Sistemas de priorización de la demanda ambulatoria en Salud mental Infantil y de la Adolescencia
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Derechos de autor 2023 Revista de Psiquiatría Infanto-Juvenil
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
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https://doi.org/10.31766/revpsij.v40n4a5Palabras clave:
lista de espera, calidad asistencial, sistemas información en atención ambulatoria, salud mental, derivación y consultaResumen
Objetivo: El incremento de demandas asistenciales, en un contexto de crisis generalizada de recursos, hace necesario la utilización de sistemas de gestión diferencial, que garantice la equidad y la calidad en la atención ambulatoria, similares a los sistemas de priorización de demandas en los Servicios de Urgencias. Material y métodos: Se utilizaron las escalas HEADS-ED (Home, Education, Activities/peers, Drugs/alcohol, Suicidality, Emotions/behavior, Discharge resources) y Western Canada Waiting List (WCWL), para evaluar retrospectivamente la demanda de varios centros ambulatorios de salud mental infantil y de la adolescencia de la Comunidad de Castilla y León (España), recogiéndose motivos, tiempos de respuesta y los sistemas de priorización vigentes (normal o preferente). Resultados: Se ha observado que la mediana en el tiempo de espera para una demanda normal es de 60 días (Rango intercuartílico o RIC=40,75-113,25) vs 35,0 días (RIC=21,0-35,0) en la demanda preferente, que disminuye con la entrevista de acogida hasta 21,0 días (RIC=11,0-29,0) vs 5,0 días (RIC=1,0-7,0) respectivamente.. Según el sistema empleado (HEADS-ED ó WCWL modelo Finlandés o Canadiense) en los casos derivados a Salud Mental Infanto-Juvenil no se alcanza el punto de corte entre un 13,2%, 40,7% y un 76,3%, respectivamente. Conclusiones: Los sistemas de priorización (HEADS-ED y WCWL) han detectado demandas injustificadas. Se sugiere la necesidad de establecer sistemas de gestión de la demanda online, sistemas de priorización y ampliación de las modalidades de atención, para que de forma coordinada mejoren los procesos de atención.
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Johnston OG, Burke JD. Parental Problem Recognition and Help-Seeking for Disruptive Behavior Disorders. J Behav Health Serv Res. 2020;47: 146-63. https://doi.org/10.1007/s11414-018-09648-y DOI: https://doi.org/10.1007/s11414-018-09648-y
Mechanic D. Is The Prevalence Of Mental Disorders A Good Measure Of The Need For Services?. Health Aff (Millwood). 2003;22(5): 8-20. https://doi.org/10.1377/hlthaff.22.5.8 DOI: https://doi.org/10.1377/hlthaff.22.5.8
Sayal K, Taylor E. Detection of child mental health disorders by general practitioners. Br J Gen Pract. 2004;54(502): 348-52. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1266168/
Martínez Farrero P. Del motivo de consulta a la demanda en psicología. Rev Asoc Esp Neuropsiquiatría. 2006;26(1):53-69. DOI: https://doi.org/10.4321/S0211-57352006000100004
Sawrikar V, Diaz AM, Tully L, Hawes DJ, Moul C, Dadds MR. Bridging the gap between child mental health need and professional service utilisation: Examining the influence of mothers’ parental attributions on professional help-seeking intentions. Eur Child Adolesc Psychiatry. 2022;31: 239-51. https://doi.org/10.1007/s00787-020-01682-6 DOI: https://doi.org/10.1007/s00787-020-01682-6
Vera-Varela C, Manrique Mirón PC, Barrigón ML, Álvarez-García R, Portillo P, Chamorro J, et al. Low Level of Agreement Between Self-Report and Clinical Assessment of Passive Suicidal Ideation. Arch Suicide Res Off J Int Acad Suicide Res. 2022;26(4): 1895-910. https://doi.org/10.1080/13811118.2021.1945984 DOI: https://doi.org/10.1080/13811118.2021.1945984
Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, et al. Worldwide Use of Mental Health Services for Anxiety, Mood, and Substance Disorders: Results from 17 Countries in the WHO World Mental Health(WMH). Surveys. Lancet. 2007;370(9590): 841-50. https://doi.org/10.1016/S0140-6736(07)61414-7 DOI: https://doi.org/10.1016/S0140-6736(07)61414-7
Peiró S, Artells JJ, Meneu R. Identificación y priorización de actuaciones de mejora de la eficiencia en el Sistema Nacional de Salud. Gac Sanit. 2011;25(2): 95-105. https://doi.org/10.1016/j.gaceta.2010.12.005 DOI: https://doi.org/10.1016/j.gaceta.2010.12.005
Déry J, Ruiz A, Routhier F, Bélanger V, Côté A, Ait-Kadi D, et al. A systematic review of patient prioritization tools in non-emergency healthcare services. Syst Rev. 2020;9:227. https://doi.org/10.1186/s13643-020-01482-8 DOI: https://doi.org/10.1186/s13643-020-01482-8
McDonald P. Waiting lists and waiting times for health care in Canada: more management! more money?. Ottawa: Health Canada; 1998.
