CI = 1.28 to 2.33]), experience readmission, and have a diagnosis outside of the ‘severe mental illness’ definition. Conclusion: Primary care clinicians have opportunities to intervene and should prioritise patients experiencing transition from inpatient care. Clear communication and liaison between services is essential to provide timely support. |
| format | Article |
| id | doaj-art-6a44843662744b339905e44bca607a8a |
| institution | DOAJ |
| issn | 2398-3795 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Royal College of General Practitioners |
| record_format | Article |
| series | BJGP Open |
| spelling | doaj-art-6a44843662744b339905e44bca607a8a2025-08-20T02:39:51ZengRoyal College of General PractitionersBJGP Open2398-37952024-12-018410.3399/BJGPO.2023.0165Primary care contact, clinical management, and suicide risk following discharge from inpatient mental health care: a case–control studyRebecca Musgrove0https://orcid.org/0000-0003-1227-2057Matthew J Carr1Nav Kapur2Carolyn A Chew-Graham3Faraz Mughal4https://orcid.org/0000-0002-5437-5962Darren M Ashcroft5Roger T Webb6Division of Psychology and Mental Health, University of Manchester, Manchester, UKNational Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UKDivision of Psychology and Mental Health, University of Manchester, Manchester, UKSchool of Medicine, Keele University, Newcastle-under-Lyme, Staffordshire, UKNational Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UKNational Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UKDivision of Psychology and Mental Health, University of Manchester, Manchester, UKBackground: Evidence is sparse regarding service usage and the clinical management of people recently discharged from inpatient psychiatric care who die by suicide. Aim: To improve understanding of how people discharged from inpatient mental health care are supported by primary care during this high-risk transition. Design & setting: A nested case–control study, utilising interlinked primary and secondary care records in England for people who died within a year of discharge between 2001 and 2019, matched on age, sex, practice-level deprivation, and region with up to 20 living discharged people. Method: We described patterns of consultation, prescription of psychotropic medication, and continuity of care for people who died by suicide and those who survived. Mutually adjusted relative risk estimates were generated for a range of primary care and clinical variables. Results: More than 40% of patients who died within 2 weeks of discharge and >80% of patients who died within 1 year of discharge had at least one primary care consultation within the respective time periods. Evidence of discharge communication from hospital was infrequent. Within-practice continuity of care was relatively high. Those who died by suicide were less likely to consult within 2 weeks of discharge (adjusted odds ratio [AOR] 0.61 [95% confidence interval {CI} = 0.42 to 0.89]), more likely to consult in the week before death (AOR 1.71 [95% CI = 1.36 to 2.15]), be prescribed multiple types of psychotropic medication (AOR 1.73 [95% CI = 1.28 to 2.33]), experience readmission, and have a diagnosis outside of the ‘severe mental illness’ definition. Conclusion: Primary care clinicians have opportunities to intervene and should prioritise patients experiencing transition from inpatient care. Clear communication and liaison between services is essential to provide timely support.https://bjgpopen.org/content/8/4/BJGPO.2023.0165primary health caresuicidepsychiatric dischargemental health |
| spellingShingle | Rebecca Musgrove Matthew J Carr Nav Kapur Carolyn A Chew-Graham Faraz Mughal Darren M Ashcroft Roger T Webb Primary care contact, clinical management, and suicide risk following discharge from inpatient mental health care: a case–control study BJGP Open primary health care suicide psychiatric discharge mental health |
| title | Primary care contact, clinical management, and suicide risk following discharge from inpatient mental health care: a case–control study |
| title_full | Primary care contact, clinical management, and suicide risk following discharge from inpatient mental health care: a case–control study |
| title_fullStr | Primary care contact, clinical management, and suicide risk following discharge from inpatient mental health care: a case–control study |
| title_full_unstemmed | Primary care contact, clinical management, and suicide risk following discharge from inpatient mental health care: a case–control study |
| title_short | Primary care contact, clinical management, and suicide risk following discharge from inpatient mental health care: a case–control study |
| title_sort | primary care contact clinical management and suicide risk following discharge from inpatient mental health care a case control study |
| topic | primary health care suicide psychiatric discharge mental health |
| url | https://bjgpopen.org/content/8/4/BJGPO.2023.0165 |
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