ABSTRACT
Dual patients are usually treated in drug users services, mental health units, or both. However, each patient can choose the service to receive the health care. The aim of this study is to analyze the similarities and differences of the patient profiles that are treated in each one of these centers. The sample consists of 170 patients diagnosed with dual pathology treated at Servicio Provincial de Drogodependencias de Huelva (SPDH) and Unidades de Salud Mental Comunitaria (USMC) in the province of Huelva. In SPDH, higher prevalence of patients with cocaine and heroin dependence profile was observed (35.9% vs 2% in MH and 16.4% in coordinated). In USMC there is higher prevalence of patients with cannabis dependence profile (41.2% vs 9.4% in the DU and 16.4% in the coordinated service). The odds ratio for patients with hypomanic episodes was 2,879 (p <0.05) in SPDH compared to other services. Odds ratio observed for manic episodes was 0.483 (p <0.05) in SPDH. Patients with comorbid psychotic disorders are more prevalent in USMC compared to SPDH services (66% vs 37.5%). The differences observed in the profiles should be considered in the care planning of these centers
La atención médica y psicológica de pacientes con patología dual es realizada por servicios de salud mental, adicciones, o coordinada. No obstante, es elección de los pacientes acudir a uno u otro servicio. Este trabajo tiene como objetivo analizar las semejanzas y diferencias de pacientes con patología dual que acuden a estos centros. El estudio se ha realizado con170 pacientes diagnosticados de patología dual atendidos en el Servicio Provincial de Drogodependencias de Huelva (SPDH) y Unidades de Salud Mental Comunitaria (USMC) de la provincia de Huelva. En el SPDH la prevalencia de pacientes con dependencia a heroína y cocaína es mayor (35.9% vs 2% en USMC y 16.4% en coordinado). En las USMC se observa una mayor prevalencia de pacientes con dependencia a cannabis (41.2% vs 9.4% en el CTA y 16.4% en coordinado). La odds ratio para pacientes con episodios hipomaníacos fue de 2.879 (p<0.05) en el SPDH, y de 0.483 (p<0.05) para episodios maníacos. Hay una mayor prevalencia de pacientes con trastornos psicóticos en las USMC en comparación con el SPDH (66% vs 37.5%). Las diferencias detectadas en los perfiles deben ser consideradas en la planificación asistencial de los centros que atienden a estos pacientes
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Diagnosis, Dual (Psychiatry)/statistics & numerical data , Mental Disorders/epidemiology , Substance-Related Disorders/epidemiology , Mental Disorders/complications , Community Mental Health Centers/statistics & numerical data , Substance Abuse Treatment Centers/statistics & numerical dataABSTRACT
OBJECTIVE: World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is currently one of the most used instruments in disability assessment. The objective of this study was to analyze the clinically reliable change of WHODAS 2.0 by applying both Classical Test Theory (CTT) and the Item Response Theory (IRT). STUDY DESIGN AND SETTING: The sample consisted of 179 patients with dual pathology. The standard error of measurement (SEM) was estimated using the CTT and the rating testlet model. RESULTS: Reliability estimated by Cronbach's alpha provided acceptable values for all domains. The Rasch analysis revealed an adequate capacity to discriminate between people with high and low disability in terms of total scores but not in terms of domains. The SEM varies according to the baseline scores, failing to detect clinically reliable change in patients with lower scores. Kappa coefficients are low for the most of dimensions (except participation) and adequate for total scores. CONCLUSION: The use of total WHODAS 2.0 scores may be useful from a clinical perspective; however, more evidence is required for domain scores to support its usefulness. The decision to use the CTT or the IRT impacts in terms of calculating clinically reliable change.