Boden MT, Smith CA, Klocek JW, Trafton JA. Mental Health Treatment Quality, Access, and Satisfaction: Optimizing Staffing in an Era of Fiscal Accountability. Psychiatr Serv 2019;70(3): 168-75. https://doi.org/10.1176/appi.ps.201800229 DOI: https://doi.org/10.1176/appi.ps.201800229
Rosenbaum S. Principles to Consider for the Implementation of a Community Health Needs Assessment Process. Washington D.C.: Department of Health Policy School of Public Health and Health Services; 2013.
World Health Organization R Ann, McClelland, Billingham K, University of Sheffield, Institute of General Practice & Primary Care, editors. Community health needs assessment an introductory guide for the family health nurse in Europe. Copenhagen: WHO; 2001.
Alvarez-Monjarás M, Bucay-Harari L. Modelo de tamizaje, atención y monitoreo de la salud mental para adultos en casos de desastre. Salud Pública México. 2018;60(Supl.1): 23-30. https://doi.org/10.21149/9340 DOI: https://doi.org/10.21149/9340
Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, et al. A children’s global assessment scale (CGAS). Arch Gen Psychiatry. 1983;40(11): 1228-31. https://doi.org/10.1001/archpsyc.1983.01790100074010 DOI: https://doi.org/10.1001/archpsyc.1983.01790100074010
Cohen E, Mackenzie RG, Yates GL. HEADSS, a psychosocial risk assessment instrument: Implications for designing effective intervention programs for runaway youth. J Adolesc Health. 1991;12(7): 539-44. https://doi.org/10.1016/0197-0070(91)90084-Y DOI: https://doi.org/10.1016/0197-0070(91)90084-Y
Smith DH, Hadorn DC. Lining Up for Children’s Mental Health Services: A Tool for Prioritizing Waiting Lists. J Am Acad Child Adolesc Psychiatry. 2002;41(4): 367-76. https://doi.org/10.1097/00004583-200204000-00007 DOI: https://doi.org/10.1097/00004583-200204000-00007
Kaltiala-Heino R, Fröjd S, Autio V, Laukkanen E, Närhi P, Rantanen P. Transparent criteria for specialist level adolescent psychiatric care. Eur Child Adolesc Psychiatry. 2007;16: 260-70. https://doi.org/10.1007/s00787-006-0598-4 DOI: https://doi.org/10.1007/s00787-006-0598-4
Bellón JA, Conejo-Cerón S, Rodríguez-Bayón A, Ballesta-Rodríguez MI, Mendive JM, Moreno-Peral P. Enfermedades mentales comunes en atención primaria: dificultades diagnósticas y terapéuticas, y nuevos retos en predicción y prevención. Informe SESPAS 2020. Gac Sanit. 2020;34(Supl.1): 20-6. https://doi.org/10.1016/j.gaceta.2020.05.013 DOI: https://doi.org/10.1016/j.gaceta.2020.05.013
Freedman S, Thull-Freedman J, Lightbody T, Prisnie K, Wright B, Coulombe A, et al. Introducing an innovative model of acute paediatric mental health and addictions care to paediatric emergency departments: a protocol for a multicentre prospective cohort study. BMJ Open Qual. 2020;9(4): e001106. https://doi.org/10.1136/bmjoq-2020-001106 DOI: https://doi.org/10.1136/bmjoq-2020-001106
Cappelli M. The HEADS-ED: Review of a Mental Health Screening Tool for Pediatric Patients in the Emergency Department. Psychiatr Times. 2012;29(2): 14-5. https://doi.org/10.1542/peds.2011-3798 DOI: https://doi.org/10.1542/peds.2011-3798
Clark SE, Cloutier P, Polihronis C, Cappelli M. Evaluating the HEADS-ED Screening Tool in a Hospital-Based Mental Health and Addictions Central Referral Intake System: A Prospective Cohort Study. Hosp Pediatr. 2019;9(2): 107-14. https://doi.org/10.1542/hpeds.2018-0112 DOI: https://doi.org/10.1542/hpeds.2018-0112
Cawthorpe D, Wilkes TCR, Rahman A, Smith DH, Conner-Spady B, McGurran JJ, et al. Priority-Setting for Children’s Mental Health: Clinical Usefulness and Validity of the Priority Criteria Score. J Can Acad Child Adolesc Psychiatry. 2007;16(1): 18-26. https://pubmed.ncbi.nlm.nih.gov/18392175/
Kaltiala-Heino R, Bergman H, Työläjärvi M, Frisén L. Gender dysphoria in adolescence: current perspectives. Adolesc Health Med Ther. 2018;9: 31-41. https://doi.org/10.2147/AHMT.S135432 DOI: https://doi.org/10.2147/AHMT.S135432
Noseworthy TW, McGurran JJ, Hadorn DC, The Steering Committee of the Western Canada Waiting List Project. Waiting for scheduled services in Canada: development of priority-setting scoring systems. J Eval Clin Pract. 2003;9(1): 23-31. https://doi.org/10.1046/j.1365-2753.2003.00377.x DOI: https://doi.org/10.1046/j.1365-2753.2003.00377.x
