[Use of Datasus to evaluate psychiatric inpatient care patterns in Southern Brazil]

Changes in major psychiatric disorders in children and adolescents from 2001 to 2020: A retrospective single-center study

OBJECTIVE

This study aimed to determine the hospitalization rates, length of stay, age at the time of admission, and sex distribution for major psychiatric disorders in children and adolescents and provide a reference for early intervention for these diseases and distribution of medical resources in hospitals.

METHODS

We screened 4,423 patients in the child and adolescent wards of the Anhui Provincial Mental Health Center from 2001 to 2020, and examined the top four (81.1%) mental health disorders that accounted for the overall proportion of patients admitted, namely schizophrenia (SCZ) (45.7%), depressive disorder (DD) (14.5%), bipolar disorder (BD) (9.3%), and childhood emotional disorder (CED) (11.6%), and for each disorder, the percentage of hospitalization, length of stay, age at admission, and sex distribution were analyzed.

RESULTS

From 2001 to 2020, there was a significantly decreasing trend in the proportion of hospitalizations for SCZ (p < 0.001) and an increasing trend for depression and CED (p < 0.001). In terms of length of stay, SCZ was significantly longer than the other three disorders (p < 0.001), whereas there was no significant difference between DD, BD, and CED, and there was no significant trend in length of stay for any of the four disorders. The age at admission for CED was significantly lower than that for the other three disorders (p < 0.001). There was a decreasing trend in the age at admission for DD (p = 0.011) and an increasing trend for BD (p = 0.001). A significant increase in the number of female patients admitted for SCZ, DD, and CED was observed, while there was no significant change in the sex ratio for BD.

CONCLUSION

Although there is a significant downward trend in the percentage of hospitalizations for SCZ, it is still the most common psychiatric disorder in children and adolescents. We observed a significant increase in the percentage of hospitalizations for DD and CED. In addition, the proportion of female patients being hospitalized is on the rise, and this aspect requires continuous attention.

Trends in treatment of retinal disorders in the Brazilian Public Health System over a 10-year period

Objective:

To investigate trends in terms of number and cost of intravitreal injection, photocoagulation and panphotocoagulation procedures performed by the Brazilian Public Health System, from 2010 to 2019.

Methods:

The Brazilian Public Health System Database was used as the primary source of data. Intravitreal injection, photocoagulation and panphotocoagulation procedures performed from 2010 to 2019 were investigated. Procedure prevalence and cost trends were analyzed according to year and region. Annual trends were examined using generalized linear models, with a significance level of 5% (p=0.05).

Results:

There was a significant increase in the prevalence of intravitreal injections (1,088%), panphotocoagulation (51%) and photocoagulation (37%) procedures from 2010 to 2019. Intravitreal injections accounted for the most significant increase. However, costs were not significantly readjusted over the years.

Conclusion:

Over a 10-year period, there was a significant increase in the number of procedures associated with retinal disorders. Procedure costs saw little readjustments over time. In spite of limitations, inaccuracies and lack of details, the Brazilian Public Health System Database is the primary source of data for the Public Health System related research in Brazil, and can contribute with information on ocular health and costs of ophthalmic procedures.

Psychiatric hospitalizations by the Unified Health System in Brazil between 2000 and 2014

OBJECTIVE

To characterize the profile of patients hospitalized for mental and behavioral disorders by the Unified Health System (SUS) in Brazil between 2000 and 2014, and to verify how aspects of the new mental health policy influenced the rate of hospitalized patients in that period.

METHODS

Non-concurrent prospective cohort study using secondary data from inpatients with a primary diagnosis of mental and behavioral disorders between 01/01/2000 and 12/31/2014. Sociodemographic, clinical, and hospital characteristics variables were selected. Overall rates of hospitalized patients were calculated according to reason for admission, type of hospital, legal nature, and number of admissions per year for each patient. The association between rates of hospitalized patients, number of psychiatric beds per year, and number of Psychosocial Care Centers per year were tested.

RESULTS

We selected a total of 1,549,298 patients, whose most frequent diagnoses on first admission were psychoactive substance use disorders, followed by schizophrenia and mood disorders. The median of hospitalizations per patient was 1.9 and the length of stay per patient was 29 days. The overall rate of hospitalized patients was reduced by almost half in the period. The number of beds per year was positively associated with the rates of hospitalized patients; the number of CAPS per year was negatively associated with some rates of hospitalized patients.

CONCLUSION

Even in the face of adversity, the National Mental Health Policy has advanced in its goal of progressively reducing hospital beds and increasing the supply of substitute services such that both strategies were associated with the reduced inpatient rates. But the changes were felt with greater intensity in the first years of the policy's implementation, becoming less pronounced in recent years.

Child psychiatric hospitalizations in the Brazilian public health system: an exploratory study

Objective

To describe the characteristics and rates of child psychiatric hospitalizations in the Brazilian public health system, as well as their variation according to the country’s macro-regions.

Methods

This was a descriptive study focusing on year 2017, having as main source the Brazilian Ministry of Health’s hospital information system. Child hospitalizations were considered to encompass those of individuals under 13 years of age whose main diagnosis was included in Chapter V of the International Classification of Diseases, 10th edition (ICD-10).

