RESUMEN
ABSTRACT: The aim of this study was to identify, analyze, and synthesize the best evidence on the effectiveness of clinical practicum experience in drug addiction treatment facilities on nursing students' attitudes toward alcohol, alcohol use disorder (AUD), and persons with AUD. This systematic review followed the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses and used the System for the Unified Management of the Assessment and Review of Information to assess methodological quality and extract data for meta-analysis. A comprehensive literature search of the EBSCO databases, Embase, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, PsycINFO, Scopus, Web of Science, Mednar, Coordenadoria de Aperfeiçoamento de Pessoal de Nível Superior, and ProQuest Dissertations & Theses catalog was conducted. The System for the Unified Management of the Assessment and Review of Information tool was used for the extraction and critical evaluation of the selected articles followed by a meta-analysis. After removing duplicates, 2,831 publications were identified, and eight met the inclusion criteria. More positive attitudes were observed after performing practicum experience in specialized services (-1.27, 95% confidence interval [-2.85, -0.30]), and an increase in the motivation and satisfaction among the students to care for patients with AUD was also noted. In conclusion, the review suggests that clinical practicum experience in a drug addiction treatment facility has the potential to change the attitudes of nursing students toward AUD and persons with AUD.
Asunto(s)
Alcoholismo , Actitud del Personal de Salud , Estudiantes de Enfermería , Humanos , Estudiantes de Enfermería/psicología , Alcoholismo/enfermería , Alcoholismo/terapia , Trastornos Relacionados con Sustancias , Centros de Tratamiento de Abuso de SustanciasRESUMEN
INTRODUCTION: Hispanics report higher rates of problematic alcohol use compared to non-Hispanic Whites while also reporting lower rates of alcohol treatment utilization compared to non-Hispanics. The study employs Anderson's Behavioral Model of Healthcare Utilization Model to guide the exploration of alcohol use, help-seeking and healthcare utilization. METHODS: The present qualitative study explored help-seeking and alcohol treatment utilization for Hispanic men of Mexican ethnicity. A total of 27 participants (Mage = 35.7, SD = 10.82) completed a semi-structured interview that explored the treatment experiences and underlying psychological mechanisms that shaped their help-seeking. RESULTS: Through a thematic content analysis, the following themes emerged: 1) perceiving need with subthemes of familismo, role as protector and provider, and positive face; 2) predisposing beliefs on help-seeking; and 3) treatment experiences and elements of patient satisfaction with subthemes of monetized treatment, respect, and perceiving professional stigma. CONCLUSIONS: The findings in this article may assist in improving strategies for increasing alcohol treatment utilization among men of Mexican ethnicity. By exploring beliefs, values, and experiences health researchers can develop culturally informed intervention strategies.
Asunto(s)
Consumo de Bebidas Alcohólicas , Americanos Mexicanos , Aceptación de la Atención de Salud , Humanos , Masculino , Adulto , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicología , Consumo de Bebidas Alcohólicas/etnología , Consumo de Bebidas Alcohólicas/psicología , Consumo de Bebidas Alcohólicas/epidemiología , Americanos Mexicanos/psicología , Americanos Mexicanos/estadística & datos numéricos , Investigación Cualitativa , Persona de Mediana Edad , Conducta de Búsqueda de Ayuda , Alcoholismo/etnología , Alcoholismo/psicología , Alcoholismo/terapia , Satisfacción del Paciente/etnologíaRESUMEN
ABSTRACT: The paucity of education and training on alcohol use disorders (AUDs) in nursing curricula is the main predictor of negative attitudes and results in limited knowledge access and delivery of health care for persons experiencing these problems. Although experts advocate increasing the time devoted to alcohol-related content in a crowded curriculum, didactic strategies for teaching about addiction in prequalifying nursing education have been discussed. This study aimed to verify the effectiveness of an educational experience that integrated clinical practicum experience in addiction treatment facilities for nursing students' attitudes. A quasi-experimental one-group study with pre-and-post 3-month follow-ups was carried out with 108 nursing students who answered the Attitudes Scale toward Alcohol, Alcohol Use Disorder, and Patients with Alcohol Use Disorders. The effect of the clinical practicum was apparent, with statistically significant changes to more positive global attitude scores in all measures. Previous educational intervention for AUDs during nursing education was a predictor of positive attitudes (OR = 7.21, p < .04). Students' self-perceived skills and professional preparation to deliver and direct care for patients with AUDs improved after the intervention, suggesting that clinical practice influenced students' skills for AUD identification across nursing practice. Previous contact with this population with lack of training in substance use disorder seems to favor negative attitude development. Clinical practicum experience in addiction treatment facilities improved nursing students' attitudes toward AUDs and patients with AUDs, and its effects were sustained 3 months later.
