Effect of an intervention for organizing mental health care in primary health care

Abstract

Background The “Mental Health Care in Primary health Care (PHC)” project (SMAPS, from Portuguese) was developed in six health districts from three Brazilian states. Considering the gap and relevance of monitoring and assessing mental health (MH) care in real-world settings using data from service records, this study aimed to evaluate the effect of SMAPS on MH indicators in PHC. Methods This is a pilot study conducted between January 2022 and September 2023. The sample comprised 18 basic health units (BHU) in 14 municipalities, which were in one of the three Brazilian states that adhered to SMAPS and assigned to one of two groups: intervention and control (2:1). Secondary data were collected at two times using the same instrument to systematize the retrieval of aggregated data, which were extracted from management reports from BHU or municipalities departments. Data analysis was performed using descriptive statistics at the BHU or municipality level. Results The rate of referrals to MH specialties per consultation with a MH classifications record declined in intervention (75.3%) and control group (63.2%). The percentage of benzodiazepine medications dispensed for PHC decreased from 16.1–11.3% in intervention group municipalities but increased from 20.3–24.1% in control group. An inverse pattern was observed for antipsychotic, anticonvulsant, and antidepressant medications (increased from 82.2–86.2% in intervention group municipalities and declined from 77.6–74.4% in control group). There was no difference in suicide death rates on average across municipalities, but some variations were observed when analyzing each health district separately. Indicators related to the diagnosis of mental disorders and collective activities were also collected, however important inconsistencies were observed in the data collected for both groups. Conclusion The present pilot study points to potential effects of SMAPS for organizing MH care in PHC, especially regarding the referrals to specialty mental health care and the dispensation of psychotropic medications. Thus, contributes to the formulation of proposals for evaluating MH care based on data already available from records and reports from health services and emphasizes the need to improve the quality of MH care recording in PHC work routines.