Grace Niu_Protocol #5 Prevention of Suicide in the Elderly

Grace Niu_Protocol #5 Prevention of Suicide in the Elderly

by Grace -

A. Describe one tool that you will employ in your intervention strategy using the following domains....

Tool—type: Identification of barriers in the detection of depression and suicidal ideation in patients

Target Population: Primary Care Providers (Doctors, Nurse Practitioners, Physician's Assistants) at Kaiser Hospitals and who have clinical appointments at UCSF (members of the research practice-based networks).

Target Behavior: Use screening tools/assessments for depression and suicidal ideation in primary care practice and make proper follow-up referrals

PRECEDE Category: Enabling

Platform: Educational talks, seminars, In-person lecture during grand rounds

B. For a multi-tool intervention strategy, use the PER worksheet attached to describe how you will address each of the PRECEDE framework components 

PER Worksheet. 

Target Behavior

Use screening assessment for depression and suicidal ideation in patients during primary care visits

Target Audience

PCP’s (physicians, nurse practitioners, physicians’ assistants)

Other Key Individuals

Geriatric Patients, Administrators, Educators, Nurses

PREDISPOSING

ENABLING

REINFORCING

KNOW

BE ABLE TO DO (skills)

REMINDED

Large percentage of older patients who commit suicide visit their PCP’s within weeks of completing suicide. Physicians don’t always know how to ask about suicide or how to provide follow-up care for depression and suicidal ideation.

Ask specific questions in regards to depression and suicidal ideation.

Official screening tool (logic and algorithm) that providers can use that have preset questions and follow-up steps.

 

 

 

BELIEVE/VALUE

ACCESS TO

POSITIVE REINFORCEMENT

Depression is a normal part of aging and suicidal ideation in older adults is a sign that older adults are thinking about end of life as they age.

Behavioral Health staff (psychiatrists, psychologists, social workers)

 

Helpline that provides direction for next steps

Use of screening tool (reflects well on performance reviews and ratings)

 

Assurance that patients will be well cared for by behavioral health staff

 

 

 

INTENTION

ACCESS REMOVED

NEGATIVE REINFORCEMENT

Improve overall care for geriatric patients especially those with depression.

 

Increased time for visits talking about physical concerns.

 

 

 

OTHER

 

SOCIAL SUPPORT

 

 

Peer pressure

 

 

Listening to concerns

 

 

 

Re: Grace Niu_Protocol #5 Prevention of Suicide in the Elderly

by Ralph Gonzales -

Thanks Grace.

I’d reorient your answers a little bit.  Your “Tool type” seems to be a screening tool/assessment for depression.  Your platform is pretty typical (educational seminars, etc), but I would encourage you to think about ways to get the tool in provider’s hands in real-time, and the point-of-care when they need it.  You want to place it INTO the workflow as much as possible, without adversely affecting the workflow (and even better—improving the workflow).

Nice Job with the PER worksheet.  On “Intention”, you’d like to include intentions that are more specific to your target behavior (use screening tool), and you’d like to include the other “Key Individuals” across all constructs of the PER worksheet as applicable.  The “Intention” construct is particularly useful to use as a metric for pilot testing or comparing the effects of different approaches to implementing your screening tool.  You can compare PCPs responses to the question “how likely are you to use the screening tool” across different platform strategies, for example.  Same is true for deciding what are the key messages in an educational campaign, for both PCPs as well as patients.

Under “Access to”, I would also include access to/access removed for utilizing the screening tool.  One of the most common access barriers to remove in Primary Care is the lack of available time to do the complete assessment for complex patients.

Re: Grace Niu_Protocol #5 Prevention of Suicide in the Elderly

by Purba Chatterjee -

Hi Grace,

Nice job! Is it possible to do task shifting here and have the nurses do the screening? That would fall under Enabling - Able to Do. This would reduce the burden on the physician and perhaps would be easier to implement the screening tool.

-Purba

Re: Grace Niu_Protocol #5 Prevention of Suicide in the Elderly

by Ralph Gonzales -

excellent suggestion!  task shifting/repurposing professional roles is often a very effective strategy in health care settings with teams.