Psicodiagnóstico na internação psiquiátrica da infância e adolescência: panorama do triênio 2015-2016-2017 / Psychological assessment in a child and adolescent inpatient psychiatric unit: 2015-2016-2017 triennial overview

Introdução: A internação psiquiátrica é um recurso terapêutico utilizado para a estabilização dos sintomas, contenção de riscos, elucidação diagnóstica e planejamento terapêutico. O psicodiagnóstico permite acesso a questões emocionais e cognitivas do indivíduo. Objetiva-se apresentar um panorama referente à realização de psicodiagnósticos em leitos da especialidade da Psiquiatria Infância e Adolescência de um hospital geral nos anos 2015, 2016 e 2017. Métodos: Trata-se de um estudo transversal, em que foram obtidas informações a partir do prontuário eletrônico de pacientes internados em leitos da especialidade. Os dados analisados foram sexo, idade, naturalidade, realização de psicodiagnóstico, motivo e tempo de internação. Resultados: Durante o triênio estudado, houve realização de psicodiagnóstico em 65,1% das internações. Entretanto, constatou-se diminuição estatisticamente significativamente (p = 0,006) no número de psicodiagnósticos em relação ao número de internações: 82% em 2015; 63% em 2016; e 53% em 2017. Conclusão: Esta diminuição no número de psicodiagnósticos realizados durante a internação indica que houve uma mudança nesse processo, onde se passou de um período em que a grande maioria das crianças e adolescentes (82%) realizava a avaliação, para um panorama onde metade dos pacientes (53%) realiza o psicodiagnóstico. Esse resultado sugere que estratégias de psicoeducação, voltadas para equipes assistentes, tendo por objetivo otimizar custo-efetividade e qualidade da assistência, levaram esses profissionais a refletirem sobre relevância, riscos e benefícios da realização do psicodiagnóstico durante a internação psiquiátrica de crianças e adolescentes. (AU)

Introduction: Inpatient psychiatry is a therapeutic resource for symptom stabilization, risk management, diagnostic clarification and/or treatment planning. Psychological assessment provides information on emotional and cognitive functioning. This study aims to provide an overview of psychological assessment in a child and adolescent inpatient psychiatric unit at a general hospital in southern Brazil in 2015, 2016 and 2017. Methods: This cross-sectional retrospective study obtained information from electronic medical records of patients admitted to the hospital psychiatric unit. Data for analysis were sex, age, place of birth, psychological assessment, reason and length of stay. Results: In those three years, psychological assessments were requested in 65.1% of all unit admissions. However, there was a statistically significant decrease (p = 0.006) in the number of psychological assessments in relation to the number of admissions: 82% in 2015; 63% in 2016; and 53% in 2017. Conclusion: The decrease in the number of psychological assessments performed in the inpatient unit indicates that there was some changes in the process, as first most children and adolescents (82%) underwent the assessment and then the rate reduced to half of all patients (53%). This can be explained by the implementation of strategies to educate the health care team about psychological assessment, with the purpose of improving costeffectiveness and quality of care. This led to greater reflection on relevance, risks and benefits of psychological assessment in a child and adolescent inpatient psychiatric unit. (AU)

Understanding the medical and nonmedical value of diagnostic testing.

OBJECTIVES: To develop a framework for defining the potential value of diagnostic testing, and discuss its implications for the health-care delivery system. METHODS: We reviewed the conceptual and empirical literature related to the valuing of diagnostic tests, and used this information to create a framework for characterizing their value. We then made inferences about the impact of this framework on health insurance coverage, health technology assessment, physician-patient relationships, and public health policy. RESULTS: Three dimensions can effectively classify the potential value created by diagnostic tests: 1) medical value (impact on treatment decisions); 2) planning value (affect on patients' ability to make better life decisions); and 3) psychic value (how test information affects patients' sense of self). This comprehensive framework for valuing diagnostics suggests that existing health technology assessments may systematically under- or overvalue diagnostics, leading to potentially incorrect conclusions about cost-effectiveness. Further, failure to account for all value dimensions may lead to distorted payments under a value-based health-care system. CONCLUSIONS: The potential value created by medical diagnostics incorporates medical value as well as value associated with well-being and planning. Consideration of all three dimensions has important implications for technology assessment and value-based payment.