Actions and strategies for the follow-up of patients with deinstitutionalized mental disorders

Abstract

The deinstitutionalization, the effective care and the reintegration of people with serious and persistent mental disorders have been growing in Brazil. However, significant faults are still found in the implementation and consolidation of such processes. One of the biggest current challenges in public health care systems is the systematic use of the best scientific evidence available in public policy-making and implementing processes. In a scenery of scarce resources and strong socio-cultural interferences, the translation and dissemination of knowledge take on a leading role, considering the local context and its restraints. Besides this, and especially in the case of antipsychotics, addressing aspects about the use of drugs could contribute to user's improved management in the realm of the Brazilian Public Health Care System. Objective: elaborate a synthesis of evidence for patient care in the case of deinstitutionalized mental disorders, and also subsidize actions and strategies for the implementation of monitoring and assessment policies for this population in the region comprehending the Health Regional Department - 16 (DRS-16), São Paulo. At the same time, evaluate the use of the antipsychotics available for the treatment of schizophrenia in the Public Health Care System in Brazil. Method: during the synthesis development, we will exchange information with decision-makers (DRS-16 coordinators, Sorocaba City Mental Health coordinators, Psycho-Social Attention Net managers, working professionals, and Mental Health Social Organizations), and we will hold awareness workshops and deliberative dialogue. The synthesis and the Deliberative dialogue are to be elaborated according to SUPPORT Tools for evidence-informed policies. The use of antipsychotics will be evaluated by a cohort study of patients with schizophrenia admitted to the Specialized Component of Pharmaceutical Care, between 2008 and 2016. The source of data is to be Health Ministry's databases (Datasus): Authorization of High Complexity Procedures of the Outpatient Information System of the Unified Health System (Apac/SIA). Cox regression will be used to identify factors associated with antipsychotics'adherence and replacement. Expected results: we expect to reduce gaps between knowledge and practice in policies and assistance for patients with deinstitutionalized mental disorders. We also hope to learn about users' profile, as well as about antipsychotic usage, replacement, exposure, adherence and withdrawal features. In addition, we intend to identify the main factors associated with changes of antipsychotics during treatments, contributing to improved guidance in the program and to the appropriate use of antipsychotics for the treatment of schizophrenia. (AU)