Clemente C, McGrath R, Stevenson C, Barnes J. Evaluation of a Waiting List Initiative in a Child and Adolescent Mental Health Service. Child Adolesc Ment Health. 2006;11(2): 98-103. https://doi.org/10.1111/j.1475-3588.2005.00386.x
Campbell LA, Clark SE, Ayn C, Chorney J, Emberly D, MacDonald J, et al. The Choice and Partnership Approach to community mental health and addictions services: a realist-informed scoping review protocol. BMJ Open. 2019;9(12): e033247. https://doi.org/10.1136/bmjopen-2019-033247 DOI: https://doi.org/10.1136/bmjopen-2019-033247
Clemente C, McGrath R, Stevenson C, Barnes J. Evaluation of a Waiting List Initiative in a Child and Adolescent Mental Health Service. Child Adolesc Ment Health. 2006;11(2): 98-103. https://doi.org/10.1111/j.1475-3588.2005.00386.x DOI: https://doi.org/10.1111/j.1475-3588.2005.00386.x
Pérez Martínez DA, Puente Muñoz AI. La autorización previa para acceder al neurólogo desde atención primaria puede ser innecesaria: resultados de un estudio prospectivo y controlado. Rev Neurol. 2006;43(7): 388-92. https://doi.org/10.33588/rn.4307.2006219 DOI: https://doi.org/10.33588/rn.4307.2006219
Bonis Sanz J, Gérvas J, Simó J, Martín P. La función genuina de filtro del médico de atención primaria. Rev Neurol. 2007;44(3): 189-90. https://doi.org/10.33588/rn.4403.2006574 DOI: https://doi.org/10.33588/rn.4403.2006574
Lora A, Lesage A, Pathare S, Levav I. Information for mental health systems: an instrument for policy-making and system service quality. Epidemiol Psychiatr Sci. 2016;26(4): 383-94. https://doi.org/10.1017/S2045796016000743 DOI: https://doi.org/10.1017/S2045796016000743
Gutiérrez-Colosía MR, Salvador-Carulla L, Salinas-Pérez JA, García-Alonso CR, Cid J, Salazzari D, et al. Standard comparison of local mental health care systems in eight European countries. Epidemiol Psychiatr Sci. 2017;28(2): 1-14. https://doi.org/10.1017/S2045796017000415 DOI: https://doi.org/10.1017/S2045796017000415
Montagni I, Salvador-Carulla L, Mcdaid D, Straßmayr C, Endel F, Näätänen P, et al. The REFINEMENT Glossary of Terms: An International Terminology for Mental Health Systems Assessment. Adm Policy Ment Health Ment Health Serv Res. 2018;45: 342-51. https://doi.org/10.1007/s10488-017-0826-x DOI: https://doi.org/10.1007/s10488-017-0826-x
Ala-Nikkola T, Pirkola S, Kaila M, Joffe G, Kontio R, Oranta O, et al. Identifying Local and Centralized Mental Health Services—The Development of a New Categorizing Variable. Int J Environ Res Public Health. 2018;15(6): 1131. https://doi.org/10.3390/ijerph15061131 DOI: https://doi.org/10.3390/ijerph15061131
Ala-Nikkola T, Sadeniemi M, Kaila M, Saarni S, Kontio R, Pirkola S, et al. How size matters: exploring the association between quality of mental health services and catchment area size. BMC Psychiatry. 2016;16: 289. https://doi.org/10.1186/s12888-016-0992-5 DOI: https://doi.org/10.1186/s12888-016-0992-5
Thune Jørstad H. Preparticipation screening-the way forward is smart screening. Neth Heart J Mon J Neth Soc Cardiol Neth Heart Found. 2018;26: 120-2. https://doi.org/10.1007/s12471-018-1081-9
van Bebber J, Meijer RR, Wigman JT, Sytema S, Wunderink L. A Smart Screening Device for Patients with Mental Health Problems in Primary Health Care: Development and Pilot Study. JMIR Ment Health. 2018;5(2): e41. https://doi.org/10.2196/mental.9488 DOI: https://doi.org/10.2196/mental.9488
Thune Jørstad H. Preparticipation screening-the way forward is smart screening. Neth Heart J Mon J Neth Soc Cardiol Neth Heart Found. 2018;26: 120-2. https://doi.org/10.1007/s12471-018-1081-9 DOI: https://doi.org/10.1007/s12471-018-1081-9
Henderson JL, Cheung A, Cleverley K, Chaim G, Moretti ME, de Oliveira C, et al. Integrated collaborative care teams to enhance service delivery to youth with mental health and substance use challenges: protocol for a pragmatic randomised controlled trial. BMJ Open. 2017;7(2): e014080. https://doi.org/10.1136/bmjopen-2016-014080 DOI: https://doi.org/10.1136/bmjopen-2016-014080
McGorry PD, Mei C, Chanen A, Hodges C, Alvarez-Jimenez M, Killackey E. Designing and scaling up integrated youth mental health care. World Psychiatry Off J World Psychiatr Assoc WPA. 2022;21(1): 61-76. https://doi.org/10.1002/wps.20938 DOI: https://doi.org/10.1002/wps.20938
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