Zitko Pedro, Ramírez Jorge, Markkula Niina, Norambuena Pablo, Ortiz Ana Maria, Sepúlveda Rafael
Dr. Zitko is with the Unidad de Estudios Asistenciales, Hospital Barros Luco Trudeau, Santiago, Chile, and with the Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago. Dr. Ramírez and Dr. Sepúlveda are with the School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago. Dr. Sepúlveda is also with Clinical Psychiatry Service, Hospital Barros Luco Trudeau, Santiago, where Ms. Ortiz is affiliated. Dr. Markkula and Mr. Norambuena are with the Department of Mental Health, Ministry of Health, Santiago. Dr. Markkula is also with the Faculty of Medicine, Universidad Diego Portales, Santiago. Mr. Norambuena is also with the Department of Psychology, Universidad de Santiago de Chile, Santiago.
Psychiatr Serv. 2017 Aug 1;68(8):832-838. doi: 10.1176/appi.ps.201600371. Epub 2017 May 1.
The community model of mental health care (CMMHC) is recommended as the best way to organize mental health care, but evidence of its successful implementation and effectiveness is scarce, particularly in resource-poor settings. This study aimed to evaluate the impact of CMMHC on the rate of psychiatric emergency visits in Santiago, Chile.
The rate of psychiatric emergency visits from 2006 to 2011 was compared between two health care administrative districts: district 1 (D1), in which CMMHC was being systematically implemented, and D2, where CMMHC implementation was very limited and inconsistent. In addition, rates of psychiatric emergency visits in ten D1 municipalities were compared by the degree to which they had implemented CMMHC.
Compared with D2, D1 had higher rates of psychiatric emergency visits during the observation period. In D1, the rate of visits per 100,000 inhabitants declined from 541 in 2006 to 414 in 2011. In D2, the rate increased from 104 in 2006 to 130 in 2011. In D1 municipalities, the reduction in the rate of psychiatric emergency visits was greater in those with well-implemented CMMHC compared with those with partially implemented CMMHC. When distance to the emergency room was taken into account, the 2011 rate of emergency visits in the ten D1 municipalities was 21% (p<.01) lower in those with well-implemented CMMHC than in those with partially implemented CMMHC.
CMMHC implementation leads to reduction in psychiatric emergency visits, which are burdensome to both users and providers. Results support CMMHC implementation in resource-poor settings.
社区精神卫生保健模式（CMMHC）被推荐为组织精神卫生保健的最佳方式，但关于其成功实施及有效性的证据却很匮乏，尤其是在资源匮乏地区。本研究旨在评估CMMHC对智利圣地亚哥精神科急诊就诊率的影响。
比较了2006年至2011年两个医疗保健行政区的精神科急诊就诊率：1区（D1），在该区CMMHC正在系统实施；以及2区（D2），在该区CMMHC的实施非常有限且不一致。此外，还按CMMHC的实施程度比较了D1区十个市的精神科急诊就诊率。
与D2区相比，D1区在观察期内精神科急诊就诊率更高。在D1区，每10万居民的就诊率从2006年的541降至2011年的414。在D2区，该比率从2006年的104增至2011年的130。在D1区的各市中，与CMMHC部分实施的市相比，CMMHC实施良好的市精神科急诊就诊率下降幅度更大。考虑到与急诊室的距离后，2011年D1区十个市中，CMMHC实施良好的市的急诊就诊率比CMMHC部分实施的市低21%（p<0.01）。
CMMHC的实施可降低精神科急诊就诊率，而急诊就诊对患者和医疗机构来说都是负担。研究结果支持在资源匮乏地区实施CMMHC。
