Matrix support in mental health in Primary Health Care: Barriers and facilitating factors

Hirdes, Alice; Silva, Maira Kelly Rosa da

doi:10.1590/1982-02752017000400006

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…Organisational support for integration including facilitation of meetings, development of local guidelines, provision of training, supervision and feedback is associated with better staff engagement, change management and sustainability of the collaborative care. 10 11 Conversely, weak local agreements and inconsistent guidance over time have been identified as barriers to implementation of matrix support in Brazil, 38 as well as of collaborative care in the USA. 39 Only 22% of PC teams in Brazil reported receiving any management support to implement matrix support.…”

Section: Discussionmentioning

confidence: 99%

Bridging the mental health treatment gap: effects of a collaborative care intervention (matrix support) in the detection and treatment of mental disorders in a Brazilian city

et al. 2020

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ObjectiveTo analyse temporal trends in diagnosis and treatment of mental disorders in primary care following implementation of a collaborative care intervention (matrix support).DesignDynamic cohort design with retrospective time-series analysis. Structured secondary data on medical visits to general practitioners of all study clinics were extracted from the municipal electronic records database. Annual changes in the odds of mental disorders diagnoses and antidepressants prescriptions were estimated by multiple logistic regression at visit and patient-year levels with diagnoses or prescriptions as outcomes. Annual changes during two distinct stages of the intervention (stage 1 when it was restricted to mental health (2005–2009), and stage 2 when it was expanded to other areas (2010–2015)) were compared by adding year–period interaction terms to each model.Setting49 primary care clinics in the city of Florianópolis, Brazil.ParticipantsAll adults attending primary care clinics of the study setting between 2005 and 2015.Results3 131 983 visits representing 322 100 patients were analysed. At visit level, the odds of mental disorder diagnosis increased by 13% per year during stage 1 (OR 1.13, 95% CI 1.11 to 1.14, p<0.001) and decreased by 5% thereafter (OR 0.95, 95% CI 0.94 to 0.95, p<0.001). The odds of incident mental disorder diagnoses decreased by 1% per year during stage 1 (OR 0.99, 95% CI 0.98 to 1.00, p=0.012) and decreased by 7% per year during stage 2 (OR 0.93, 95% CI 0.92 to 0.93, p<0.001). The odds of antidepressant prescriptions in patients with a mental disorder diagnosis increased by 7% per year during stage 1 (OR 1.07, 95% CI 1.05 to 1.20, p<0.001); this was driven by selective serotonin reuptake inhibitor prescriptions which increased 14% per year during stage 1 (OR 1.14, 95% CI 1.12 to 1.18, p<0.001) and 9% during stage 2 (OR 1.09, 95% CI 1.08 to 1.10, p<0.001). The odds of incident antidepressant prescriptions did not increase during stage 1 (OR 1.00, 95% CI 0.97 to 1.02, p=0.665) and increased by 3% during stage 2 (OR 1.03, 95% CI 1.00 to 1.04, p<0.001). Changes per year were all significantly greater during stage 1 than stage 2 (p values for interaction terms <0.05), except for antidepressant prescriptions during visits (p=0.172).ConclusionThe matrix support intervention may increase diagnosis and treatment of mental disorders when inter-professional collaboration is adequately supported. Competing demands to the primary care teams can subsequently reduce these effects. Future studies should assess clinical outcomes and identify active components and factors associated with successful implementation.

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Section: Discussionmentioning

confidence: 99%

Bridging the mental health treatment gap: effects of a collaborative care intervention (matrix support) in the detection and treatment of mental disorders in a Brazilian city

et al. 2020

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“…Most research of this type in mental health has been in hospital settings with only modest progress in community mental health services (319). In addition, although better than episode-based models, the ability to explain variance in resource use in psychiatry is lower than in more homogeneous care settings such as nursing homes (320).…”

Section: Resource Allocationmentioning

confidence: 99%

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care

et al. 2020

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The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection

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Impasses e desafios para consolidação e efetividade do apoio matricial em saúde mental no Brasil

Treichel

Campos

2019

Interface (Botucatu)

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Passados dez anos da implementação do apoio matricial nas redes de saúde por meio dos Núcleos de Apoio à Saúde da Família, ainda sente-se a falta de dados consistentes quanto à consolidação e efetividade desse arranjo. Nesse sentido, este estudo teve como objetivo revisar a bibliografia nacional dos últimos dez anos a fim de identificar os impasses e desafios vivenciados no apoio matricial em saúde mental na Atenção Primária, classificando-os a partir de uma reconstrução teórico-conceitual e fazendo uma articulação destes com os desafios pontuados em congêneres internacionais do apoio matricial. Entre os principais pontos levantados pelo estudo, destacou-se a necessidade de delineamentos claros para prática de matriciamento; investimento maciço em formação e capacitação dos profissionais; e criação de espaços institucionalizados com encontros sistemáticos dos profissionais para discussão dos casos e avaliação conjunta do andamento das atividades.

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Matrix support in mental health in Primary Health Care: Barriers and facilitating factors

Cited by 3 publications

References 19 publications

Bridging the mental health treatment gap: effects of a collaborative care intervention (matrix support) in the detection and treatment of mental disorders in a Brazilian city

Bridging the mental health treatment gap: effects of a collaborative care intervention (matrix support) in the detection and treatment of mental disorders in a Brazilian city

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care

Impasses e desafios para consolidação e efetividade do apoio matricial em saúde mental no Brasil

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