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Integrated mental healthcare: outcomes from Brazilian primary care

Leonardo Moscovici, Joao Mazzoncini de Azevedo-Marques, Antonio Waldo Zuardi

Abstract


Objectives: To compare outcomes from Brazilian patients with anxiety and/or depression followed by primary care teams working with and without access to mental health integrated care.

Method: The study was conducted with patients from 4 Brazilian Family Health Strategy teams. Only 2 of these teams had access to an integrated care model. A psychiatrist and a psychiatric nurse conducted weekly activities in primary healthcare units. Patients waiting for an appointment underwent screening and those diagnosed with major depression and/or generalized anxiety disorder were assessed during 12 months. The outcomes measures were the scores of the respective modules of “Mini International Neuropsychiatric Interview-TRACKING”.

Results: One hundred and forty-seven patients underwent screening. Eighty-five had positive screening and 42 were diagnosed with depression and/or anxiety. Twenty-one patients in each arm of the study, that is, with and without integrated mental healthcare, were diagnosed at baseline. There were no differences in demographic and clinical characteristics between the 2 groups. Fifteen patients in each study arm performed 5 assessments and completed 12 months of follow-up. Repeated Measures Analysis of Variance (ANOVArm) showed significant differences in time factor (F4,120 = 16.6, p <0.001), in interaction time x group, in contrasts between the first and fourth assessment (F 1,30 = 4.55, p = 0.041) and between the first and fifth assessment (F 1,30 = 5.33, p = 0.028).

Conclusion: Integration of mental health specialists into Brazilian primary care seems to be a relevant factor to generate better mental health outcomes.


Keywords


Family health strategy, health systems, integrated care, mental health, person-centered healthcare, primary care

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DOI: http://dx.doi.org/10.5750/ejpch.v4i4.1190

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