Sampaio Mariá Lanzotti, Bispo Júnior José Patrício
Instituto de Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil.
Cad Saude Publica. 2021 Apr 7;37(3):e00042620. doi: 10.1590/0102-311X00042620. eCollection 2021.
This study aimed to assess the structure and process of linkage of mental healthcare, with a focus on services in the Network of Psychosocial Care (RAPS, in Portuguese) and other social and community devices. This was an evaluative study with a qualitative approach through the identification of the RAPS structure and the evaluation of the process of linking mental healthcare in Vitória da Conquista, Bahia State, Brazil. Semi-structured interviews were held with 33 participants including administrators, professionals, and patients and participant observation in RAPS services. Analytical procedures featured a matrix with three dimensions: structure and composition of RAPS; organization and linkage of RAPS; and comprehensiveness of care and inter-sector linkage. The results showed that despite the expansion of RAPS, the services proved insufficient for meeting the demand, with difficulties in access by users. The linkage between services showed the shaping of a fragmented network, with centralization of specialized services and difficulties in communication with primary care and the emergency care network. The study found a lack of established flows, which left weaknesses in the coordination of care. The development of inter-sector actions, although present, proved to be limited to some sectors. The insufficient structure and segmentation of RAPS were limiting factors for the development of comprehensive and longitudinal mental healthcare.
本研究旨在评估心理卫生保健的联系结构与过程，重点关注心理社会关怀网络（葡萄牙语简称RAPS）及其他社会和社区机构所提供的服务。这是一项采用定性方法的评估研究，通过确定RAPS的结构以及对巴西巴伊亚州孔基斯塔维多利亚市心理卫生保健联系过程进行评估。对33名参与者进行了半结构化访谈，包括管理人员、专业人员和患者，并对RAPS服务进行了参与观察。分析程序采用了一个具有三个维度的矩阵：RAPS的结构与组成；RAPS的组织与联系；护理的全面性与部门间联系。结果显示，尽管RAPS有所扩展，但服务仍不足以满足需求，用户获取服务存在困难。服务之间的联系呈现出一个分散网络的形态，专业服务集中化，与初级保健和急救网络的沟通存在困难。研究发现缺乏既定流程，这导致护理协调存在缺陷。部门间行动虽已开展，但事实证明仅限于某些部门。RAPS结构不足和分割是全面和长期心理卫生保健发展的限制因素。
