[Show abstract][Hide abstract] ABSTRACT: Background: Weaknesses in the collaboration between Primary Care (PC) and Mental Health (MH) are a relevant problem in the care of depressed patients. It is necessary to analyse and appraise the existing models of collaboration to assess their applicability to the Spanish Health System. The aim of this study is to know the main characteristics of the different models of collaboration between PC and MH in the care of patients with depression and the quality of their effectiveness evidence. Methods: Systematic overview of secondary studies published from 2001 to 2010 in MEDLINE, PsycINFO, Embase, LILACS, IBECS, IME and The Cochrane Library. Assessment of reviews applying the AMSTAR tool. Approximative synthesis of the quality of evidences. Results: A total of 69 studies were assessed. Quality of evidences is generally low or inconclusive due to the great variability among contexts and the methodological weaknesses. The most effective strategies integrate interventions for assigning responsibility for patient follow-up, redesigning management and communication/information sharing. Overviews of secondary studies on collaborative models facilitate access to published evidence, but entail important methodological challenges. Conclusion: The quality of evidences on effectiveness of PC-MH collaboration models in depression care is mainly low or inconclusive, and the more simplified are the analysis of components, processes and implementation conditions, the less meaningful and applicable they are.
Revista Española de Salud Pública 02/2014; 88(1):113-33. · 0.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: To determine the incidence of persons with no diagnosable mental disorder who go for consulation in a mental health center and to describe their socio-demographic, clinical, and medical care patterns. Method: Consecutively and without exemptions, all persons (n=1004) going for first-time consultation in a mental health center in the course of a year were clinically examined for mental disorder. Those with no diagnosable mental disorder were registered with a Z code. In addition, information about their socio-demographic and, clinical characteristics as well as their medical care patterns was collected through a clinical interview, a medical record, an expectancy scale, the GHQ-28, the SCL-90-R, and a life events scale (CSV). Results: Of the persons examined, 24.4% were not diagnosed with mental disorders and so were registered as having only a Z code. The initiative of seeking help in a mental health center was generally either the patient's own or his family's, not a general practitioner's. Half of them were already receiving some kind of drug therapy before their first visit. Over half of these patients (52%) were discharged after the first interview. Conclusions: Recourse to mental health services in the absence of diagnosable mental disorder is a phenomenon that has much bearing on the effectiveness of the health care system. These consultations amount to a considerable percentage of clinical activity in mental health center. It is important to figure out how these people can receive adequate attention without prejudice the health care system.
[Show abstract][Hide abstract] ABSTRACT: Se analizan los factores que intervienen en las ausencias a las primeras consultas en un Centro de Salud Mental desde los tres grupos que los definen: atención primaria, el paciente y el centro de salud mental. La edad del paciente, la celeridad en la derivación y la lista de espera son las variables más importantes que influyen en este fenómeno.