Salgado Manoela Alves, Fortes Sandra Lucia Correia Lima
Universidade do Estado do Rio de Janeiro, Rio de janeiro, Brasil.
Cad Saude Publica. 2021 Oct 15;37(9):e00178520. doi: 10.1590/0102-311X00178520. eCollection 2021.
The objective was to demonstrate the rate of detection of mental disorders in primary healthcare units as a marker of access and indicator of care in mental health. A comparative case study was performed in the electronic patient files of adults seen in two neighboring primary care units in the city of Rio de Janeiro, Brazil, in 2015-2016 and 2016-2017. Diagnoses of mental disorders were extracted, using the International Classification of Diseases, dividing them into three groups: common mental disorders (CMD: F32; F33 F40-45, except F42, and R45), severe mental disorders (SMD: F20-F29; F31-F39), and alcohol and drug use (AD: F10-F19 and Z72). The results were compared to the community prevalence of mental disorders reported in the literature. Statistical analysis was applied with the chi-square test, in addition to a qualitative analysis of each unit´s scenario. Unit A (2015-2016) showed a low detection rate for all disorders [SMD = 45 (0.8%); CMD = 148 (2.64%) and AD = 0]; unit B detected about 50% of the expected cases [SMD = 23 (0.98%); CMD = 140 (5.97%) and AD = 130 (5.54%)]. In 2016-2017 there was an increase in the overall detection of mental disorders at unit A [SMD = 89 (1.6%); CMD = 298 (5.24%) and AD = 7 (0.12%)], in unit B the detection rate remained similar [SMD = 25 (1.0%); CMD = 176 (7.14%) and AD = 121 (4.9%)]. Changes in the units were detected. Distinction in the detection rate was used as an indicator for analysis of mental health care, allowing the study of factors potentially associated with this variation, influencing access to care. Monitoring this indicator helps improve mental health care.
目的是证明基层医疗单位精神障碍的检出率，以此作为心理健康服务可及性的标志和护理指标。2015 - 2016年及2016 - 2017年，在巴西里约热内卢市两个相邻的基层医疗单位对成年患者的电子病历进行了一项比较案例研究。使用国际疾病分类提取精神障碍诊断，将其分为三组：常见精神障碍（CMD：F32；F33、F40 - 45，F42除外，以及R45）、严重精神障碍（SMD：F20 - F29；F31 - F39）和酒精及药物使用障碍（AD：F10 - F19和Z72）。将结果与文献中报道的社区精神障碍患病率进行比较。除了对每个单位的情况进行定性分析外，还应用卡方检验进行统计分析。单位A（2015 - 2016年）所有障碍的检出率较低[严重精神障碍 = 45例（0.8%）；常见精神障碍 = 148例（2.64%），酒精及药物使用障碍 = 0例]；单位B检测到约50%的预期病例[严重精神障碍 = 23例（0.98%）；常见精神障碍 = 140例（5.97%），酒精及药物使用障碍 = 130例（5.54%）]。2016 - 2017年，单位A精神障碍的总体检出率有所增加[严重精神障碍 = 89例（1.6%）；常见精神障碍 = 298例（5.24%），酒精及药物使用障碍 = 7例（0.12%）]，单位B的检出率保持相似[严重精神障碍 = 25例（1.0%）；常见精神障碍 = 176例（7.14%），酒精及药物使用障碍 = 121例（4.9%）]。发现了各单位的变化。将检出率的差异用作心理健康护理分析的指标，从而能够研究可能与这种差异相关的因素，这些因素会影响护理的可及性。监测这一指标有助于改善心理健康护理。
