Universidade Federal de Sao Paulo, CEP 04021-070 Sao Paulo, Brazil.
Gen Hosp Psychiatry. 2013 May-Jun;35(3):304-8. doi: 10.1016/j.genhosppsych.2013.01.003. Epub 2013 Mar 19.
The aim of this research was to investigate whether a training intervention to enhance collaboration between mental health and primary care professionals improved the detection and management of mental health problems in primary health care in four large cities in Brazil. The training intervention was a multifaceted program over 96 h focused on development of a shared care model.
A quasiexperimental study design was undertaken with assessment of performance by nurse and general practitioners (GPs) pre- and postintervention. Rates of recognition of mental health disorders (compared with the General Health Questionnaire) were the primary outcome, while self-reports of patient-centered care, psychosocial interventions and referral were the secondary outcomes.
Six to 8 months postintervention, no changes were observed in terms of rate of recognition across the entire sample. Nurses significantly increased their recognition rates (from 23% to 39%, P=.05), while GPs demonstrated a significant decrease (from 42% to 30%, P=.04). There were significant increases in reports of patient-centered care, but no changes in other secondary outcomes.
Training professionals in a shared care model was not associated with consistent improvements in the recognition or management of mental health problems. Although instabilities in the local context may have contributed to the lack of effects, wider changes in the system of care may be required to augment training and encourage reliable changes in behavior, and more specific educating models are necessary.
本研究旨在探讨一项旨在增强精神卫生和初级保健专业人员之间协作的培训干预措施是否改善了巴西四个大城市初级保健中心精神卫生问题的检出和管理。培训干预措施是一个为期 96 小时的多方面方案，重点是发展共享护理模式。
采用准实验设计，在干预前后评估护士和全科医生的表现。主要结局是精神卫生障碍的识别率（与一般健康问卷相比），而以患者为中心的护理、心理社会干预和转诊的自我报告为次要结局。
干预后 6 至 8 个月，整个样本的识别率没有变化。护士的识别率显著提高（从 23%提高到 39%，P=.05），而全科医生的识别率则显著降低（从 42%降低到 30%，P=.04）。以患者为中心的护理报告显著增加，但其他次要结局没有变化。
在共享护理模式中培训专业人员并没有一致改善精神卫生问题的识别或管理。尽管当地情况的不稳定可能导致了缺乏效果，但可能需要对护理系统进行更广泛的改变，以增强培训并鼓励行为的可靠变化，还需要更具体的教育模式。
