The development of an electronic clinical decision support system to assist with the identification, assessment and management of suicidality in primary care
Background: Primary care, is usually the first and last healthcare contact recorded by people who die by suicide. It previously been suggested that primary care holds potential to make a significant contribution to enhancing suicide and self-harm prevention. However, previous research highlights sig...
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| Format: | Thesis (University of Nottingham only) |
| Language: | English English |
| Published: |
2023
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| Online Access: | https://eprints.nottingham.ac.uk/71997/ |
| Summary: | Background: Primary care, is usually the first and last healthcare contact recorded by people who die by suicide. It previously been suggested that primary care holds potential to make a significant contribution to enhancing suicide and self-harm prevention. However, previous research highlights significant variability in the way GPs conceptualise, assess and manage patient suicidality, and previous attempts to offer GPs suicidality prevention training have generated inconclusive results. Previous research has identified a range of organisational and contextual factors negatively impacting on GPs ability to support patients in suicidality distress. As a result of these contextual considerations, GPs have previously suggested a clinical decision-making tool could support them in working with patient suicidality. Clinical decision support systems (CDSS) have been widely implemented in primary care for a range of ambulatory presentations, however no empirically evaluated CDSS exists to support GPs in working with patient suicidality. A CDSS could support GPs by guiding the consultation, supporting GPs’ clinical decision-making and standardising the way the consultation is recorded in patient’s clinical records.
Methods: A mixed methods approach was adopted to develop the content of the CDSS and provide an initial evaluation of the prototype. The CDSS was developed following four empirical studies within the thesis. The first two studies gained perspectives of GPs through one-to-one interviews, and patients with experience of consulting a GP in relation to suicidality, through embedded consultation groups. The third empirical study brought together patients, GPs and suicide prevention experts to participate in a modified Delphi and expert consensus workshops to agree and shape the CDSS content. The fourth empirical study provided an initial usability evaluation of the prototype CDSS.
Findings: Results of the studies corroborated known variation in the way GPs understand and conceptualise suicidality, and highlighted a range of contextual, organisational, and socio-cultural mechanisms which could influence GPs use of the CDSS. The studies shaped the content of the CDSS so that it was appropriate for the clinical and contextual demands of primary care practice. GPs reported the prototype CDSS possessed adequate usability and was acceptable in terms of its ease of use, content and ability to support their clinical decision-making.
Conclusions: This research shows that the prototype CDSS has potential to improve GPs’ assessment and clinical management of patient suicidality in primary care. As an evidence-based quality improvement the CDSS could support GPs, and patients, to collaboratively discuss and care-plan in relation to suicidality and make an important contribution to promoting shared decision-making whilst enhancing suicide prevention efforts in primary care. |
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