Improving the Effectiveness of Healthcare: Diagnosis-Centered Care Vs. Person-Centered Health Promotion, a Long Forgotten New Model.

Performance of healthcare can be measured as its ability to restore and preserve health with acceptable costs for the society. Under the current prevalence of chronic disease, medical care (the major content of healthcare) underperforms in all key indicators: clinical effectiveness, benefit/risk ratio of interventions, cost/benefit ratio, and general population health. In Russia key performance indicators (KPI) of healthcare do not allow effective decision-making; a similar situation is seen worldwide: most KPIs are either focused on the process (not results) of medical care, or depend on efforts out of control of healthcare decision-makers. The key root factors limiting clinical effectiveness and cost-effectiveness of healthcare are reactive diagnosis-centered organizational model of care and the underlying biomedical paradigm, generally inadequate in chronic diseases. They make healthcare intervene too late, use less effective prevention and treatment instruments, and be in a state of resource scarcity. In Russia there is also a lack of interdisciplinary and interagency cooperation essential for health preservation and promotion. Performance of healthcare system in overcoming the chronic disease epidemic can be improved through supplementing the current 'reactive' organizational model with preventive person-centered model based on the biopsychosocial paradigm. Enabling patients for early lifestyle-based interventions, the core P4 medicine approach, should prevail in managing chronic disease. Communication and information technologies should allow fast scaling up of the best person-centered practices.

Paradigma Biomédico X Psicossocial: Onde são Ancoradas as Representações Sociais Acerca do Sofrimento Psíquico? / Paradigma Biomédico X Psicosocial: ¿Dónde están Ancladas las Representaciones Sociales Acerca del Sufrimiento Psíquico? / Psychosocial X Biomedical Paradigm: Where is the Social Representation Anchored in Psychic Suffering?

Resumo Este estudo tem como objetivo conhecer as representações sociais de profissionais da saúde mental, universitários da área da saúde e estudantes do ensino médio acerca do louco e do doente mental, relacionando-as aos paradigmas de atenção à saúde mental. A amostra dessa pesquisa foi formada por 150 participantes, sendo 50 de cada grupo social. Para a coleta de dados, foi usada a TALP (Técnica de Associação Livre de Palavras), com os estímulos louco e doente mental. Os dados foram analisados no programa Tri-Deux-Mots, por meio da Análise Fatorial de Correspondência. Os estudantes do ensino médio e os universitários apresentaram representações do louco e do doente mental ancoradas no paradigma biomédico, o qual enfatiza a medicalização e a hospitalização na assistência à saúde mental; já os profissionais apresentaram representações ancoradas no paradigma psicossocial, o qual norteia as ideias da Reforma Psiquiátrica. Percebe-se que apesar de a assistência em saúde mental no Brasil ser pautada nos preceitos da reforma, ainda há na sociedade uma visão negativa do doente mental/louco ancorada no paradigma biomédico, a qual reforça a exclusão e manutenção do estigma social frente a esses sujeitos.

Resumen El objetivo fue conocer las representaciones sociales de profesionales de salud mental, estudiantes de la salud y de enseñanza secundaria sobre locos y enfermos mentales, relacionándose los paradigmas de la atención a la salud mental. Muestra formada por 150 participantes, 50 de cada grupo social. Para recolección de datos, se utilizó la Técnica de Asociación Libre de Palabras, con estímulos locos y enfermos mentales. Datos analizados en el software Tri-Deux-Mots, a través del análisis factorial de correspondencia. Los estudiantes de enseñanza secundaria y los universitarios presentaron representaciones de loco y enfermo mental ancladas en el paradigma biomédico, que hace hincapié a la medicalización y hospitalización en la atención de salud mental; ya los profesionales presentaron representaciones ancladas en el paradigma psicosocial, que guía las ideas de la Reforma Psiquiátrica. Se percibió que a pesar de la atención en salud mental en Brasil se basada en los preceptos de la Reforma, todavía hay en la sociedad visión negativa de enfermos mentales/loco anclada en el paradigma biomédico, lo que refuerza la exclusión y el mantenimiento del estigma social delante de estos sujetos.

Abstract This study aims to determine the social representation of mental health professionals, university students from the health area, and secondary school students with regard to the crazy person and the mentally ill person, regarding the paradigms of mental health care. The study sample was composed of 150 participants, with 50 in each social group. For data collection, the free word association technique (TALP) was used, with the prompts "crazy person" and "mentally ill person". The data were analyzed using the Tri-Deux-Mots software,through correspondence factor analysis. The secondary school students and university students presented representations of the crazy person and the mentally ill person anchored in the biomedical paradigm, which emphasizes medicalization and hospitalization with regard to mental health care. The professionals, on the other hand, presented representations anchored in the psychosocial paradigm, which guides the ideas of the Psychiatric Reform. It is recognized that although mental health care in Brazil is based on the principles of the Reform, there is still a negative view of the mentally ill person/crazy person on the part of society anchored in the biomedical paradigm, which reinforces the exclusion and maintenance of the social stigma that these individuals face.