Asunto(s)
Alcoholismo , Conducta Adictiva , Estudiantes de Enfermería , Humanos , Alcoholismo/terapia , Preceptoría , EscolaridadRESUMEN
OBJECTIVE: (1) A remote intervention with a positive impact on reducing anxiety and alcohol use. (2) Nursing as a protagonist of preventive care in mental health (3) A low-cost intervention that covers several population groups. (4) Telenursing in mental health as a care strategy during COVID-19. to investigate the effect of a remote intervention on anxiety symptoms and alcohol use in users of the Primary Health Care service. METHOD: a quasi-experimental study conducted with 1,270 participants who answered the Alcohol Use Disorders Identification Test and the State-Trait Anxiety Inventory-6. Of these, 1,033 interviewees scored for moderate/severe anxiety symptoms (STAI-6 > 3) and moderate/severe risk alcohol use (AUDIT-C > 3), and received the interventions via telephone calls with follow-up periods lasting seven and 180 days. For data analysis, a mixed-effects regression model was used. RESULTS: the effect of the intervention performed was positive in reducing anxiety symptoms between T0 and T1 (µ=1.6, p<0.001) and in reducing the alcohol use pattern between T1 and T3 (µ=1.57, p<0.001). CONCLUSION: the follow-up results suggest a positive effect of the intervention in reducing anxiety and the alcohol use pattern, which tends to be maintained over time. There is diverse evidence that the intervention proposed can be an alternative for preventive care in mental health, in situations where accessibility of the user or the professional is compromised.
Asunto(s)
Alcoholismo , COVID-19 , Teleenfermería , Humanos , COVID-19/prevención & control , Salud Mental , Alcoholismo/terapia , Pandemias , Ansiedad/terapia , Ansiedad/psicología , Consumo de Bebidas Alcohólicas/prevención & controlRESUMEN
This article aims to analyze the experiences related to motherhood and care among mothers who attend mutual support groups to address alcohol-related harm in Mexico City and the State of Mexico. Drawing on the conceptual framework of collective health from a gender perspective, we contend that socioeconomic and gender-related factors influence the social determination of alcoholism and the health-disease-attention-care process. A qualitative study was conducted between May 2020 and January 2021, which included interviews with ten women who were selected based on specific criteria, as well as non-participant observation in a women's Alcoholics Anonymous group. The main findings show how trajectories of alcohol abuse and its management are interconnected with trajectories of care. From there, it was possible to identify a "break in care," a category that sheds light on mistreatment and the precariousness of life and health of women and their children.
Este artículo se propone analizar las experiencias sobre la maternidad y los cuidados de mujeres madres que asisten a grupos de apoyo mutuo en la Ciudad de México y el Estado de México para autoatender los daños asociados al alcohol. A partir del marco conceptual de la salud colectiva y la perspectiva de género, se concibe que la condición de género y socioeconómica inciden en la determinación social del alcoholismo y en el proceso salud-enfermedad-atención-cuidado. Desde este enfoque, de mayo de 2020 a enero de 2021, se realizó un estudio cualitativo, en el que se entrevistó a diez mujeres elegidas bajo ciertos criterios y se realizó observación no participante en un grupo femenino Alcohólicos Anónimos. Entre los principales resultados, se reconoce una trayectoria de abuso de alcohol y su atención, concatenada con la trayectoria de cuidados. Este hallazgo delimitó la categoría de "ruptura en el cuidado" para develar el maltrato, la precarización de vida y salud de las mujeres y sus hijos e hijas.
