Adjunctive Team Enhanced Intervention to Improve Suicide Prevention Evidence-Based Practices in Primary Care

In order to achieve a 20% reduction in suicide rates by 2025, successful suicide prevention efforts need to optimize care delivered by primary care teams due to their increased likelihood of having contact with patients prior to suicide attempts. Several evidence-based recommendations exist in the clinical practice guidelines for primary care team members to improve suicide prevention at every visit with an at-risk patient (i.e., patient has a risk factor for suicide, such as substance use diagnosis). However, past research has shown there are opportunities for improvement. Successful implementation of these guidelines relies on the knowledge and delivery of the elements of evidence-based care, which often involves several primary care team members working together. In addition, the delivery must be patient-centered to improve success of a patient feeling comfortable enough to share honestly. Both are areas of deficit. Thus, leveraging the team to utilize the team skillsets for interactive learning to improve knowledge, patient-centered care, and address team processes may be ideal to overcome provider's reported barriers to providing evidence-based care, such as lack of self-efficacy. The proposed research will examine the use of evidence-based strategies to improve task-specific team processes packaged within a brief interactive interprofessional educational intervention called Team Education for Adopting Changes in Healthcare (TEACH). Matching the commonly used primary care huddle format often used daily for the team to review patients prior to engaging in clinical services, TEACH involves 4 brief (~20 minutes) team meetings with all members of the primary care teamlet, including the increasing number of embedded behavioral health providers in primary care to discuss suicide prevention. We will conduct a small randomized clinical trial, which will examine the feasibility, acceptability, and effectiveness of TEACH on improving evidence-based suicide prevention care (as assessed via components in the electronic medical record) as well as team processes (as assessed by the Team Development measure) compared to standard practice (i.e., mandated didactics, electronic medical record support) within 8 primary care teamlets. In addition, we will assess the feasibility of recruiting at-risk Veterans to complete a structured interview regarding their experience of the team's suicide prevention efforts during a visit and provide objective measurement of CPG-adherence via audio recording of a recent visit. This work aims to provide preliminary data supporting the use of TEACH as an adjunctive educational strategy to improve patient-centered evidence-based suicide prevention care. If successful, future work would continue to examine the effectiveness of TEACH and work towards examining implementation strategies to help facilitate uptake of TEACH in primary care.