Transitions of Care in Mental Health

Introduction: The occurrence of mental disorders and chronic diseases is associated with low treatment compliance and an increased mortality. The main objective of this study was to analyze medication prescriptions at hospital discharge in order to verify the patients’ access to the prescribed treatment. Methods: This is a descriptive and retrospective study performed between September 2013 and September 2018 with patients admitted in the psychiatric ward of a university hospital in the state of Rio Grande do Sul. The studied patients consisted of 274 adults over 18 years of age admitted to this hospital with at least one psychiatric comorbidity included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) who lived in the city of Porto Alegre used specially controlled drugs, and had been hospitalized for at least 7 days. Results: Out of the 274 patients, 68.5% were readmitted once, 17.5% were readmitted twice, 9.5% were readmitted 3times, and 4.5% went through this process 4 times or more. A significant association (p = 0.014) was observed between the number of drugs not included in the Municipal Essential Medicines List upon first readmission and the number of readmissions. Among patients who were readmitted 3 times or more, 79% were prescribed drugs that were not on this list. Conclusions: The understanding of how therapeutic itineraries are established when searching for drugs contributes to setting effective lines of care where professionals may position themselves more proactively to reduce mental health complications

Psicofármacos prescritos em uma unidade psiquiátrica hospitalar da região Sul do Brasil e a cobertura prevista na REMUME

Introdução: O uso de medicamentos no tratamento de transtornos psiquiátricos vem em crescimento nos últimos anos, e a falta de acesso adequado aos medicamentos é um dos motivos pelo qual o paciente retorna ao serviço de saúde. Grande parte dos pacientes internados acabam alterando pelo menos um medicamento de uso prévio sujeito a controle especial da Relação Municipal de Medicamentos por um ou mais medicamentos não constantes nessa seleção. O objetivo deste estudo foi identificar os medicamentos não pertencentes a lista municipal de medicamentos prescritos aos pacientes internados na Unidade Psiquiátrica do Hospital de Clínicas de Porto Alegre. Método: Estudo descritivo com análise retrospectiva no período de junho de 2017 a junho de 2018 dos pacientes admitidos na internação psiquiátrica da rede pública e privada. Através do prontuário eletrônico, foi possível analisar 281 prontuários de pacientes internados na Unidade Psiquiátrica do Hospital de Clínicas de Porto Alegre. Resultados: Dos 281 prontuários analisados, 64 (22,8%) apresentavam prescrições de admissão hospitalar com todos os medicamentos presentes na lista REMUME, enquanto 217 (77,2%) utilizavam no mínimo um medicamento não presente na lista. Essa diferença foi ainda maior nas prescrições de alta hospitalar, com diferenças relevantes entre o setor público e o privado. Conclusões: Torna-se importante a atualização periódica da lista municipal de medicamentos com uma maior integração das secretarias de saúde com os hospitais, gerando uma avaliação mais econômica e que contemple os diferentes tipos de tratamentos possíveis para os diferentes transtornos psiquiátricos.Introduction: The use of medicines in the treatment of psychiatric diseases has grown in the past decades, and the lack of appropriate access to them is one of the reasons why the patient returns to the health services. Most of the hospitalized patients end up changing at least one of their previous drugs under special control of the municipal list of medicines (REMUME) for one or more drugs not available on the list. The main goal of this study is to identify the prescribed drugs not available on REMUME of the hospitalized patients in the Psychiatric Ward of the Hospital de Clínicas de Porto Alegre (HCPA). Metodology: Descriptive and retrospective study with analysis between June of 2017 and June of 2018 of the hospitalized patients in the Psychiatric Ward of HCPA. 281 prescriptions were analyzed using electronic medical records of patients from the public health care and patients from the private health care. Results: Within the 281 electronic medical records, 64 (22.8%) had prescriptions only with drugs present in the REMUME, while 217 (77.2%) had at least one drug not available on the list. The difference between prescriptions with REMUME drugs and not REMUME drugs was even higher at the time of the hospital discharges of the patients, with a relevant difference between the public and the private health care. Conclusions: It is important to have a periodic update of the municipal list of medicines with more integration of the Health Departments and the hospitals to create an evaluation more economic that contemplates the different kinds of treatments available to the current psychiatric diseases

Transitions of Care in Mental Health

Introduction: The occurrence of mental disorders and chronic diseases is associated with low treatment compliance and an increased mortality. The main objective of this study was to analyze medication prescriptions at hospital discharge in order to verify the patients’ access to the prescribed treatment. Methods: This is a descriptive and retrospective study performed between September 2013 and September 2018 with patients admitted in the psychiatric ward of a university hospital in the state of Rio Grande do Sul. The studied patients consisted of 274 adults over 18 years of age admitted to this hospital with at least one psychiatric comorbidity included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) who lived in the city of Porto Alegre used specially controlled drugs, and had been hospitalized for at least 7 days. Results: Out of the 274 patients, 68.5% were readmitted once, 17.5% were readmitted twice, 9.5% were readmitted 3times, and 4.5% went through this process 4 times or more. A significant association (p = 0.014) was observed between the number of drugs not included in the Municipal Essential Medicines List upon first readmission and the number of readmissions. Among patients who were readmitted 3 times or more, 79% were prescribed drugs that were not on this list. Conclusions: The understanding of how therapeutic itineraries are established when searching for drugs contributes to setting effective lines of care where professionals may position themselves more proactively to reduce mental health complications