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Vol. 19. Núm. 6.
Páginas 448-455 (Noviembre - Diciembre 2005)
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Vol. 19. Núm. 6.
Páginas 448-455 (Noviembre - Diciembre 2005)
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Variaciones del consumo de recursos ambulatorios en la atención especializada de salud mental a niños y adolescentes
Variability in outpatient resource use in mental health services for children and adolescents
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496
Juan Alday, Virginia Alonso, Belén Fernández-Calatrava, Raquel García-Baró, Carlos González-Juárez
Autor para correspondencia
cgonzalez.ipjg@salud.madrid.org

Correspondencia: Carlos González. Instituto Psiquiátrico José Germain. Luna, 1. 28911 Leganés. Madrid. España.
, Esther Pérez-Pérez, Alfonso Poza
Instituto Psiquiátrico José Germain. Leganés. Madrid. España
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Bibliografía
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Estadísticas
Resumen
Objetivos

Conocer la variabilidad en las respuestas asistenciales que se ofrecen en la atención psiquiátrica ambulatoria a los menores de 18 años, medidas por el número de consultas y el tiempo de duración de los tratamientos.

Método

Estudio observacional, analítico, prospectivo con datos históricos y longitudinal de seguimiento de 298 sujetos que consultan por primera vez en las unidades de atención ambulatoria de Leganés y Fuenlabrada (Madrid).

Resultados

La mediana del número de consultas por paciente en Leganés fue de 6, mientras que en Fuenlabrada fue de 3 (p < 0,001). La mediana de la duración del tratamiento fue más del doble en Leganés (276 días) que Fuenlabrada (119 días) (p < 0,001). El análisis estratificado muestra que los tratamientos del distrito de Fuenlabrada suponen un menor número de consultas, ya sea el profesional responsable psiquiatra o psicólogo, se lleve a cabo psicoterapia individual, de otro tipo, o no se indique tratamiento de modo explícito, se realice alta concertada o ésta se produzca por abandono. Similares resultados se aprecian para la duración del tratamiento.

Conclusiones

Las diferencias encontradas de estilos de práctica clínica ilustran las dificultades para desarrollar un sistema de ajustes de riesgos útil en salud mental, puesto que las diferencias en uso de recursos no son fácilmente atribuibles a variables relacionadas con el paciente, sino al tipo de intervención prestada, que depende de la discrecionalidad del facultativo.

Palabras clave:
Centro de salud mental comunitaria/utilización
Investigación de servicios de salud
Infancia y adolescencia
Abstract
Objectives

To assess possible variability in the therapeutic approaches provided to patients aged less than 18 years old in community mental health centres (CMHC) in terms of the number of visits and length of treatment.

Method

An observational, analytical, prospective, longitudinal study was performed in a clinical cohort of 298 subjects attending the CMHC of Leganés and Fuenlabrada (Madrid) for the first time.

Results

The median number of visits per patient was six in Leganés and three in Fuenlabrada (p < 0.001). The mean length of treatment was more than twice as long in Leganés (276 days) than in Fuenlabrada (119 days) (p < 0.001). Stratified analysis showed that the treatments provided in Fuenlabrada involved fewer visits, irrespective of the health professional in charge (psychiatrist or psychologist), the treatment modality prescribed (individual psychotherapy, other psychotherapies or no explicit treatment prescribed), or whether the patient abandoned treatment or the discharge was agreed. Similar results were found for the length of treatment.

Conclusions

The different clinical styles illustrate the difficulty of developing useful risk adjustment systems in mental health. The differences in resource consumption and costs cannot easily be attributed to patient-related variables, but are due rather to the intervention provided, which depends on the staff.