Asunto(s)
Alcoholismo , Mujeres , Niño , Humanos , Femenino , Alcoholismo/diagnóstico , Alcoholismo/terapia , México , Madres , Relaciones InterpersonalesRESUMEN
El uso de sustancias psicoactivas contribuye a la aparición de diferentes trastornos cuando se asocia con variaciones sociales y la fisiopatología del individuo, como aspectos genéticos, ambientales y neurológicos. Así, surge la necesidad de producir métodos de revisión de la literatura, entre los cuales destacamos la revisión integradora. Las palabras clave "alcohol" Y "estrategias de afrontamiento" Y "terapia cognitiva" fueron cruzadas en las bases de la Biblioteca Virtual en Salud (BVS) y SciELO, resultando en 200 artículos publicados en portugués, inglés y español, de 2018 a 2022. La inclusión los criterios fueron: ser un artículo de investigación completo; publicado en portugués, inglés y español; estar disponible electrónicamente y abordar el tema en estudio. Los resultados indicaron avances en prácticas que involucran la práctica de la TC y que, asociadas a otras técnicas de intervención, modifican el perfil tradicional de atención al paciente. Así, la literatura apunta para una mayor demanda de rehabilitación en la que se inserta la Terapia Cognitivista AU
O uso de substâncias psicoativas contribuem para o aparecimento de diferentes transtornos quando associadas a variações sociais e à fisiopatologia do indivíduo, como aspectos genéticos, ambientais e neurológicos. Desta forma, há necessidade de produção demétodos de revisão de literatura, dentre estes, destacamos a revisão integrativa. Foram cruzados os unitermos "álcool" AND "estratégias de enfrentamento" AND "terapia cognitiva" nas bases da Biblioteca Virtual em Saúde (BVS) e SciELO, resultando em 200 artigos publicados em português, inglês e espanhol, no período de 2018 a 2022. Os critérios de inclusão foram: ser artigo de pesquisa completo; publicado nos idiomas português, inglês e espanhol; estar disponível eletronicamente e abordar o tema em estudo. Os resultados indicaram avanços nas práticas que envolvem a prática da TC e que associadas a outras técnicas de intervenção, modificam o perfil tradicional de atenção aos pacientes. Assim a literatura aponta uma maior demanda de reabilitação na qual a Terapia Cognitivista está inserida AU
The use of psychoactive substances contributes to the appearance of different disorders when associated with social variations and the pathophysiology of the individual, such as genetic, environmental and neurological aspects. Thus, there is a need to produce literature review methods, among which we highlight the integrative review. The keywords "alcohol" AND "coping strategies" AND "cognitive therapy" were crossed in the bases of the Virtual Health Library (VHL) and SciELO, resulting in 200 articles published in Portuguese, English and Spanish, from 2018 to 2022. The inclusion criteria were: being a complete research article; published in Portuguese, English and Spanish; be electronically available and address the topic under study. The results indicated advances in practices that involve the practice of CT and that, associated with other intervention techniques, modify the traditional profile of patient care. Thus, the literature points to a greater demand for rehabilitation in which Cognitivist Therapy is inserted AU
Asunto(s)
Humanos , Masculino , Femenino , Terapia Cognitivo-Conductual , Trastornos Relacionados con Alcohol/psicología , Estrategias de Salud , Alcoholismo/terapiaRESUMEN
INTRODUCTION: Alcohol misuse emerges from a complex range of psychopathological experiences and personal and cultural values. For this reason, understanding the reasons why a person seeks treatment is crucial to effective care. This study aimed to identify the values which guide the decision-making process of persons seeking voluntary hospitalization for treatment for alcohol misuse, as well as the values of significant others. METHODS: A phenomenological investigation was conducted through interviews with 25 individuals (and family members) who had voluntarily admitted themselves to a hospital in São Paulo, Brazil, with the objective of maintaining abstinence from alcohol dependence. RESULTS: The main factors that determined the treatment-seeking decision were damage to social relationships and fear of illness and deterioration of the physical condition; the factors related to treatment expectations were restoring personality and awareness of morbidity; and the single factor considered most important to the success of the treatment was willpower. CONCLUSIONS: The results of this study contribute to developing strategies for bringing care closer to the patient's perspective of the disease and encourage their active participation in the formulation of care.
