Factors associated with the hospitalization of users referred from primary health care to follow-up in Psychosocial Care Centers in the city of São Paulo, Brazil

Sanine, Patricia Rodrigues; Godoi, Lídia Pereira da Silva; Rosa, Tereza Etsuko da Costa; Garcia, Érica Marvila; Belotti, Lorrayne; Campos, Rosana Teresa Onocko; Tanaka, Oswaldo Yoshimi

doi:10.1590/1413-81232024292.19932022EN

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FREE THEMES • Ciênc. saúde coletiva 29 (2) • Feb 2024 • https://doi.org/10.1590/1413-81232024292.19932022EN copy

Factors associated with the hospitalization of users referred from primary health care to follow-up in Psychosocial Care Centers in the city of São Paulo, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study evaluated factors associated with hospitalization related to the mental health of people undergoing follow-up in Psychosocial Care Centers (CAPS, in Portuguese) in the city of São Paulo, Brazil, referred from Primary Health Care (PHC). This was an evaluative study conducted with 297 individuals in 24 adult CAPS. This study analyzed the prevalence ratios (PR) and their respective 95% confidence intervals (95% CI), obtained through Poisson Regression with robust variance. A statistically significant association was found with hospitalization during follow-ups in CAPS: having health insurance and/or medical plan; waiting time between the diagnosis and the first consultation with a non-medical professional of more than seven days; not having received medical advice regarding how long to use medication; not having received a psychopharmaceutical prescription at PHC; and having a medical history of the hospitalization due to mental health. The results warn of the need to expand access to the more socially vulnerable population, in addition to a restructuring of the services in order to provide more interactive and inclusive practices geared toward the singularities of the users.

Key words:
Mental health; Mental health services; Community services in mental health; Primary health care; Health evaluation

Variables/Questions	Answer categories
Sociodemographic characteristics of users
Self-reported sex	1: Female 2: Male
Age at the time of the interview	1: 18 to 39 years 2: ≥ 40 years
Self-reported skin color	1: White 2: Not white
Education (in years of study)	1: < 9 years 2: 9 to 11 years 3: > 11 years
Have health insurance and/or a medical plan	1: No 2: Yes
Time of diagnosis (in years)	1: ≤ 6 years 2: > 6 years
Monitoring time at CAPS (in months)	1: ≤ 7 months 2: > 7 months
Occurrence of mental health-related hospitalization (prior to monitoring at CAPS)	1: No 2: Yes
Characteristics of the care offered to users by the PHC and CAPS services
Time between diagnosis and the first consultation with the CAPS psychiatrist (in days)	1: ≤ 7 days 2: > 7 days
Time between diagnosis and the first consultation with a CAPS non-medical professional (in days)	1: ≤ 7 days 2: > 7 days
Received a prescription for psychopharmaceutical medication at PHC	1: Yes 2: No
Received guidance at CAPS on how long to use the medication	1: Yes 2: No
Difficulty in accessing some psychopharmaceutical medication (in the last 6 months)	1: No 2: Yes, once 3: Yes, more than once
Hospitalized with a mental health-related issue (during the monitoring at CAPS) ^a	1: No 2: Yes

Variables	N	Hospitalization related to mental health during follow-up at CAPS
Variables	N	Yes N (%)	No N (%)	p-value^*
Soiodemographic characteristics of the users
Self-reported sex
Female	185	14(7.6)	171(92.4)	0.498**
Male	112	11(9.8)	101(90.2)	0.498**
Age at time of interview
18-39 years	126	13(10.3)	113(89.7)	0.311**
≥40 years	171	12(7.0)	159(93.0)	0.311**
Skin color (self-reported)
White	144	12(8.3)	132(91.7)	0.932**
Not white	151	13(8.6)	138(91.4)	0.932**
Education (in years of study)
< 9 years	148	9(6.1)	139(93.9)	0.135
9-11 years	37	6(16.2)	31(83.8)
> 11 years	110	10(9.1)	100(90.9)
Has health insurance and/or medical plan^a
No	280	21(7.5)	259(92.5)	0.014
Yes	16	4(25.0)	12(75.0)
Time of diagnosis (in years)^a
≤ 6 years	145	10(6.9)	135(93.1)	0.271**
> 6 years	142	15(10.6)	127(89.4)	0.271**
Time of follow-up at CAPS
≤ 7 months	154	7(4.5)	147(95.5)	0.013
> 7 months	143	18(12.6)	125(87.4)	0.013
Hospitalization related to mental health (before follow-up at CAPS^a
No	128	16(12.5)	112(87.5)	0.029
Yes	168	9(5.4)	159(94.6)	0.029
Characteristics of care provided to the users through PHC and CAPS services
Time between diagnosis and first consultation with a psychiatrist at CAPS (in days)^a
≤ 7 days	125	12(9.6)	113(90.4)	0.420**
> 7 days	158	11(7.0)	147(93.0)	0.420**
Time between diagnosis and first consultation with non-medical CAPS professional (in days)^a
≤ 7 days	191	13(6.8)	178(93.2)	0.100
> 7 days	95	12(12.6)	83(87.4)	0.100
Received psychopharmaceutical prescription at PHC^a
Yes	174	12(6.9)	162(93.1)	0.135
No	98	12(12.2)	86(87.8)	0.135
Received medical advice at CAPS about how long to use the medication^a
Yes	169	9(5.3)	160(94.7)	0.023
No	116	15(12.9)	101(87.1)	0.023
Difficult access to some psychopharmaceuticals (last 6 months)^a
No	178	12(6.7)	166(93.3)	0.107
Yes, once	49	8(16.3)	41(83.7)
Yes, more than once	61	5(8.2)	56(91.8)

Variables	Gross values			Adjusted values
Variables	PR	CI	p-value*	PR	CI	p-value*
Sociodemographic characteristics of the users
Education (in years of study)
< 9 years	1.00
9 - 11 years	2.67	1.01-7.03	0.047
> 11 years	1.50	0.63-3.56	0.364
Has health insurance and/or medical plan
No	1.00	-	-	1.00
Yes	3.33	1.29-8.57	0.012	3.56	1.43-8.88	0.006
Time of follow-up at CAPS (in months)
≤ 7 months	1.00	-	-
> 7 months	2.77	1.19-6.44	0.018
Hospitalization related to mental health (before follow-up at CAPS)
No	1.00			1.00
Yes	2.33	1.06-5.11	0.034	2.24	1.03-4.86	0.041
Characteristics of care provided to users through PHC and CAPS services
Time between diagnosis and first consultation with non-medical CAPS professional (in days)
≤ 7 days	1.00	-	-	1.00	-
> 7 days	1.85	0.88-3.91	0.104	2.44	1.17-5.07	0.017
Received psychopharmaceutical prescription at PHC
Yes	1.00			1.00
No	1.77	0.83-3.80	0.140	2.23	1.02-4.84	0.043
Received medical advice at CAPS about how long to use the medication
Yes	1.00			1.00
No	2.43	1.10-5.37	0.028	2.51	1.14-5.52	0.022
Difficult access to some psychopharmaceuticals (last 6 months)
No	1.00
Yes, once	2.42	1.05-5.60	0.039
Yes, more than once	1.21	0.44-3.32	0.703

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[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva