Structured follow-up by general practitioners after deliberate self-poisoning: a randomised controlled trial

T K Grimholt, D Jacobsen, O R Haavet, L Sandvik, T Jorgensen, A B Norheim, O Ekeberg, T K Grimholt, D Jacobsen, O R Haavet, L Sandvik, T Jorgensen, A B Norheim, O Ekeberg

Abstract

Background: General Practitioners (GPs) play an important role in the follow-up of patients after deliberate self-poisoning (DSP). The aim was to examine whether structured follow-up by GPs increased the content of, adherence to, and satisfaction with treatment after discharge from emergency departments.

Methods: This was a multicentre, randomised trial with blinded assignment. Five emergency departments and general practices in the catchment area participated. 202 patients discharged from emergency departments after DSP were assigned. The intervention was structured follow-up by the GP over a 6-month period with a minimum of five consultations, accompanied by written guidelines for the GPs with suggestions for motivating patients to follow treatment, assessing personal problems and suicidal ideation, and availability in the case of suicidal crisis. Outcome measures were data retrieved from the Register for the control and payment of reimbursements to health service providers (KUHR) and by questionnaires mailed to patients and GPs. After 3 and 6 months, the frequency and content of GP contact, and adherence to GP consultations and treatment in general were registered. Satisfaction with general treatment received and with the GP was measured by the EUROPEP scale.

Results: Patients in the intervention group received significantly more consultations than the control group (mean 6.7 vs. 4.5 (p = 0.004)). The intervention group was significantly more satisfied with the time their GP took to listen to their personal problems (93.1% vs. 59.4% (p = 0.002)) and with the fact that the GP included them in medical decisions (87.5% vs. 54. 8% (p = 0.009)). The intervention group was significantly more satisfied with the treatment in general than the control group (79% vs. 51% (p = 0.026)).

Conclusions: Guidelines and structured, enhanced follow-up by the GP after the discharge of the DSP patient increased the number of consultations and satisfaction with aftercare in general practice. Consistently with previous research, there is still a need for interventional studies.

Trial registration: ClinicalTrials.gov Identifier: NCT01342809. Registered 18 April 2011.

Figures

Fig. 1
Fig. 1
Consort flow chart
Fig. 2
Fig. 2
Satisfaction with general practitioner