Asunto(s)
Alcoholismo , Humanos , Alcoholismo/diagnóstico , Alcoholismo/terapia , Brasil , Familia , Trastornos de la Personalidad , Relaciones InterpersonalesRESUMEN
BACKGROUND: Harmful use of alcohol is highly prevalent around the world and results in a large disease burden. Most people who meet the criteria for an alcohol use disorder do not receive treatment. Those in a person's social network can be useful in recognizing a problem and encouraging the person to seek treatment. However, many people lack the knowledge and skills to do this effectively. This study reports on the cultural adaptation for Brazil of the 2009 English-language mental health first aid guidelines for helping someone with problem drinking. METHODS: A Delphi expert consensus study with two expert panels, one comprising health professionals with experience in the treatment of problem drinking and the other comprising people with lived experience was conducted. Participants rated the importance of actions to be taken to help a person with problem drinking. RESULTS: Over two rounds, 60 participants (30 professionals and 30 people with lived experience) rated 197 items. A total of 166 items were included in the final guidelines. CONCLUSIONS: While there were many similarities with the English-language guidelines for high-income countries, the guidelines also incorporate actions of importance for Brazil, including compulsory treatment and different approaches to dealing with people with problem drinking. Further research is necessary to assess their impact.
Asunto(s)
Alcoholismo , Primeros Auxilios , Alcoholismo/terapia , Brasil , Técnica Delphi , Primeros Auxilios/métodos , Humanos , Salud Mental , Encuestas y CuestionariosRESUMEN
BACKGROUND: Among all psychoactive substances, alcohol consumption presents the most significant public health problem and is a leading risk factor for overall disease burden in Latin America. However, most people who meet criteria for a substance use disorder do not receive treatment in primary or secondary care sources. Community members can play a role in helping people to seek help as they are likely to encounter people experiencing problem drinking and recognize the signs. However, many do not have adequate mental health first aid knowledge or skills to provide help. We aimed to culturally adapt the existing English-language mental health first aid guidelines for helping someone with problem drinking for Argentina and Chile. METHODS: The Delphi consensus method was used to determine the importance of helping actions translated from the English-language guidelines and to add new actions suggested by expert panellists. The importance of each statement was rated by two expert panels. Panel one included people with lived experience (either their own or as a support person, n = 23) recruited in Argentina and panel two included health professionals (n = 31) recruited in Argentina and Chile. RESULTS: Overall, 165 helping actions were endorsed by panellists across two consecutive survey rounds. Endorsed items included 132 of the 182 items translated into Spanish from the English-language guidelines and 33 of the 61 new items generated from panellists' comments in the first survey round. CONCLUSIONS: While there were some similarities in recommended helping actions between English-speaking countries, and Argentina and Chile, key differences were seen in attitudes to low-risk drinking. While there was a relatively high level of agreement between health professionals and people with lived experience, some divergence of opinion was seen, particularly in the area of commitment to recovery as a condition for help. Future research should explore the implementation of the guidelines.
Asunto(s)
Alcoholismo , Primeros Auxilios , Alcoholismo/terapia , Argentina , Chile , Técnica Delphi , Primeros Auxilios/métodos , Humanos , Salud MentalRESUMEN
INTRODUCTION: Female alcoholism is a public health problem for which membership in Alcoholics Anonymous (AA) groups is an effective treatment. As AA is predominantly attended by men in Brazil, the aim of this article is to understand the meaning of this problem and the experience of AA meetings for women. METHODS: A qualitative ethnographic study was conducted between August and September 2019 and included 15 participants of a women-only AA meeting in the city of São Paulo, Brazil. Data were collected by means of direct participant observation, records in field diaries, ethnographic interviews and records of experience sharing between the women during the AA meetings. RESULTS: An intelligible, interpretative and comprehensive synthesis of the data collected resulted in two categories: 'Alcohol, Alcoholism and Gender' and 'What AA means to women'. The first category allowed alcoholism to be analysed as a disease associated with gender asymmetries. The second category permitted an assessment to be made of how women-only AA meetings served to provide alcoholic women with a safe and morally privileged place in which they could share their experiences and treat their addiction. DISCUSSION AND CONCLUSIONS: Alcoholism in women is marked by social stigma, making it difficult to find women willing to share their experiences and participate in qualitative research on this important issue in public health. In these women-only meetings, they shared their experiences, and alcoholism is referred to as a 'wounded soul' that causes deep anguish often experienced in the isolation of their own homes.
