Rocha Hugo André da, Santos Alaneir de Fátima Dos, Reis Ilka Afonso, Santos Marcos Antônio da Cunha, Cherchiglia Mariângela Leal
Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Rev Saude Publica. 2018;52:17. doi: 10.11606/s1518-8787.2018052000051. Epub 2018 Feb 26.
OBJECTIVE To determine the items of the Brazilian National Program for Improving Access and Quality of Primary Care that better evaluate the capacity to provide mental health care. METHODS This is a cross-sectional study carried out using the Graded Response Model of the Item Response Theory using secondary data from the second cycle of the National Program for Improving Access and Quality of Primary Care, which evaluates 30,523 primary care teams in the period from 2013 to 2014 in Brazil. The internal consistency, correlation between items, and correlation between items and the total score were tested using the Cronbach's alpha, Spearman's correlation, and point biserial coefficients, respectively. The assumptions of unidimensionality and local independence of the items were tested. Word clouds were used as one way to present the results. RESULTS The items with the greatest ability to discriminate were scheduling of the agenda according to risk stratification, keeping of records of the most serious cases of users in psychological distress, and provision of group care. The items that required a higher level of mental health care in the parameter of location were the provision of any type of group care and the provision of educational and mental health promotion activities. Total Cronbach's alpha coefficient was 0.87. The items that obtained the highest correlation with total score were the recording of the most serious cases of users in psychological distress and scheduling of the agenda according to risk stratification. The final scores obtained oscillated between -2.07 (minimum) and 1.95 (maximum). CONCLUSIONS There are important aspects in the discrimination of the capacity to provide mental health care by primary health care teams: risk stratification for care management, follow-up of the most serious cases, group care, and preventive and health promotion actions.
目的 确定巴西初级保健改善可及性与质量国家计划中能更好评估提供精神卫生保健能力的项目。方法 这是一项横断面研究，采用项目反应理论的等级反应模型，使用来自初级保健改善可及性与质量国家计划第二个周期的二手数据，该计划在2013年至2014年期间对巴西的30523个初级保健团队进行了评估。分别使用克朗巴哈α系数、斯皮尔曼相关性和点二列相关系数检验项目的内部一致性、项目之间的相关性以及项目与总分之间的相关性。检验了项目的单维性和局部独立性假设。词云被用作呈现结果的一种方式。结果 具有最大区分能力的项目是根据风险分层安排议程、记录心理困扰最严重的用户病例以及提供团体护理。在地点参数方面需要更高水平精神卫生保健的项目是提供任何类型的团体护理以及开展教育和精神卫生促进活动。克朗巴哈α系数总分是0.87。与总分相关性最高的项目是记录心理困扰最严重的用户病例以及根据风险分层安排议程。最终得分在-2.07（最小值）和1.95（最大值）之间波动。结论 初级卫生保健团队在提供精神卫生保健能力的区分方面存在重要方面：护理管理的风险分层、最严重病例的随访、团体护理以及预防和健康促进行动。
