Evaluación del modelo comunitario de atención a los trastornos mentales en España / Evaluation of the community mental health care model in Spain

Introducción: El objetivo de este trabajo consiste en evaluar la implementación del modelo comunitario de atención en salud mental en el Estado español en 2014. Secundariamente, se analizan los cambios que el modelo experimentó en 2008, en relación con la recesión económica. Material y Método: Se adoptó la definición de modelo comunitario que se propone en la Estrategia en Salud Mental del SNS, según la cual el modelo se rige por 8 principios y se implementa mediante 39 prácticas asistenciales. Se elaboró una encuesta dirigida a las Juntas Autonómicas de Gobierno de la Asociación Española de Neuropsiquiatría sobre el grado de cumplimiento del modelo comunitario en cada comunidad. Resultados: Se obtuvieron respuestas de 13 Juntas Autonómicas que incluyeron información sobre el 93% de la población española. Conclusión: Las carencias más importantes en la implementación del modelo comunitario en 2014 se relacionaron con la ausencia de una perspectiva de salud pública, con la mala gestión y rendición de cuentas, y la ralentización del desarrollo de equipos, servicios y redes de servicios de orientación comunitaria. El modelo se modificó poco globalmente entre 2008 y 2014, pero algunas prácticas clave, como la universalidad y gratuidad del sistema, la atención sectorizada, el acortamiento de los tiempos de espera, las subvenciones a las asociaciones de usuarios y familiares, y la aplicación de la "ley de dependencia" se contrajeron de forma sustancial en muchas comunidades. Otras prácticas, como la historia clínica informatizada, los planes Individualizados de atención y el tratamiento asertivo comunitario, incrementaron su cobertura en algunas comunidades a pesar de la recesión

Introduction: The objective of this study is to evaluate the implementation of the community mental health care model in the Spanish state in 2014. Secondly, we aim to analyze the changes experienced by the model in 2008, in relation to the economic recession. Materials and methods: We adopted the definition of community model proposed in the Strategy in Mental Health of the National Health System; according to which the model is based on 8 principles and is implemented by means of 39 care practices. The Autonomous Boards of the Spanish Association of Neuropsychiatry conducted a survey on the degree of compliance with the community model in each autonomous community. Results:Responses were obtained from 13 Autonomous Boards, which provided information on the 93% of the Spanish population. Conclusion: The most important shortcomings in the implementation of the community model in 2014 were related to the absence of a public health perspective, to poor management and accountability, and a slowdown in the diversification of community-based teams, services and networks. Globally, the model changed little between 2008 and 2014, but some key practices, such as the free and universal health coverage, the sectorization, the shortening of waiting times, the financial support to users and associations of relatives, and the implementation of the "Dependency Act", deteriorated substantially in many autonomous communities. However, other practices, such as the computerization of medical files, individualized care plans (Care Programme Approach), and the assertive community treatment, increased their coverage in some communities despite the recession

Efficacy of the unified protocol for the treatment of emotional disorders in the Spanish public mental health system using a group format: study protocol for a multicenter, randomized, non-inferiority controlled trial.

BACKGROUND: Emotional disorders, which include both anxiety and depressive disorders, are the most prevalent psychological disorders according to recent epidemiological studies. Consequently, public costs associated with their treatment have become a matter of concern for public health systems, which face long waiting lists. Because of their high prevalence in the population, finding an effective treatment for emotional disorders has become a key goal of today's clinical psychology. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders might serve the aforementioned purpose, as it can be applied to a variety of disorders simultaneously and it can be easily performed in a group format. METHODS: The study is a multicenter, randomized, non-inferiority controlled clinical trial. Participants will be 220 individuals with emotional disorders, who are randomized to either a treatment as usual (individual cognitive behavioral therapy) or to a Unified Protocol condition in group format. Depression, anxiety, and diagnostic criteria are the primary outcome measures. Secondary measures include the assessment of positive and negative affect, anxiety control, personality traits, overall adjustment, and quality of life. An analysis of treatment satisfaction is also conducted. Assessment points include baseline, post-treatment, and three follow-ups at 3, 6, and 12 months. To control for missing data and possible biases, intention-to-treat and per-protocol analyses will be performed. DISCUSSION: This is the first randomized, controlled clinical trial to test the effectiveness of a transdiagnostic intervention in a group format for the treatment of emotional disorders in public settings in Spain. Results obtained from this study may have important clinical, social, and economic implications for public mental health settings in Spain. TRIAL REGISTRATION: Retrospectively registered at https://clinicaltrials.gov/ . Trial NCT03064477 (March 10, 2017). The trial is active and recruitment is ongoing. Recruitment is expected to finish by January 2020.

Promoción, prevención, detección y actuación en salud sexual y ante la violencia sexual y de género en infancia y adolescencia desde atención primaria de salud / Promotion, prevention, detection and intervention in sexual health and sexual and gender based violence in children and adolescents from primary health care

Objetivo: Analizar las actividades que los profesionales sanitarios de atención primaria realizan en salud sexual y ante la violencia sexual y de género en infancia y adolescencia, además de los factores asociados en la realización. Diseño: Estudio multicéntrico observacional transversal. Material y método: Han participado 499 profesionales de Atención Primaria: medicina de familia, pediatría, enfermería y matronas de 41 Centros de Salud de la ciudad de Valencia. Las variables se han recogido mediante un cuestionario autoaplicado y anónimo con dos versiones, una para profesionales de medicina (medicina de familia y pediatría) y otra para profesionales de enfermería (enfermera y matrona). Resultados: En la forma habitual de proceder ante la demanda, detección o sospecha, los profesionales médicos superan a los de enfermería, en cambio, en la práctica preventiva habitual sucede lo contrario y son sobre todo las matronas las que destacan (p<0,001). Todos los profesionales destacan como principales dificultades para la intervención en salud sexual en infancia y adolescencia: la falta de tiempo en consulta, la insuficiente formación y no contar con equipo multidisciplinar.Conclusión: Realizar actividades de promoción, prevención y detección de posibles conductas y situaciones de riesgo frente a la violencia sexual y de género en infancia y adolescencia, permitiría, sin duda, una intervención sanitaria más eficaz, pero se evidencia la necesidad de aplicar medidas correctoras sobre las principales dificultades detectadas en los profesionales de atención primaria de salud (AU)

Objective: Analyze the activities performed by primary care health professionals in sexual health and sexual and gender based violence in childhood and adolescence, and the factors associated with the production. Design: multicenter study observational cross. Material and Method: Have taken part 499 professionals in primary care: family medicine, pediatrics,nursing and midwives of 41 health centers of the city of Valencia. The variables were collected through a self-administered and anonymous questionnaire with two versions, one for medical professionals (family medicine and pediatrics) and one for nurses (nurse and midwife). Results: In the usual way to proceed against demand, detection or suspicion, doctors outnumber nurses, but in routine preventive practice the opposite occurs and are mostly midwives most notably (p<0.001). All professionals stand out as major difficulties in sexual health intervention in childhood and adolescence: lack of time in consultation, insufficient training and not having multidisciplinary team. Conclusion: Make activities for promotion, prevention and detection of possible behaviors and risk situations against sexual and gender based violence in childhood and adolescence, would, without doubt, a more effective health intervention, but highlights the need for corrective action on the main difficulties encountered in the primary health care (AU)