Asunto(s)
Alcohólicos Anónimos , Alcoholismo , Alcoholismo/terapia , Brasil , Femenino , Identidad de Género , Humanos , Masculino , Resultado del TratamientoRESUMEN
The prevalence of alcohol use disorder (AUD) has been steadily increasing over the past decade. In parallel, alcohol-associated liver disease (ALD) has been increasing at an alarming rate, especially among young patients. Data suggest that most patients with ALD do not receive AUD therapy. Although liver transplantation is the only curative therapy for end-stage ALD, transplant candidacy is often a matter of debate given concerns about patients being under-treated for AUD and fears of post-transplantation relapse affecting the allograft. In this Review, we discuss diagnosis, predictors and effects of relapse, behavioural therapies and pharmacotherapies, and we also propose an integrative, multidisciplinary and multimodality approach for treating AUD in patients with cirrhosis, especially in the setting of liver transplantation. Notably, this approach takes into account the utility of AUD pharmacotherapy in patients on immunosuppressive medications and those with renal impairment after liver transplantation. We also propose a comprehensive and objective definition of relapse utilizing contemporary biomarkers to guide future clinical trials. Future research using the proposed approach and definition is warranted with the goal of optimizing AUD treatment in patients with cirrhosis, the transplant selection process and post-transplantation care of patients with AUD.
Asunto(s)
Alcoholismo/terapia , Cirrosis Hepática Alcohólica/cirugía , Trasplante de Hígado , Alcoholismo/complicaciones , Alcoholismo/diagnóstico , Humanos , Cirrosis Hepática Alcohólica/etiología , Cirrosis Hepática Alcohólica/psicologíaRESUMEN
This narrative literature review addresses grassroots interventions for alcohol use disorders as practiced in Mexican immigrant communities. These organic efforts are 24-hour AA groups, or anexos, fourth and fifth step AA groups, juramentos, and curanderismo. Literature was identified using PubMed and CINAHL and limited to works published from 2000 to 2018. In all, three publications on 24-hour groups were found, two on fourth and fifth step groups, four on juramentos, and one on curanderismo use. The review offers insight on their practices and concludes that the interventions' cultural resonance provides advantages over cultural competency AUDs programs developed in public health.
Asunto(s)
Alcoholismo , Emigrantes e Inmigrantes , Alcoholismo/terapia , Competencia Cultural , Humanos , MéxicoRESUMEN
BACKGROUND: Because of the shortage of health professionals in Chilean primary care, Health Technicians (HT) are providing Brief Interventions (BI) for risky alcohol consumption. We compared the efficacy of two AUDIT-linked interventions provided by HTs: an informative leaflet and a BI plus leaflet. METHODS: This is a parallel-group randomized controlled trial with 1:1 randomization. Participants were identified through screening with the Alcohol Use Disorders Identification Test (AUDIT) at five primary care centers between March 2016 and July 2017. People older than 18 years at intermediate-risk (AUDIT score 8 to 15, inclusive) were randomized to receive either an HT-delivered BI (n = 174) or an informative leaflet (n = 168). Only data from participants (n = 294) who completed the 6-month assessment were analyzed. The leaflet was delivered without further advice. It contains alcohol consumption limits, a change planner, and strategies to decrease drinking. The BI was a 5-min discussion on the leaflet´s content plus normative feedback, tailored information on alcohol and health, and a change plan. The change in the AUDIT risk category six months after randomization (primary outcome) was compared among groups with a Chi-squared test. Changes in the secondary outcomes, which were scores on the AUDIT and the AUDIT´s consumption items (AUDIT-C), were compared with T-tests. Mixed-effects linear models adjusted for potential confounders. Outcome adjudicators were blinded to group assignment. RESULTS: At 6-month follow-up, low-risk alcohol consumption was observed in 119 (80%) participants in the BI group, and in 103 (71%) in the leaflet group, with no difference among groups ([Formula: see text] [1, N = 294] = 2.6, p = 0.1; adjusted odds ratio 0.6; 95% confidence interval [CI] 0.34, 1.05). The mean AUDIT score decreased by 5.76 points in the BI group, and by 5.07 in the leaflet group, which represents a 0.86 AUDIT point reduction attributable to the BI (secondary outcome) (T = 2.03, p = 0.043; adjusted mean difference 0.86 CI 0.06, 1.66). CONCLUSIONS: The AUDIT-linked BI delivered by HTs was not associated with a greater reduction of risky alcohol consumption than an informative leaflet. Delivering a leaflet could be more efficient than a BI when provided by HTs; however, more research on the effectiveness of the leaflet is needed. Trial registration ClinicalTrials.gov NCT02642757 (December 30, 2015) https://clinicaltrials.gov/ct2/show/NCT02642757 .
