Ghesquiere Angela R, Pinto Rogerio M, Rahman Rahbel, Spector Anya Y
Brookdale Center for Healthy Aging, Hunter College of the City University of New York, 2180 Third Ave, New York, NY 10035, USA.
School of Social Work, University of Michigan, Room 3792 SSWB, 1080 S. University Ave., Ann Arbor, MI 48109, USA.
Int J Environ Res Public Health. 2015 Dec 23;13(1):ijerph13010033. doi: 10.3390/ijerph13010033.
Brazil has a unique mental health care system, characterized by universal coverage delivered by interdisciplinary teams both in the community and in specialized centros de atenção psicossocial (CAPS-psychosocial care centers). Provision of patient-centered mental health care is an important principle of Brazilian mental health care, but this topic has not been well-studied. We analyzed data from a cross-sectional survey of 151 community health workers (CHWs), nurses, and physicians in Santa Luzia, Minas Gerais State, Brazil. Chi-squares, t-tests and multivariate regression analyses examined differences in socio-demographics, caseload, engagement in evidence-based practices (EBPs), and transdisciplinary collaboration between providers who reported providing high levels of patient-centered mental health care and those who did not. In multivariate regression models, components of transdisciplinary collaboration were significantly associated with providers' perceptions of patient-centered mental health care (p < 0.05). CHWs were also significantly more likely to report providing patient-centered care than physicians and nurses. EBP engagement and sociodemographics were not associated with perceptions. Results suggest that training efforts to improve patient-centered mental health care in Brazil could build upon CHWs' skills and focus on transdisciplinary collaboration. Findings may inform practice in other countries with similar health care systems.
巴西拥有独特的精神卫生保健系统,其特点是由社区和专门的心理社会关怀中心(CAPS)的跨学科团队提供全民覆盖的服务。提供以患者为中心的精神卫生保健是巴西精神卫生保健的一项重要原则,但这一主题尚未得到充分研究。我们分析了来自巴西米纳斯吉拉斯州圣卢西亚的151名社区卫生工作者(CHW)、护士和医生的横断面调查数据。卡方检验、t检验和多元回归分析考察了在社会人口统计学、工作量、循证实践(EBP)参与度以及报告提供高水平以患者为中心的精神卫生保健的提供者与未提供此类保健的提供者之间的跨学科协作方面的差异。在多元回归模型中,跨学科协作的组成部分与提供者对以患者为中心的精神卫生保健的认知显著相关(p < 0.05)。与医生和护士相比,CHW报告提供以患者为中心的护理的可能性也显著更高。EBP参与度和社会人口统计学与认知无关。结果表明,巴西为改善以患者为中心的精神卫生保健所做的培训努力可以基于CHW的技能,并侧重于跨学科协作。研究结果可能为其他拥有类似卫生保健系统的国家的实践提供参考。