RESUMO
Nowadays, mental health has acquired greater relevance and attention as a consequence mainly of the COVID-19 pandemic, to which is attributed a negative impact on the development of life, work and social coexistence of people, along with the magnitude derived from non-communicable diseases. This is why the Instituto Mexicano del Seguro Social (IMSS, Mexican Institute for Social Security) developed the Mental Health Comprehensive Program 2021-2024, whose main purpose was to establish strategies and lines of action for the prevention, early detection and timely management regarding mental health and addictions. Based on this, different actions have been carried out, for example, the identification of the material and human resources available at IMSS to meet the mental health issue; the training of healthcare professionals at the three levels of care; the integration of a census that has reported a prevalence of anxiety and depressive episodes in the users of 39.9 and 3%, respectively, as well as the evaluation of instruments for screening mental disorders. Therefore, this document describes what has been done in the IMSS in relation to the user's mental health in the context of the COVID-19 pandemic.
Hoy en día la salud mental ha adquirido mayor relevancia y atención como consecuencia principalmente de la pandemia por COVID-19, a la cual se le atribuye un impacto negativo en el desarrollo de la vida, el trabajo y la convivencia social de las personas, todo esto aunado a la magnitud derivada de los padecimientos no transmisibles. Es por eso que en el Instituto Mexicano del Seguro Social (IMSS) se elaboró el Programa Integral de Salud Mental 2021-2024, cuyo principal propósito fue establecer estrategias y líneas de acción para la prevención, detección temprana y manejo oportuno respecto a la salud mental y adicciones. A partir de ello se han materializado diferentes acciones, entre las que destaca la identificación de los recursos materiales y humanos con los que cuenta el IMSS para atender esta necesidad; la capacitación del personal de salud de los tres niveles de atención; la integración de un censo que ha reportado una prevalencia de ansiedad y episodio depresivo en la población derechohabiente de 39.9 y 3%, respectivamente, y la evaluación de instrumentos para realizar tamizajes de trastornos mentales. Por lo anterior, en este documento se describe lo que se ha hecho en el IMSS en relación con la salud mental de la población derechohabiente en el contexto de la pandemia por COVID-19.
RESUMO
BACKGROUND: Primary care level close monitoring of mild COVID-19 patients has shown to provide a risk reduction in hospitalization and death. We aimed to compare the risk of all-cause death among COVID-19 ambulatory patients who received and did not receive telephonic follow-up in primary health care settings. METHODS: A secondary database analysis, 2-group comparative study, was conducted with data from the medical information systems of the Mexican Institute of Social Security. A total of 1,498,808 ambulatory patients aged 20 years old and over and with laboratory confirmed SARS-CoV-2 by PCR or rapid antigen test were analyzed. Of them, 535,898 (35.8%) where followed by telephonic calls. The cases were attended from October 14, 2020, to April 10, 2022. Death incidence was evaluated. To assess the association between death and telephonic follow-up we calculated risk ratio using a multivariate logistic model. RESULTS: Case fatality rate was 1.29% in the patients who received telephonic follow-up and 2.95% in the cases who did not receive phone calls. Medical history of chronic kidney disease, COPD, cardiovascular disease, tobacco consumption and diabetes were associated with increased risk of death. In the multivariate model, telephonic follow-up was associated with lower risk of all-cause death, with an adjusted risk ratio of 0.61 (95% confidence interval from 0.59, 0.64). CONCLUSION: Our data suggest that telephonic follow-up is associated with a risk of death reduction in adult outpatients with mild COVID-19, in the context of a multimodal strategy in the primary health care settings.
Assuntos
COVID-19 , Adulto , Humanos , Adulto Jovem , COVID-19/epidemiologia , SARS-CoV-2 , Seguimentos , Hospitalização , Fatores de TempoRESUMO
In the context of the 80th anniversary of the Instituto Mexicano del Seguro Social (IMSS), there are several health problems and challenges to be faced in relation to user population, which currently represents 42% of Mexico´s population. Among these issues, once five waves of COVID-19 infections have passed and mortality rates have decreased, mental and behavioral disorders stand out as a re-emerging and priority problem. In response to this, in 2022 the Mental Health Comprehensive Program (MHCP, 2021-2024) materialized, which represents, for the first time, the opportunity to provide health services that address mental disorders and addictions of user´s population IMSS, under the Primary Health Care model. That is, prioritizing health promotion, risk factors prevention, screening, timely diagnosis, and not just hospitalization and drug supply. Among the MHCP strategies, which motivated the writing of this document, we highlight the availability of reliable data, through the census of mental and behavioral disorders, related to important characteristics in terms of population, state, hospital, prevalence of disorders, in order to act accordingly through the infrastructure and human resources available at the IMSS, with emphasis on the first level of care.
En el contexto del 80 aniversario del Instituto Mexicano del Seguro Social (IMSS), son varios los problemas de salud y retos que afrontar en relación con la población derechohabiente, que en la actualidad representa aproximadamente el 42% de los habitantes en México. Entre éstos, una vez que han transitado cinco olas de contagios por COVID-19 y disminuido los índices de mortalidad, destacan los trastornos mentales y del comportamiento como problema re-emergente y prioritario. En atención a ello, en el 2022 se materializó el Programa Integral de Salud Mental del IMSS 2021-2024 (PISM-IMSS), lo que representa, por primera vez, la oportunidad de proporcionar servicios de salud que atiendan los problemas de salud mental y adicciones de la población derechohabiente, bajo el modelo de Atención Primaria de la Salud. Esto es, priorizando la promoción de la salud, prevención de factores de riesgo, tamizaje, diagnóstico oportuno, y no sólo la hospitalización y suministro de fármacos. Entre las estrategias del PISM-IMSS, que motivaron la redacción de este documento, destacamos la disponibilidad de datos confiables, a través del censo de trastornos mentales y del comportamiento, relacionados con importantes características en cuanto a la población, representación, unidad médica, prevalencias de trastornos, para así actuar en consecuencia mediante la infraestructura y recursos humanos disponibles en el IMSS, con énfasis en el primer nivel de atención.