Consulta de urgencia psiquiátrica y modelo comunitario de atención en salud mental

Abstract

Introduction: Health care model evaluation in mental health is complex, and there is a lackof impact studies on those services, as well as on the Community Mental Health Care Model(CMHC). Emergency Psychiatric Consultation (EPC) is used as an indicator of results: it includesboth real emergencies and unresolved demand. The Barros Luco Health Care Complex (BLHC)provides an opportunity to study the impact of the CMHC model: it provides EPC to two healthservices, South (SHS) and South-East (SEHS). The former has more widely implemented theCMHC model, and the counties of the SHS range in their implementation of the CMH model.Objective: Compare the variation in rates of EPC in the BLHC by health service of origin, and by county within the SHS. Methodology: This is an observational retrospective study (2006-2007).Counties within the SHS were categorized by implementation of the CMH model and distance tothe BLHC, and analyzed using Poisson regression models. Results: 11,760 EPC were analyzed.A decrease in EPC rates can be observed, which is greater in the SHS and in the counties thathave implemented the CMHC model. Nevertheless, counties with the CMHC model had incidencerate ratios (IRR) for EPC that were more than twice as high. After adjusting for distance andyears, the IRR decreased (1.38 [96% CI 1.07-1.77]). There are differences in the decrease inEPC between counties that are not explained by the factors studied. Discussion: Greater developmentof the CMHC model could be associated with the decrease in EPC. There are limitations: shortobservation period, lack of adjustments for other confounding factors, imprecise categories.