Perfil sócio-demográfico e clínico de pacientes psiquiátricos tratados em Hospital Dia / The socio-demographic and clinical profile of psychiatric patients attended at the Day Hospital

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Introduction. The reform of psychiatric assistance in Brazil has progressively decreased the number of beds in conventional psychiatric hospitals. Concomitantly, a substitute network of extra-hospital services has developed, among which is the Day Hospital (HD) of the HCFMRP-USP of the DRS-XIII, based in Ribeirão Preto, SP. This service, source of the data presented here, is less strict than full-time hospitalization and more protective than outpatient clinics. This process, however, presented as an undesired effect the phenomenon termed revolving door, represented by the significant increase in the rate of readmissions, which in some hospitals responds for over 50% of all admissions. Objectives. To characterize the clinical and socio-demographic profile of the clientele attended at the HD between January 1996 and December 2005; to identify and describe the characteristics of patients who had previous full-time hospitalizations and were readmitted at the HD; to investigate whether there is any association between the time spent at the HD and clinical and socio-demographic variables. Methodology. Data were collected from the patients medical records by means of a protocol elaborated for this purpose. Participants were 689 patients who had 914 admissions at the HD. Variables were analyzed with the software SPSS, version 13.0. Results. Patients were predominantly females (58,4%), aged between 20 and 39 years (53,5%), white (84,2%), not married (59,7%), living with family or friends (57,9%), original from Ribeirão Preto and neighboring cities (90,2%), with elementary education (53,6%), unemployed (90,5%), and with no individual income (51,2%). Most patients were discharged by medical orders (73,3%), were referred to outpatient clinics after discharge (86,2%), had a single admission at the HD (77,8%), and mean hospitalization of 49 days. The most prevalent diagnoses at discharge were: Schizophrenia (32,8%), Depressive Episode (27,0%), Manic Episode/ Affective Disorder (15,1%), Personality Disorder (14,7%), and Others/ Neurotic Episode (10,4%). Patients with previous full-time hospitalizations accounted for 47,0% of admissions. Discussion. The results show that the HD treats young adults whose disease onset occurs at the peak of their productive age, with a predominance of Schizophrenia. The patients are economically and emotionally dependent on the family and on the regional public system of medication dispense and transportation. The severity of their psychiatric conditions together with the social complexity of mental disorders has a negative impact on the patients educational status. The mean hospitalization time is in accordance with the reccomendations of Regulation 224. This permanence enables brief focal therapy for most patients and a positive intervention, keeping patients away from hospitalizations and guiding them toward outpatient follow-up. Conclusion. The HD proved able to treat patients with severe and persistent mental disorders, to be inserted in the assistance network of the DRS-XIII, and to be a service that performs functions of resocialization and reintegration of severely ill patients in the community. The HD treats patients of the DRS-XIII with a previous history of full-time hospitalization, however, it does not repeat the revolving door phenomenon with these patients.

ASSUNTO(S)

fatores sócio-econômicos mental disorders mental health hospital dia health policy serviços de saude mental mental health services saúde mental política de saúde day hospital socioeconomic factors transtornos mentais

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