Knowledge Support to support clinicians to manage self-harm and preventing suicide in primary care

Development work question What are the requirements and acceptability criteria of knowledge support interventions for the management of self-harm in primary care, and which methods and outcomes are needed to test effectiveness?

Background The rate of people who have harmed themselves is increasing, and those who have self-harmed are many times more likely to die by suicide than those who have not.

Due to a limited availability of specialised services, primary care plays an important role in the management of patients who have self-harmed.

Despite this, patient experience in primary care is often poor: patients are unsure of which support services are available to them or may not be offered any by their GP, whilst many GPs are unaware of guidelines, which may lead to unsafe practice.

The need for personalised risk assessment and tailored support is widely championed, yet few tools are available to assist with this.

There is evidence to suggest that knowledge support tools may improve GP services – these are tools which provide knowledge to patients and clinicians (during or outside of consultations) to help facilitate the delivery of optimal treatment.

Prior to the development of this proposal, the concept of a digital support intervention was discussed during a patient and carer involvement and engagement group meeting (Mutual Support for Mental Health-Research).

They identified a lack of resources and signposting information for patients within primary care, and outlined that improved care from GPs in the early stages of the care pathway could improve patient experience.

Aims and objectives The overall aim of this development work will be to: (i) understand the required features of digital knowledge support interventions to support clinical care for people who have self-harmed, (ii) test acceptability of these interventions with clinicians and patients, and (iii) determine how to test the effectiveness of these interventions.

The content of interventions will be co-developed and tested in a future programme.

Development work plan Workstream 1: develop a research infrastructure to assist with the development work and future programme. Workstream 2: use OpenSAFELY to explore current management of self-harm and evaluate risk factors for adverse outcomes.

Workstream 3: perform qualitative work with clinicians and patients to understand required features for knowledge support.

Workstream 4: perform qualitative work with clinicians and patients to explore the format and acceptability of knowledge support.

Workstream 5: determine the approach and choice of outcomes for testing the effectiveness of knowledge support in the future programme. We will work closely with clinicians, patients and carers throughout. Timelines for delivery The development work will be completed in 23 months.

It is anticipated that a Programme Grant for Applied Research will be applied for following completion of the development work, should success criteria be met.

Anticipated impact and dissemination This development work will lead to the co-development of knowledge support interventions and a trial to determine if such tools improve patient care.

Our work will be disseminated through reports and publications, as well as infographics and lay-summaries for patient and public engagement.