RESUMO
OBJECTIVES: We aimed to evaluate a hepatitis C (HCV) micro-elimination program in 2 addiction centers among subjects with substance use disorders (SUD). METHODS: The program was based on simplifying the diagnosis of HCV infections by avoiding referral to primary care for the diagnosis and performing the necessary tests at the point of care (ie, the addition center) and simplifying the patient pathway by directly referring patients to the specialized care for treatment. Descriptive and multivariate analyses are presented. RESULTS: Of the 1497 subjects included in the program, 327 reported that they were anti-HCV-positive. Among the 1170 patients who were offered the HCV rapid antibody test, 180 (15.4%) did not perform the test. Performing the HCV rapid antibody test only contributed ten patients (3%) to the 337 who were anti-HCV-positive. A high proportion (147 out of 327 [45%]) of subjects who reported being anti-HCV-positive also reported that they had not been treated for HCV. Among the 67 subjects who were HCV-RNA-positive and were referred for treatment, 53 (79%) ultimately received and completed antiviral treatment. Unfortunately, we did not find any factors associated with not performing dry blood testing, and the factors associated with not performing the HCV rapid antibody test were difficult to interpret, and the model showed low goodness of fit. CONCLUSIONS: Our results suggest that a micro-elimination program focused on patients with SUD attending an addiction center is not effective for screening the presence of hepatitis C but is successful for linking patients with hepatitis C to antiviral treatment.
RESUMO
El objetivo ha sido valorar la presencia de diagnósticos comórbidos de trastornos mentales y adictivos de forma retrospectiva en la historia clínica de pacientes en tratamiento en las redes asistenciales de salud mental o de adicciones en la Comunidad de Madrid. Material y métodos: Se valoraron las historias clínicas de 400 pacientes en tratamiento en Centros de Atención al Drogodependiente (CAD), Centros de Atención Integral al Drogodependiente (CAID), Centros de Salud Mental (CSM) o servicios de psiquiatría de Hospitales de Madrid. Se recogieron de forma retrospectiva los datos de las últimas 20 historias clínicas de cada centro seleccionado. Resultados: La prevalencia de patología dual, considerando como tal la presencia de un diagnóstico actual de trastorno mental y de trastorno por uso de sustancias distinto al tabaco, fue del 34%. Había diferencias en la prevalencia entre las dos redes asistenciales, un 36.78% de los pacientes en tratamiento en la red de drogas fueron considerados duales frente a un 28.78% en la red de salud mental. Había una asociación entre el diagnóstico de patología dual y el consumo perjudicial o dependencia de alcohol o cocaína pero no con el de heroína. Los trastornos mentales más frecuentes en los pacientes duales que en los no duales fueron los trastornos del humor, los trastornos de personalidad y la esquizofrenia. Conclusión: Por lo tanto, existe una elevada prevalencia de pacientes con patología dual entre los sujetos que buscan tratamiento, siendo mayor en la red de atención al drogodependiente y mayor entre aquellos con dependencia de alcohol o cocaína. Estos datos pueden ayudar a la horade planificar los recursos asistenciales para este tipo de pacientes (AU)
Aim: To evaluate retrospectively the comorbidity of mental and addictive disorders in community mental health and substance misuse services in Madrid. Methods: The medical records of 400 patients from mental health and substance misuse services in Madrid were evaluated. Records were examined for the last 20 patients from each service unit. Results: Dual pathology was constituted when a current diagnosis of mental and addictive disorders, excluding nicotine addiction, appeared on the patients records. Prevalence of dual pathology was 34%. There were differences in the prevalence figures for the two kinds of service: 36.78% in substance misuse services, and 28.78% in mental health services. There was an association of dual diagnosis with alcohol or cocaine dependence, but not with opioid dependence. The mental disorders more prevalent in dually diagnosed than in non-dually diagnosed patients were mood disorders, personality disorders, and schizophrenia. Conclusion: There is a high prevalence of dual pathology in those seeking treatment, being higher in substance misuse services than in mental health services, and higher in patients with alcohol or cocaine dependence. These findings could be of help in the planning of care resource policies for these patients (AU)
Assuntos
Humanos , Diagnóstico Duplo (Psiquiatria)/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Mentais/epidemiologia , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Serviços de Saúde Mental/organização & administraçãoRESUMO
AIM: To evaluate retrospectively the comorbidity of mental and addictive disorders in community mental health and substance misuse services in Madrid. METHODS: The medical records of 400 patients from mental health and substance misuse services in Madrid were evaluated. Records were examined for the last 20 patients from each service unit. RESULTS: Dual pathology was constituted when a current diagnosis of mental and addictive disorders, excluding nicotine addiction, appeared on the patient's records. Prevalence of dual pathology was 34%. There were differences in the prevalence figures for the two kinds of service: 36.78% in substance misuse services, and 28.78% in mental health services. There was an association of dual diagnosis with alcohol or cocaine dependence, but not with opioid dependence. The mental disorders more prevalent in dually diagnosed than in non-dually diagnosed patients were mood disorders, personality disorders, and schizophrenia. CONCLUSION: There is a high prevalence of dual pathology in those seeking treatment, being higher in substance misuse services than in mental health services, and higher in patients with alcohol or cocaine dependence. These findings could be of help in the planning of care resource policies for these patients.
