Percepção de psiquiatras em relação ao tratamento de transtornos mentais na atenção básica
Data
2022-02-16
Autores
Haddad, Michel 
Orientadores
Mari, Jair de Jesus
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A prevalência de transtornos mentais em pessoas atendidas em serviços de atenção básica é maior do que na população geral, chegando a mais da metade dos indivíduos atendidos. O tratamento de transtornos mentais comuns em unidades de atenção básica tem sido sugerido como estratégia prioritária para garantir acesso e adesão ao tratamento. Contudo, pouco é conhecido sobre a percepção dos psiquiatras acerca do encaminhamento de pacientes com transtornos mentais comuns para serem tratados por médicos generalistas.
Objetivo: Avaliar a percepção dos psiquiatras em relação aos transtornos mentais que podem ser tratados nos cuidados primários de saúde, e quais deveriam ser encaminhados à atenção especializada de acordo com especificidades regionais.
Método: Trata-se de um estudo de corte transversal descritivo, nas cidades de São Paulo (Brasil), La Paz (Bolívia), Santiago (Chile) e Havana (Cuba). As condutas clínicas dos psiquiatras em relação aos transtornos mentais comuns e a acurácia diagnóstica foram investigadas por meio de vinhetas clínicas (identificação de um transtorno mental, prescrição de um medicamento, encaminhamento do paciente para um especialista ou um médico de atenção primária etc.). Modelos de análise multivariada foram desenvolvidos para verificar a associação entre características dos psiquiatras e as condutas clínicas.
Resultados: 230 psiquiatras preencheram os questionários on-line (102 do Brasil, 29 da Bolívia, 29 do Chile e 70 de Cuba). Os psiquiatras do Brasil eram menos propensos a reconhecer a depressão como um transtorno mental em comparação com os profissionais de Cuba (Odds Ratio (OR) = 0,30, intervalo de confiança de 95% (IC), 0,10 a 0,91, p <0,04), as psiquiatras mulheres apresentaram menor probabilidade de aceitar que esses pacientes sejam tratados com médicos de atenção primária (MAP) em comparação com os psiquiatras homens (OR = 0,19, IC 95%, 0,04 a 0,91, p <0,02). Ao mesmo tempo, um aumento na idade dos entrevistados foi associado a uma menor possibilidade de ser tratado por um MAP (OR = 0,92, IC 95%, 0,87 a 0,97, p <0,01). Na vinheta de ansiedade, os participantes da Bolívia eram mais propensos do que os de Cuba a considerar importante que esses pacientes procurassem um psiquiatra em vez de um MAP (OR = 4,19, IC 95%, 1,22 a 14,42, p <0,02), as profissionais do sexo feminino foram associadas a uma maior probabilidade encaminharem esses pacientes para tratamento com psiquiatras quando comparados aos do sexo masculino (OR = 2,38, IC 95%, 1,10 a 5,13, p <0,01).
Conclusões: A maioria dos psiquiatras entrevistados concordou que os pacientes com depressão devem ser tratados por MAPs e que os casos somatoformes e de ansiedade devem ser tratados por psiquiatras. Esses resultados mostram que os psiquiatras consideram que eles, e não os MAPs, devem tratar pacientes com transtornos mentais comuns, independentemente da evidência que mostre que os transtornos mentais comuns podem ser tratados pelos médicos da atenção básica em PC.
Introduction: The prevalence of mental disorders in people assisted in primary care services is higher than in the general population, reaching more than half of those assisted. The treatment of common mental disorders in primary care units has been suggested as a priority strategy to ensure access to and adherence to treatment. However, little is known about the perception of psychiatrists about referring patients with common mental disorders to be treated by general practitioners. Objective: To explore clinical decisions of psychiatrists regarding the management of common mental disorders in primary care (PC). Methods: Using a cross-sectional design, we conducted a self-administered online questionnaire survey of psychiatrists from Bolivia, Brazil, Cuba, and Chile. The questionnaire covered sociodemographic and professional information. The psychiatrists’ clinical decisions were assessed through three clinical vignettes representing typical PC cases of depression, anxiety, and somatization. Results: 230 psychiatrists completed the online survey. Psychiatrists from Brazil were less likely to recognize depression as a mental disorder than those from Cuba (odds ratio (OR) = 0.30, 95% confidence interval (CI), 0.10 to 0.91, p < 0.04). Female sex (OR = 0.19, 95% CI, 0.04 to 0.91, p < 0.02) and older age (OR = 0.92, 95% CI, 0.87 to 0.97, p < 0.01) reduced the likelihood of agreement that the depression case should be treated by a Primary Care Physician (PCP). In the somatoform symptoms vignette, longer training duration increased the likelihood of agreement that treatment should be done by a psychiatrist instead of a PCP (OR = 1.19, 95% CI, 1.04 to 1.37, p < 0.01). In the anxiety vignette, females (OR = 2.38, 95% CI, 1.10 to 5.13, p < 0.01) and participants from Bolivia (compared with Cubans, OR = 4.19, 95% CI, 1.22 to 14.42, p < 0.02) were more likely to consider that these patients should be treated by a psychiatrist instead of a PCP. Discussion: Most psychiatrist respondents agreed that patients with depression should be treated by PCPs and that somatoform and anxiety cases should be treated by psychiatrists. These results show that psychiatrists consider that they, and not PCPs, should treat patients with common mental disorders, regardless of the evidence showing that common mental disorders can be treated by primary care physicians in PC.
Introduction: The prevalence of mental disorders in people assisted in primary care services is higher than in the general population, reaching more than half of those assisted. The treatment of common mental disorders in primary care units has been suggested as a priority strategy to ensure access to and adherence to treatment. However, little is known about the perception of psychiatrists about referring patients with common mental disorders to be treated by general practitioners. Objective: To explore clinical decisions of psychiatrists regarding the management of common mental disorders in primary care (PC). Methods: Using a cross-sectional design, we conducted a self-administered online questionnaire survey of psychiatrists from Bolivia, Brazil, Cuba, and Chile. The questionnaire covered sociodemographic and professional information. The psychiatrists’ clinical decisions were assessed through three clinical vignettes representing typical PC cases of depression, anxiety, and somatization. Results: 230 psychiatrists completed the online survey. Psychiatrists from Brazil were less likely to recognize depression as a mental disorder than those from Cuba (odds ratio (OR) = 0.30, 95% confidence interval (CI), 0.10 to 0.91, p < 0.04). Female sex (OR = 0.19, 95% CI, 0.04 to 0.91, p < 0.02) and older age (OR = 0.92, 95% CI, 0.87 to 0.97, p < 0.01) reduced the likelihood of agreement that the depression case should be treated by a Primary Care Physician (PCP). In the somatoform symptoms vignette, longer training duration increased the likelihood of agreement that treatment should be done by a psychiatrist instead of a PCP (OR = 1.19, 95% CI, 1.04 to 1.37, p < 0.01). In the anxiety vignette, females (OR = 2.38, 95% CI, 1.10 to 5.13, p < 0.01) and participants from Bolivia (compared with Cubans, OR = 4.19, 95% CI, 1.22 to 14.42, p < 0.02) were more likely to consider that these patients should be treated by a psychiatrist instead of a PCP. Discussion: Most psychiatrist respondents agreed that patients with depression should be treated by PCPs and that somatoform and anxiety cases should be treated by psychiatrists. These results show that psychiatrists consider that they, and not PCPs, should treat patients with common mental disorders, regardless of the evidence showing that common mental disorders can be treated by primary care physicians in PC.