References

    1. Carroll R, Metcalfe C, Gunnell D. Hospital presenting self-harm and risk of fatal and non-fatal repetition: systematic review and meta-analysis. PLoS One. 2014;9 doi: 10.1371/journal.pone.0089944.
    1. Bjornaas MA, Jacobsen D, Haldorsen T, Ekeberg O. Mortality and causes of death after hospital-treated self-poisoning in Oslo: a 20-year follow-up. Clin Toxicol (Phila) 2009;47:116–23. doi: 10.1080/15563650701771981.
    1. Heyerdahl F, Bjornaas MA, Dahl R, Hovda KE, Nore AK, Ekeberg O, et al. Repetition of acute poisoning in Oslo: 1-year prospective study. Br J Psychiatry. 2009;194:73–9. doi: 10.1192/bjp.bp.107.048322.
    1. Owens D, Horrocks J, House A. Fatal and non-fatal repetition of self-harm. Systematic review. Br J Psychiatry. 2002;181:193–9. doi: 10.1192/bjp.181.3.193.
    1. WHO . Preventing suicide: a global imperative. 2014.
    1. Hawton K, Arensman E, Townsend E, Bremner S, Feldman E, Goldney R, et al. Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition. BMJ. 1998;317:441–7. doi: 10.1136/bmj.317.7156.441.
    1. Hawton K, Townsend E, Arensman E, Gunnell D, Hazell P, House A, et al. Psychosocial versus pharmacological treatments for deliberate self harm. Cochrane Database Syst Rev. 2000;(2)
    1. De LD, Dello BM, Dwyer J. Suicide among the elderly: the long-term impact of a telephone support and assessment intervention in northern Italy. Br J Psychiatry. 2002;181:226–9. doi: 10.1192/bjp.181.3.226.
    1. Motto JA, Bostrom AG. A randomized controlled trial of postcrisis suicide prevention. Psychiatr Serv. 2001;52:828–33. doi: 10.1176/appi.ps.52.6.828.
    1. Carter GL, Clover K, Whyte IM, Dawson AH, D’Este C. Postcards from the EDge: 5-year outcomes of a randomised controlled trial for hospital-treated self-poisoning. Br J Psychiatry. 2013;202:372–80. doi: 10.1192/bjp.bp.112.112664.
    1. Brown GK, Ten HT, Henriques GR, Xie SX, Hollander JE, Beck AT. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA. 2005;294:563–70. doi: 10.1001/jama.294.5.563.
    1. Guthrie E, Kapur N, Mackway-Jones K, Chew-Graham C, Moorey J, Mendel E, et al. Randomised controlled trial of brief psychological intervention after deliberate self poisoning. BMJ. 2001;323:135–8. doi: 10.1136/bmj.323.7305.135.
    1. Johannessen HA, Dieserud G, De LD, Claussen B, Zahl PH. Chain of care for patients who have attempted suicide: a follow-up study from Baerum, Norway. BMC Public Health. 2011;11:81. doi: 10.1186/1471-2458-11-81.
    1. Hvid M, Vangborg K, Sorensen HJ, Nielsen IK, Stenborg JM, Wang AG. Preventing repetition of attempted suicide–II,The Amager project, a randomized controlled trial. Nord J Psychiatry. 2011;65:292–8. doi: 10.3109/08039488.2010.544404.
    1. Morthorst B, Krogh J, Erlangsen A, Alberdi F, Nordentoft M. Effect of assertive outreach after suicide attempt in the AID (assertive intervention for deliberate self harm) trial: randomised controlled trial. BMJ. 2012;345 doi: 10.1136/bmj.e4972.
    1. Cedereke M, Monti K, Ojehagen A. Telephone contact with patients in the year after a suicide attempt: does it affect treatment attendance and outcome? A randomised controlled study. Eur Psychiatry. 2002;17:82–91. doi: 10.1016/S0924-9338(02)00632-6.
    1. Grimholt TK, Bjornaas MA, Jacobsen D, Dieserud G, Ekeberg O. Treatment received, satisfaction with health care services, and psychiatric symptoms 3 months after hospitalization for self-poisoning. Ann Gen Psychiatry. 2012;11:10. doi: 10.1186/1744-859X-11-10.
    1. Wittouck C, De Munck S, Portzky G, Van Rijsselberghe L, Van Autreve S, van Heeringen K. A comparative follow-up study of aftercare and compliance of suicide attempters following standardized psychosocial assessment. Arch Suicide Res. 2010;14:135–45. doi: 10.1080/13811111003704746.
    1. Kapur N, House A, Creed F, Feldman E, Friedman T, Guthrie E. Management of deliberate self poisoning in adults in four teaching hospitals: descriptive study. BMJ. 1998;316:831–2. doi: 10.1136/bmj.316.7134.831.
    1. Gunnell D, Bennewith O, Peters TJ, Stocks N, Sharp DJ. Do patients who self-harm consult their general practitioner soon after hospital discharge? A cohort study. Soc Psychiatry Psychiatr Epidemiol. 2002;37:599–602. doi: 10.1007/s00127-002-0592-1.
    1. Bennewith O, Stocks N, Gunnell D, Peters TJ, Evans MO, Sharp DJ. General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial. BMJ. 2002;324:1254–7. doi: 10.1136/bmj.324.7348.1254.