Asunto(s)
Alcoholismo , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/prevención & control , Alcoholismo/epidemiología , Alcoholismo/terapia , Intervención en la Crisis (Psiquiatría) , Humanos , Tamizaje Masivo , Atención Primaria de SaludRESUMEN
Depression and alcohol use disorder (AUD) greatly contribute to the burden of disease worldwide, and have large impact on Colombia's population. In this study, a qualitative analysis evaluates the implementation of a technology-supported model for screening, decision support, and digital therapy for depression and AUD in Colombian primary care clinics. Patient, provider, and administrator interviews were conducted, exploring attitudes towards depression and AUD, attitudes towards technology, and implementation successes and challenges. Researchers used qualitative methods to analyze interview themes. Despite stigma around depression and AUD, the model improved provider capacity to diagnose and manage patients, helped patients feel supported, and provided useful prevalence data for administrators. Challenges included limited provider time and questions about sustainability. The implementation facilitated the identification, diagnosis, and care of patients with depression and AUD. There is ongoing need to decrease stigma, create stronger networks of mental health professionals, and transition intervention ownership to the healthcare center.
Asunto(s)
Alcoholismo , Alcoholismo/diagnóstico , Alcoholismo/terapia , Colombia , Atención a la Salud , Depresión , Humanos , Atención Primaria de SaludRESUMEN
BACKGROUND: Harmful alcohol use is a leading cause of global disability and death. However, increased detection and brief intervention capacity of more severe alcohol use disorders has not been accompanied by increased availability of treatment services. Incorporating treatment for such disorders into primary care is of paramount importance for improving access and health outcomes. This study aims to estimate the effectiveness of a Brief Motivational Treatment (BMT) applied in primary care for treatment of these disorders. METHODS: A parallel-group, single-blinded, severity-stratified, randomized clinical trial will test the superiority of BMT over enhanced usual care. Eligible participants will be those seeking treatment and who fulfill DSM-V criteria for alcohol use disorder and criteria for harmful alcohol use. With an estimated a loss to follow-up of 20%, a total of 182 participants will be recruited and equally randomized to each treatment group. The intervention group will receive an adaptation of the motivational enhancement therapy, as manualized in Project MATCH. This treatment consists of four 45-min sessions provided by a general psychologist with at least 3 years of primary care experience. The primary outcome is the change from baseline in the drinks per drinking day during the last 90 days, which will be captured using the Timeline Follow Back method. Secondary outcomes will describe the changes in alcohol use pattern, motivational status, and severity of the disorder. All participants will be analyzed according to the group they were allocated, regardless of the treatment actually received. Mean differences (MD) will be computed for continuous outcomes and relative risks (RR) and RR reductions (RRR) for dichotomous results. Linear models will deliver the subgroup analyses. Missingness is assumed to be associated with the baseline alcohol use pattern and severity, so a multiple imputation method will be used to handle missing data. DISCUSSION: This trial aims to test the superiority of BMT over enhanced usual care with a reasonable superiority margin, over which the BMT could be further considered for incorporation into PC in Chile. Its pragmatic approach ultimately aims to inform policymakers about the benefit of including a brief psychosocial treatment into PC. TRIAL REGISTRATION: ClinicalTrials.gov NCT04345302 . Registered on 28 April 2020.