Key words:
Community mental health services utilization
Health services research
Child and adolescent
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Bibliografía
[1.]
Department of Health and Human Services, Substance Abuse and Mental Health Services.
Administration Mental health: a report of the surgeon general.
National Institute of Mental Health, (1999),
[2.]
J.M. Zito, D.J. Safer, S. DosReis, J.F. Gardner, L. Magder, K. Soeken, et al.
Psychotropic practice patterns for youth: a 10-year Perspective.
Arch Pediatr Adolesc Med, 157 (2003), pp. 17-25
[3.]
L. Juszczak, P. Melinkovich, D. Kaplan.
Use of health and mental health services by adolescents across multiple delivery sites.
J Adolesc Health, 32S (2003), pp. 108-118
[4.]
W. Weller, C. Minkovitz, G. Anderson.
Utilization of medical and health-related services among school-age children and adolescents with special health care needs (1994 National Health Interview Survey on Disability [NHIS-D] Baseline Data).
Pediatrics, 102 (2003), pp. 593-603
[5.]
L.C. Mayes.
Addressing mental health needs of infants and young children.
Child Adolesc Psychiatr Clin North Am, 8 (1999), pp. 209-224
[6.]
C. Glisson.
The organizational context of children's mental health services.
Clin Child Fam Psychol Rev, 5 (2002), pp. 233-253
[7.]
S. Evans, R. Brown.
Perception of need for child psychiatry services among parents and general practitioners.
Health Trends, 25 (1993), pp. 53-56
[8.]
R.M. Semansky, C. Koyanagi.
Accessing Medicaid's child mental health services: the experience of parents in two states.
Psychiatr Serv, 54 (2003), pp. 475-476
[9.]
N.R. Grant, D.R. Offord, H.M. Blum.
Ontario Child Health Study. Implications for clinical services, research and training.
Can J Psychiatry, 34 (1989), pp. 492-499
[10.]
J.R. Gutiérrez Casares, F. Rey Sánchez.
Planificación terapéutica de los trastornos psiquiátricos de niños y adolescents.
SmithKline Beecham, (2000),
[11.]
P.S. Jensen, V.S. Bhatara, B. Vitiello, K. Hoagwood, M. Feil, L.B. Burke.
Psychoactive medication prescribing practices for US children: gaps between research and clinical practice.
J Am Acad Child Adolesc Psychiatry, 38 (1999), pp. 557-565
[12.]
S.G. Lazar, G.O. Gabbard.
The cost-effectiveness of psychotherapy.
J Psychother Pract Res, 6 (1997), pp. 307-314
[13.]
C. Lonigan, J. Elberrt, S.B. Jhonson.
Empirically supported psychosocial interventions for children: an overview.
J Clin Child Psychol, 27 (1998), pp. 138-145
[14.]
R.Z. Ritvo, S.B. Papilsky.
Effectiveness of Psychotherapy.
Curr Opin Pediatr, 11 (1999), pp. 323-332
[15.]
H. Remschmidtt.
Evidence concerning the effectiveness of psychotherapies with children and adolescents.
Curr Opin Psychiatry, 16 (2003), pp. 389-393
[16.]
P. Armbruster, J. Lichtman.
Are school based mental health services effective? Evidence from 36 inner city schools.
Community Ment Health J, 35 (1999), pp. 493-504
[17.]
A. Angold, E.J. Costello, B.J. Burns, A. Erkanli, E. Farmer.
Effectiveness of non-residential specialty mental health services for children and adolescents in the «real world».
J Am Acad Child Adolesc Psychiatry, 39 (2000), pp. 154-160
[18.]
A.R. Andrade, E.W. Lambert, L. Bickman.
Dose effect in child psychotherapy: Outcomes associated with negligible treatment.
J Am Acad Child Adolesc Psychiatry, 39 (2000), pp. 161-168
[19.]
M.S. Salzer, L. Bickman, E.W. Lambert.
Dose-effect relationship in children's psychotherapy services.
J Consult Clin Psychol, 66 (1999), pp. 270-290
[20.]
L. Bickman, A.R. Andrade, E.W. Lambert.
Dose response in child and adolescent mental health services.
Ment Health Serv Res, 4 (2002), pp. 57-70
[21.]
B.H. Schneider, B.M. Byrne.
Children's social skills training: a meta-analysis.
Children's peer relations: issues in assessment and intervention,
[22.]
J. Marión Buen, S. Peiró, S. Márquez Calderón, R. Meneu de Guillerna.
Variaciones en la práctica médica: importancia, causas, implicaciones.
Med Clin (Barc), 110 (1998), pp. 382-390
[23.]
P. Wu, C.W. Hoven, H.R. Bird, R.E. Moore, P. Cohen, M. Alegría, et al.
Depressive and disruptive disorders and mental health services utilization in children and adolescents.
J Am Acad Child Adolesc Psychiatry, 38 (1999), pp. 1081-1090
[24.]
Instituto Psiquiátrico José Germain. Memoria 1999. Madrid: Consejería de Sanidad y Consumo; 2000.
[25.]
K. Hoagwood.
Commentary: The dose effect in children's mental health services.
J Am Acad Child Adolesc Psychiatry, 39 (2000), pp. 172-175
[26.]
T. Petti.
Commentary: More outcomes studies are needed.
J Am Acad Child Adolesc Psychiatry, 39 (2000), pp. 169-171
[27.]
A.M. Garver, V.R. Fuchs, J.F. Silverman.
Case mix costs and outcomes. Differences between faculty and community services in a university hospital.
N Engl J Med, 310 (1984), pp. 1231-1237
[28.]
W.S. Custer, R.J. Wilke.
Teaching hospital costs: the effects of medical staff characteristics.
Health Serv Res, 25 (1991), pp. 831-858
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