Dos Santos Treichel Carlos Alberto, Bakolis Ioannis, Onocko-Campos Rosana Teresa
Department of Collective Health, School of Medical Sciences, University of Campinas, St. Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz., Campinas, SP, Zip code 13083-887, Brazil.
Department of Biostatistics and Health Informatics, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Int J Ment Health Syst. 2021 Dec 4;15(1):84. doi: 10.1186/s13033-021-00507-6.
Although access to specialized services is one of the main components of the study of paths to mental health care worldwide, the factors related to the continuity of the patient's link with Primary Care after admission to a Specialized Mental Health Services still need to be explored in greater depth. Thus, this study aimed to evaluate the determinants of timely access to Specialized Mental Health Services (outcome 1) and maintenance of a link with Primary Care after patients' admission (outcome 2).
This is a cross-sectional study, conducted with 341 users of Specialized Mental Health Services at outpatient and community level in a medium-sized city in Brazil between August and November 2019. Associations between the outcomes and the other variables were explored with the use of Poisson regression models with robust variance estimators.
Factors positively associated with timely access were the diagnosis of psychosis or psychoactive substance misuse. The inversely associated factors with this outcome were higher income, having their need for mental health care identified in an appointment for general complaints, having been referred to the current service by Primary Care, having attended the current service for up to 3 years and delay until the first appointment (in a previous service). Regarding the maintenance of a link with Primary Care, factors positively associated were being referred to the current service by Primary Care or private service and receiving visits from Community Health Agents. The inversely associated factors with this outcome were male sex, being employed, having a diagnosis of psychosis or psychoactive substance misuse, and a greater perception of social support.
In addition to individual factors, factors related to the organization of services and the referral between them stood out in influencing both the access and maintenance of the patients' link with Primary Care. Thus, this study reinforces the idea that integration between Primary Care and Specialized Mental Health Services should be strengthened, both to reduce waiting times for between-service referrals and benefit of care continuity.
尽管获得专科服务是全球精神卫生保健途径研究的主要组成部分之一，但患者在进入专科精神卫生服务机构后与初级保健保持联系的相关因素仍需更深入地探讨。因此，本研究旨在评估及时获得专科精神卫生服务的决定因素（结果1）以及患者入院后与初级保健保持联系的情况（结果2）。
这是一项横断面研究，于2019年8月至11月在巴西一个中等城市的门诊和社区层面，对341名专科精神卫生服务使用者进行。通过使用具有稳健方差估计量的泊松回归模型，探讨结果与其他变量之间的关联。
与及时获得服务呈正相关的因素是精神病或精神活性物质滥用的诊断。与该结果呈负相关的因素是收入较高、在一般投诉预约中被确定有精神卫生保健需求、由初级保健机构转诊至当前服务机构、在当前服务机构就诊达3年以及首次预约（在前一个服务机构）的延迟。关于与初级保健保持联系，呈正相关的因素是由初级保健机构或私人服务机构转诊至当前服务机构以及接受社区卫生工作者的探访。与该结果呈负相关的因素是男性、就业、患有精神病或精神活性物质滥用以及对社会支持的感知更强。
除了个体因素外，与服务组织及其之间的转诊相关的因素在影响患者与初级保健的联系的获得和维持方面也很突出。因此，本研究强化了这样一种观点，即应加强初级保健与专科精神卫生服务之间的整合，以减少服务间转诊的等待时间并受益于护理连续性。
