Sepúlveda Rafael, Zitko Pedro, Ramírez Jorge, Markkula Niina, Alvarado Rubén
Universidad de Chile, Escuela de Salud Pública, Santiago de Chile, Chile.
King's College London, Health Service and Population Research Department, IoPPN, London, United Kingdom of Great Britain and Northern Ireland.
Rev Panam Salud Publica. 2018 Oct 10;42:e138. doi: 10.26633/RPSP.2018.138. eCollection 2018.
To assess the quality of consultation liaison across all primary health care centers in Chile, and its potential relationship with the psychiatric hospitalization rate.
We carried out a countrywide ecological cross-sectional study on 502 primary health centers in 275 municipalities (87.3% of total primary health centers in Chile) during 2009. We characterized the presence of consultation liaison using four criteria: availability, frequency, continuity of participants, and continuity across care levels. We also created a dichotomous variable called "optimal consultation liaison" for when all four criteria were met. A quasi-Poisson regression model was used to estimate the rate of hospitalization due to different psychiatric disorders, adjusting by population attributes.
Of the primary health centers, 28.3% of them had had optimal consultation liaison during the preceding year, concentrated in the poorest and richest municipalities. Continuity of care was the criterion that was met least often (38.3%). The presence of optimal consultation liaison at the municipal level was associated with fewer psychiatric discharges, with the following incidence rate ratios and 95% confidence intervals (CIs): schizophrenia, 0.65 (95% CI: 0.49-0.85); other psychoses, 0.68 (95% CI: 0.52-0.89); and personality disorders, 0.66 (95% CI: 0. 49-0.89). Municipalities with optimal consultation liaison showed 2.44 fewer total psychiatric discharges per 10 000 inhabitants, although without reaching statistical significance (-0.85 to 5.70).
Using a nationally representative sample, we found that consultation liaison in primary care was associated with having fewer psychiatric hospitalizations. More studies are required to understand the role of each component of consultation liaison.
评估智利所有初级卫生保健中心的会诊联络质量及其与精神科住院率的潜在关系。
2009年，我们在275个市的502个初级卫生保健中心（占智利初级卫生保健中心总数的87.3%）开展了一项全国性生态横断面研究。我们使用四个标准来描述会诊联络的情况：可及性、频率、参与者的连续性以及不同护理层面之间的连续性。当所有四个标准都满足时，我们还创建了一个名为“最佳会诊联络”的二分变量。使用准泊松回归模型来估计因不同精神疾病导致的住院率，并根据人口属性进行调整。
在前一年，28.3%的初级卫生保健中心具备最佳会诊联络，这些中心集中在最贫困和最富裕的市。护理连续性是最常未达标的标准（38.3%）。市级层面存在最佳会诊联络与精神科出院人数减少相关，以下是发病率比及95%置信区间（CI）：精神分裂症，0.65（95%CI：0.49 - 0.85）；其他精神病，0.68（95%CI：0.52 - 0.89）；人格障碍，0.66（95%CI：0.49 - 0.89）。每10000名居民中，具备最佳会诊联络的市精神科出院总人数少2.44例，尽管未达到统计学显著性（-0.85至5.70）。
通过具有全国代表性的样本，我们发现初级保健中的会诊联络与精神科住院人数减少相关。需要更多研究来了解会诊联络各组成部分的作用。