Asunto(s)
Alcoholismo , Entrevista Motivacional , Alcoholismo/diagnóstico , Alcoholismo/terapia , Chile , Humanos , Motivación , Atención Primaria de Salud , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Recomenda ad referendum do Pleno do Conselho Nacional de Saúde ao Ministério da Saúde, que: 1. Revise a Nota Técnica nº 12/2020 - CGMAD/DAPES/SAPS/MS, visando o fortalecimento de ações e serviços de base territorial e comunitária para atenção psicossocial no contexto de pandemia, e orientações específicas para o funcionamento dos hospitais psiquiátricos, visando evitar os riscos de contaminação em massa por Coronavírus; 2. Oriente a participação de representantes do controle social e da gestão da política de saúde mental na composição dos Comitês Gestores de Crise para o Covid-19 implementados nos estados, municípios e Distrito Federal; 3. Oriente a inclusão da organização da RAPS nos Planos de Contingência Estaduais, do Distrito Federal e Municipais como uma das dimensões estratégicas para a atenção à saúde da população; 4. Crie estratégias com os gestores de saúde dos estados e municípios, para assegurarem aos serviços da RAPS as condições necessárias para a realização de reuniões virtuais intra e intersetoriais, a ampliação de visitas e atendimentos domiciliares, ampliação do contato à distância (via internet, telefônico, etc), dentre outros recursos que possam contribuir para a manutenção de vínculos e do processo terapêutico, bem como para a diversificação de estratégias assistenciais não medicamentosas; 5. Construa medidas intersetoriais que favoreçam a proteção e atenção psicossocial de crianças e adolescentes e seus familiares pelos serviços da RAPS nos territórios, considerando as peculiaridades da sua condição de desenvolvimento e as novas necessidades de suporte decorrentes do contexto de pandemia, especialmente dos casos mais graves; 6. Apresente medidas específicas e efetivas de proteção às pessoas em situação de rua no período da pandemia, inclusive pessoas LGBTIQ+, de forma articulada com o Sistema Único de Assistência Social (SUAS) e outros setores, considerando o contexto de maior vulnerabilidade social, bem como ações de monitoramento de casos suspeitos e confirmados de Covid-19 realizadas de forma integrada pelos serviços que compõem a rede SUAS e o SUS, incluindo a RAPS; 7. Realize ações em parceria com entidades de classe e instituições formadoras voltadas ao suporte e atenção à saúde mental dos trabalhadores da saúde, que estão na linha de frente do combate à Covid-19; 8. Produza e publicize informações de monitoramento dos casos suspeitos, confirmados e de óbitos por Covid-19, entre as pessoas com transtornos mentais e aquelas com necessidades decorrentes do uso de álcool e outras drogas; 9. Elabore estratégias em parceria com o SUAS, visando a orientação aos serviços territoriais quanto ao acompanhamento e avaliação da necessidade de suporte às famílias que possam necessitar de atenção em saúde mental, álcool e outras drogas, em decorrência da instabilidade socioeconômica, do aumento de tensões, conflitos e do risco de violência doméstica no contexto de isolamento domiciliar; 10. Promova articulação com os órgãos do sistema de justiça visando à reavaliação das pessoas internadas involuntária e compulsoriamente em hospitais psiquiátricos com urgência, na perspectiva de alta e retorno ao meio comunitário; 11. Adote medidas que favoreçam a redução da concentração de pessoas internadas em hospitais psiquiátricos e hospitais de custódia e tratamento psiquiátrico, com processos de alta e desinstitucionalização, considerando a legislação vigente e objetivando minimizar o risco de contaminação em massa; 12. Assegure a regularidade de liberação de recursos financeiros federais, aos estados e municípios, destinados à implantação e habilitação (custeio) de novos serviços da RAPS, especialmente àqueles diretamente relacionados à processos de desinstitucionalização; 13. Apresente, emergencialmente, políticas que garantam recursos financeiros federais aos estados, Distrito Federal e municípios, para apoiar a ampliação, das equipes e da capacidade dos serviços de atenção psicossocial de base comunitária, especialmente os CAPS; 14. Solicite aos estados, Distrito Federal e municípios, o monitoramento do adequado fornecimento de Equipamentos de Proteção Individual (EPIs) para assegurar a proteção dos profissionais de saúde da RAPS, nos seus diferentes pontos de atenção bem como das pessoas atendidas nos serviços de saúde mental; 15. Formule indicadores de vigilância em saúde mental durante a pandemia, considerando: ações de acolhimento e de atenção à crise realizadas pelos CAPS; ações de matriciamento pelos CAPS; taxa de ocupação e tempo médio e permanência de internações psiquiátricas em hospitais gerais, taxa de ocupação por medida de segurança em hospitais de custódia e tratamento psiquiátrico; número de pessoas institucionalizadas que se enquadram nos grupos de risco; atendimentos de urgência em saúde mental, álcool e outras drogas pelo SAMU/Bombeiro; e dispensa de medicamentos psicotrópicos; e 16. Monitore as Notificações de Tentativas de Suicídio e óbitos por Suicídio, com vistas a analisar os diferentes cenários e favorecer o direcionamento de novas ações.
