Abstract
BackgroundWe aimed to describe primary care management at the time of a suicide attempt (SA) and after the SA.MethodsAn observational (cross-sectional) study was conducted among 166 sentinel GPs within France (a non-gatekeeping country) between 2013 and 2017 for all GP’s patients who attempted suicide. Measurements: frequency of patients 1) managed by the GP at the time of the SA, 2) addressed to an emergency department (ED), 3) without care at the time of the SA, and 4) managed by the GP after the SA and factors associated with GP management at the time of and after the SA.ResultsThree hundred twenty-one SAs were reported, of which N = 95 (29.6%) were managed by the GP at the time of the SA, N = (70.5%) were referred to an ED, and N = (27.4%) remained at home. Forty-eight (14.9%) patients did not receive any care at the time of the SA and 178 (55.4%) were managed directly by an ED. GPs were more likely to be involved in management of the patient at the time of the SA if they were younger (39.2% for patients < 34 years old; 22.9% for those 35 to 54 years old, and 30.3% for those more than 55 years old p = 0.02) or the SA involved a firearm or self-cutting (51.9%) versus those involving drugs (23.7%); p = 0.006). After the SA, GPs managed 174 patients (54.2%), more often (60%) when they provided care at home at the time of the SA, p = 0.04; 1.87 [1.07; 3.35]. No other factor was associated with management by GPs after the SA.ConclusionsThe study faced limitations: data were not available for patients managed solely by specialists during their SA and results may not be generalisable to countries with a stronger gatekeeping system. We concluded that GPs are involved in the management of patients at the time of a SA for a third of patients. EDs are the major provider of care at that time. Half patients consulted GPs after the SA and connections between GPs and ED upon discharge should be improved.
Highlights
We aimed to describe primary care management at the time of a suicide attempt (SA) and after the SA
The study faced limitations: data were not available for patients managed solely by specialists during their SA and results may not be generalisable to countries with a stronger gatekeeping system
We concluded that General practitioner (GP) are involved in the management of patients at the time of a SA for a third of patients
Summary
We aimed to describe primary care management at the time of a suicide attempt (SA) and after the SA. A South-African study explored the attitudes of 130 prehospital providers (not including GPs) on transport decision in the management of SA patients who refuse care. They reported a critical lack of training and certain negative attitudes and difficulties [18]. The first aim of our study was to describe further, in another non-gatekeeping country, the role of GPs as first caregiver following the SA (how often, for which patients, and their management: how often GPs refer patients to the hospital, how often they give care in place of the hospital)
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