380 This outcome is entirely expected because usual care included a follow up

380 this outcome is entirely expected because usual

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380 This outcome is entirely expected because usual care included a follow-up appointment within 72 hours of inpatient discharge. With- in the first 24 hours, a phone call was made to verify an appointment and to encourage attendance. This type of research begins to describe the attributes of expected best practices. A telephone call made 24 hours after discharge reminded the patient of an appointment 24 to 48 hours later. About half the patients in each group were provided outpatient care by the same psychiatrist that provid- ed inpatient care. Attendance was high; 69 percent of patients were involved in aftercare by one month, and 80 percent participation over another month and one-half.
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Continuity of Care for Suicide Prevention and Research 67 Section-at-a-Glance: Suicide-prone patients are more likely to adhere to the recommended treatment plan if treatment-engagement interventions are applied near or at the point of ED or psychiatric inpatient discharge. Among the successful strategies reviewed here are scheduling the first outpatient appointment 48 to 72 hours after discharge and making a reminder phone call. Time spent in the ED with patients and family discussing reasonable treatment expecta- tions and/or seeing and discussing a motivational video appears to increase participation in outpatient treatment, especially for adolescents. The added involvement in the ED of a suicide counselor who continues after the ED visit to furnish follow-up care and case management is likely to decrease the frequency of repeat suicide attempts as well as the frequency of hospital readmissions. Intensive outreach interventions such as home visits and frequent home-based therapy sessions appear to achieve the same sort of favorable outcomes. Interventions encouraging adherence that are delayed by a month or more are likely to have such unfavorable outcomes as suicide attempts and suicide deaths. These findings all support a strong basis for starting outpatient, anti-suicide treatments and mo- tivating treatment plan adherence at the time of the ED visit or concurrent with hospital discharge and for continuing these interventions for some time thereafter. Section-related Recommendations: Please see the end of the next section. Evidence-based Treatments for the Prevention of Suicide Attempts and the Enhancement of Continuity of Care Multiple suicide attempts by the same patient may be reduced by sustained outreach services and/or intensive case management: Patients that make multiple attempts present enormous challenges to every ED and inpatient unit. Repeat attempts are the subject of an important Aus- tralian investigation led by Carter. 381 Carter’s research is modeled after the study by Motto and Bostrom, which is described immediately above.
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