Evaluation of a Promising Intentional Overdose Prevention Strategy in Primary Care

Primary care settings are touted as ideal environments to deliver suicide prevention care because many patients are seen shortly prior to death. However, due to a lack of consideration for the unique challenges (e.g., time burdens) for delivering suicide prevention in primary care, uptake of effective interventions has been severely limited. Through a recently completed AFSP Young Investigator Award, our team used human-centered design to develop an incredibly promising primary care-based intervention—called the Medication Care Plan (MCP)—to prevent intentional overdose. To design this intervention, we interviewed patients with lived experience of intentional overdose, those reporting suicide ideation to primary care providers, and clinicians/leaders supporting primary care.

The MCP is a self-directed web-based intervention that a PCP could refer a patient to in under 1 minute. It is similar in format to the Stanley Brown Safety Plan, with warning signs, coping strategies, social and professional contacts for help. The lethal means section is unique because it lists immediate action steps to improve medication safety now (e.g., disposing of old medications), and action steps to take when warning signs indicate significant distress (e.g., engaging social supports to manage medications).

In open trial of the MCP (N = 29), we found that within one-month patients had already used their MCP, including coping strategies to address intense distress, disposing of old/unused medications, and talking to someone they trust about managing medications. These results are incredibly promising as they illustrate that the MCP could prevent suicide using evidence-based strategies.

There are three gaps that must be overcome before we evaluate effectiveness of the MCP in a larger trial on overdose outcomes: 1) implementation of the MCP into an EHR-compatible tool, 2) evaluating efficacy in a larger and more diverse sample using a randomized design, and 3) ensuring equitable delivery to the best fit patients. We need to build the MCP in a more patient-friendly tool that seamlessly integrates into the EHR for it to be a feasible intervention at scale.

We will partner with Dr. Jordan Braciszewski, a senior scientist at Henry Ford Health who has extensive experience with developing and integrating electronic brief interventions using the Computerized Intervention Authoring System (CIAS) in primary care. CIAS is a no-code, open-source intervention development tool that enables screening, assessment, and intervention using a patient-friendly avatar. Our first aim will use qualitative patient and clinician feedback to develop and test integration of the MCP into an EHR-ready tool (CIAS) at two unique health care institutions in Colorado and Michigan.

Aim 2 will evaluate clinical efficacy of the MCP on medication safety, overdose prevention, and suicide-related coping behaviors (primary outcomes) via randomized control trial in a diverse demographic sample of patients with suicide risk identified in primary care (N = 157). We will evaluate whether we equitably engage a demographically representative sample to complete the MCP and explore predictors of efficacy that can help inform the patient identification strategy or tailoring of the intervention in future trials