    1. Hawton K, McKeown S, Day A, Martin P, O’Connor M, Yule J. Evaluation of out-patient counselling compared with general practitioner care following overdoses. Psychol Med. 1987;17:751–61. doi: 10.1017/S0033291700025988.
    1. Platt S, Bille-Brahe U, Kerkhof A, Schmidtke A, Bjerke T, Crepet P, et al. Parasuicide in Europe: the WHO/EURO multicentre study on parasuicide. I. Introduction and preliminary analysis for 1989. Acta Psychiatr Scand. 1992;85:97–104. doi: 10.1111/j.1600-0447.1992.tb01451.x.
    1. Zelen M. A new design for randomized clinical trials. N Engl J Med. 1979;300:1242–5. doi: 10.1056/NEJM197905313002203.
    1. Houston K, Haw C, Townsend E, Hawton K. General practitioner contacts with patients before and after deliberate self harm. Br J Gen Pract. 2003;53:365–70.
    1. Grol R, Wensing M, Mainz J, Jung HP, Ferreira P, Hearnshaw H, et al. Patients in Europe evaluate general practice care: an international comparison. Br J Gen Pract. 2000;50:882–7.
    1. Osvath P, Michel K, Fekete S. Contacts of suicide attempters with healthcare services in Pecs and Bern in the WHO/EURO Multicentre Study on Parasuicide. Int J Psychiatry Clin Pract. 2003;7:3–8. doi: 10.1080/13651500310001004.
    1. Arensman E, Townsend E, Hawton K, Bremner S, Feldman E, Goldney R, et al. Psychosocial and pharmacological treatment of patients following deliberate self-harm: the methodological issues involved in evaluating effectiveness. Suicide Life Threat Behav. 2001;31:169–80. doi: 10.1521/suli.31.2.169.21516.
    1. Hepp U, Wittmann L, Schnyder U, Michel K. Psychological and psychosocial interventions after attempted suicide: an overview of treatment studies. Crisis. 2004;25:108–17. doi: 10.1027/0227-5910.25.3.108.
    1. Gjelsvik B, Heyerdahl F, Lunn D, Hawton K. Change in access to prescribed medication following an episode of deliberate self-poisoning: a multilevel approach. PLoS One. 2014;9 doi: 10.1371/journal.pone.0098086.
    1. Mortensen PB, Agerbo E, Erikson T, Qin P, Westergaard-Nielsen N. Psychiatric illness and risk factors for suicide in Denmark. Lancet. 2000;355:9–12. doi: 10.1016/S0140-6736(99)06376-X.
    1. Haw C, Hawton K, Casey D. Deliberate self-harm patients of no fixed abode: a study of characteristics and subsequent deaths in patients presenting to a general hospital. Soc Psychiatry Psychiatr Epidemiol. 2006;41:918–25. doi: 10.1007/s00127-006-0106-7.
    1. Runeson B, Tidemalm D, Dahlin M, Lichtenstein P, Langstrom N. Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study. BMJ. 2010;341:c3222. doi: 10.1136/bmj.c3222.
    1. Anderson T, Ogles BM, Patterson CL, Lambert MJ, Vermeersch DA. Therapist effects: facilitative interpersonal skills as a predictor of therapist success. J Clin Psychol. 2009;65:755–68. doi: 10.1002/jclp.20583.
    1. Gibbons JS, Butler J, Urwin P, Gibbons JL. Evaluation of a social work service for self-poisoning patients. Br J Psychiatry. 1978;133:111–8. doi: 10.1192/bjp.133.2.111.
    1. Hawton K, Catalan J. Psychiatric management of attempted suicide patients. Br J Hosp Med. 1981;25:365–72.
    1. Townsend E, Hawton K, Altman DG, Arensman E, Gunnell D, Hazell P, et al. The efficacy of problem-solving treatments after deliberate self-harm: meta-analysis of randomized controlled trials with respect to depression, hopelessness and improvement in problems. Psychol Med. 2001;31:979–88. doi: 10.1017/S0033291701004238.
    1. Suominen KH, Isometsa ET, Ostamo AI, Lonnqvist JK. Health care contacts before and after attempted suicide. Soc Psychiatry Psychiatr Epidemiol. 2002;37:89–94. doi: 10.1007/s127-002-8220-y.
    1. Runeson B. Parasuicides without follow-up. Nord J Psychiatry. 2001;55:319–23. doi: 10.1080/080394801317080819.
    1. Cooper J, Murphy E, Jordan R, Mackway-Jones K. Communication between secondary and primary care following self-harm: are National Institute of Clinical Excellence (NICE) guidelines being met? Ann Gen Psychiatry. 2008;7:21. doi: 10.1186/1744-859X-7-21.
    1. Gilbody S, House A, Owens D. The early repetition of deliberate self harm. J R Coll Physicians Lond. 1997;31:171–2.
    1. Fleischmann A, Bertolote JM, Wasserman D, De LD, Bolhari J, Botega NJ, et al. Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bull World Health Organ. 2008;86:703–9. doi: 10.2471/BLT.07.046995.

Source: PubMed

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