Consulta de urgencia psiquiátrica y modelo comunitario de atención en salud mental / Emergency psychiatric consultation and the community mental health care model

RESUMEN

Introducción: La evaluación de modelos de atención en salud mental es compleja, existiendo carencias de estudios de impactos de estos servicios; también del Modelo Comunitario de Atención en Salud Mental (MCASM). La Consulta de Urgencia Psiquiátrica (CUP) se utiliza como indicadorde resultado: reúne emergencia real y demanda no resuelta. El Complejo Asistencial Barros-Luco (CABL) constituye un modelo naturalístico de comparación provee CUP a 2 servicios de salud Sur (SSMS) y Sur-Oriente (SSMSO), el primero con mayor desarrollo del MCASM. Del mismomodo las comunas del SSMS presentan distintos grados de implementación del MCASM. Objetivo: Comparar la variación de tasas de CUP en el CABL, según SS de procedencia y comuna delSSMS. Metodología: Estudio observacional retrospectivo (años 2006-2007). Se compararoncomunas del SSMS, categorizándolas por presencia de MCASM y distancia al CABL usando modelos de regresión de poisson. Resultados: Se analizaron 11.760 CUP. Existe caída de tasasde CUP, proporcionalmente mayores en SSMS y en comunas con MCASM. Sin embargo, comunas con MCASM presentan Razón de Tasas de Incidencia (RTI) de CUP mayores al doble. Al ajustar por distancia y años, la RTI disminuye (1,38 [96%IC 1,07-1,77]). Hay diferencias en caída deCUP entre comunas, no explicables por los factores estudiados. Discusión: Mayor desarrollo del MCASM podría asociarse a disminución de CUP. Hay limitaciones periodo de observación corto, ausencia de ajustes por otros confundentes, categorizaciones poco precisas.

ABSTRACT

Introduction: Health care model evaluation in mental health is complex, and there is a lack of impact studies on those services, as well as on the Community Mental Health Care Model (CMHC). Emergency Psychiatric Consultation (EPC) is used as an indicator of results: it includes both real emergencies and unresolved demand. The Barros Luco Health Care Complex (BLHC) provides an opportunity to study the impact of the CMHC model it provides EPC to two health services, South (SHS) and South-East (SEHS). The former has more widely implemented the CMHC model, and the counties of the SHS range in their implementation of the CMH model. Objective: Compare the variation in rates of EPC in the BLHC by health service of origin, and by county within the SHS. Methodology: This is an observational retrospective study (2006-2007). Counties within the SHS were categorized by implementation of the CMH model and distance to the BLHC, and analyzed using Poisson regression models. Results: 11,760 EPC were analyzed. A decrease in EPC rates can be observed, which is greater in the SHS and in the counties that have implemented the CMHC model. Nevertheless, counties with the CMHC model had incidence rate ratios (IRR) for EPC that were more than twice as high. After adjusting for distance and years, the IRR decreased (1.38 [96 per cent CI 1.07-1.77]). There are differences in the decrease in EPC between counties that are not explained by the factors studied. Discussion: Greater development of the CMHC model could be associated with the decrease in EPC. There are limitations: short observation period, lack of adjustments for other confounding factors, imprecise categories.