Asunto(s)
Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/terapia , Alcoholismo/terapia , COVID-19/epidemiología , Hospitales Psiquiátricos/organización & administración , Trastornos Mentales/psicologíaRESUMEN
Digital information technologies are increasingly used in the treatment of mental health disorders. Through this qualitative study, researchers illuminated perspectives, experiences, and practices among diverse stakeholders in the use of digital information technologies in the management of depression and alcohol use disorders in Colombia. In-depth interviews and focus groups were conducted in five primary care institutions across Colombia. Thematic analysis was used to analyze the data. The use of technology in the treatment of mental health disorders can facilitate the evaluation and diagnosis, treatment, and promotion and prevention of mental health disorders, as well as multiple nonmental health applications in the primary care setting. Potential barriers to the use of technology in this setting include challenges of digital literacy, access to technology, confidentiality, and financing. This study can inform the implementation of digital information technologies in the care of depression and problematic alcohol use within health care systems in Colombia.
Asunto(s)
Alcoholismo , Alcoholismo/epidemiología , Alcoholismo/terapia , Colombia , Atención a la Salud , Depresión/terapia , Humanos , Tecnología de la InformaciónRESUMEN
BACKGROUND AND AIMS: Despite the significant medical and economic consequences of coexisting alcohol use disorder (AUD) in patients with cirrhosis, little is known about AUD treatment patterns and their impact on clinical outcomes in this population. We aimed to characterize the use of and outcomes associated with AUD treatment in patients with cirrhosis. APPROACH AND RESULTS: This retrospective cohort study included Veterans with cirrhosis who received Veterans Health Administration care and had an index diagnosis of AUD between 2011 and 2015. We assessed the baseline factors associated with AUD treatment (pharmacotherapy or behavioral therapy) and clinical outcomes for 180 days following the first AUD diagnosis code within the study time frame. Among 93,612 Veterans with cirrhosis, we identified 35,682 with AUD, after excluding 2,671 who had prior diagnoses of AUD and recent treatment. Over 180 days following the index diagnosis of AUD, 5,088 (14%) received AUD treatment, including 4,461 (12%) who received behavioral therapy alone, 159 (0.4%) who received pharmacotherapy alone, and 468 (1%) who received both behavioral therapy and pharmacotherapy. In adjusted analyses, behavioral and/or pharmacotherapy-based AUD treatment was associated with a significant reduction in incident hepatic decompensation (6.5% vs. 11.6%, adjusted odds ratio [AOR], 0.63; 95% confidence interval [CI], 0.52, 0.76), a nonsignificant decrease in short-term all-cause mortality (2.6% vs. 3.9%, AOR, 0.79; 95% CI, 0.57, 1.08), and a significant decrease in long-term all-cause mortality (51% vs. 58%, AOR, 0.87; 95% CI, 0.80, 0.96). CONCLUSIONS: Most Veterans with cirrhosis and coexisting AUD did not receive behavioral therapy or pharmacotherapy treatment for AUD over a 6-month follow-up. The reductions in hepatic decompensation and mortality suggest that future studies should focus on delivering evidence-based AUD treatments to patients with coexisting AUD and cirrhosis.