Results

The most prevalent diagnostic group was F10-F19, with 24.1% (21.8-26.3), followed by groups F30-39, F80-F89, F90-F99, F20-F29, with no statistical difference among them. Hospitalizations occurred more frequently in non-psychiatric hospitals, with 93.1% (91.7-94.4); most hospitalizations lasted for up to one week – 75.5% (73.2-77.8). The national hospitalization rate was 4.3 (4.1-4.5)/100,000, showing variations according to macro-regions. The highest rate was found in the South macro-region and the lowest in the Northeast, with values of 10.9 (9.9-12.0)/100,000 and 1.9 (1.6-2.2)/100,000, respectively. Intermediate values were found in the other macro-regions.

Conclusion

Some specificities of the characteristics of hospitalizations for psychiatric reasons in this age group could be attested, as well as important variations in their occurrence among the different macro-regions of the country.

[The evolution of the profile of psychiatric admissions via the Unified Health System in Minas Gerais, Brazil, 2001-2013]

The scope of this article is to analyze the evolution of the profile of psychiatric admissions via the Unified Health System in psychiatric hospitals of the State of Minas Gerais, Brazil, between 2001 and 2013. Data were obtained from the Information Technology Department of the Unified Health System. The analyses of trends were conducted by regression procedures, in which the independent variable was the year, and the dependent variables were the patients (sex, age, diagnosis) and admission characteristics (city, hospital administrative status, length of internment). A total of 202,188 admissions to 25 hospitals were appraised. There were significant changes in the diagnostic profiles of psychiatric admissions during the period under scrutiny, notably an increase in the proportion of admissions for substance abuse-related disorders and a reduction for psychotic disorders. This study is in tune with the context of the reform of mental healthcare in Minas Gerais, providing relevant input to support the mental health policies towards universalization, humanization and the overcoming of inequalities in access to health services.

Psychiatric hospitalizations in the Rio Grande do Sul State (Brazil) from 2000 to 2011

OBJECTIVE

To examine the variation in the rates of psychiatric hospitalization and the mean hospital stay time in the public health system in the state of Rio Grande do Sul, in the south of Brazil, from 2000 to 2011.

METHODS

This was an ecological study. Data were collected from DATASUS. The rates were obtained from diagnosis of admissions due to psychoactive substance use and to other causes, stratified by the gender of the patients. The data were analyzed using Poisson regression and Spearman correlation coefficient.

RESULTS

Increasing hospitalization rates were observed for women with disorders due to substance use (p < 0.001) and other causes (p < 0.001), and among men with disorders due to the use of alcohol or other drugs (p < 0.001). This elevation of the rates remained statistically significant and inversely correlated to the length of hospital stay (p < 0.001).

DISCUSSION

In a period of expansion of the local care networks for mental health, an increase in the occupancy of psychiatric beds in the state was noticed, with shorter length of stay and greater diversity of gender and causes of hospitalization.

Trends in elderly psychiatric admissions to the Brazilian public health care system

Objective:

To evaluate trends in psychiatric bed occupancy by elderly inpatients in the Brazilian public health care system between 2000 and 2010 and to determine the leading psychiatric diagnosis for hospital admissions.

Methods:

Data from all 895,476 elderly psychiatric admissions recorded in the Brazilian Public Health Care Database (DATASUS) between January 2000 and February 2010 were analyzed. Polynomial regression models with estimated curve models were used to determine the trends. The number of inpatient days was calculated for the overall psychiatric admissions and according to specific diagnoses.

Results:

A moderate decreasing trend (p < 0.001) in the number of inpatient days was observed in all geriatric psychiatric admissions (R² = 0.768) and in admissions for organic mental disorders (R² = 0.823), disorders due to psychoactive substance use (R² = 0.767), schizophrenia (R² = 0.680), and other diagnoses (R² = 0.770), but not for mood disorders (R² = 0.472). Most admissions (60 to 65%) were due to schizophrenia.

Conclusion:

There was a decreasing trend in inpatient days for elderly psychiatric patients between 2000 and 2010. The highest bed occupancy was due to schizophrenia, schizotypal, and delusional disorders.

Hospitalization due to drug use did not change after a decade of the Psychiatric Reform

OBJECTIVE

To investigate whether the psychiatric hospitalization rates due to use of psychoactive substances and average time of hospitalization suffered any changes after the first decade of effective implementation of the psychiatric reform in Brazil.

METHODS

This article examines the evolution of hospitalizations due to disorders arising from the use of alcohol or other substances in the state of Santa Catarina, Southern Brazil, from 2000 to 2012. This is an ecological, time-series study, which uses data from admissions obtained by the Informatics Service of the Brazilian Unified Health System. Hospitalization rates by 100,000 inhabitants and average time of occupancy of beds were estimated. Coefficients of variation of these rates were estimated by Poisson Regression.

RESULTS

The total and male hospitalization rates did not vary (p = 0.056 and p = 0.244, respectively). We observed an increase of 3.0% for the female sex (p = 0.049). We did not observe any significant variation for occupancy time of beds.

CONCLUSIONS

The deployment of services triggered by the Brazilian psychiatric reform was not accompanied by a reduction of hospitalization rates or mean occupancy time of hospitalized patients during this first decade of implementation of the reform.

Shortage and underutilization of psychiatric beds in southern Brazil: independent data of Brazilian mental health reform

BACKGROUND

Mental health policies throughout the world are being subjected to several changes due to increased pressure from the public and from health administrators. Mental health policies in the developing world experienced changes following advice and consultation from the World Health Organization (WHO). This was the case with Brazil, which enacted several laws and policies affecting community care and the closure of beds in psychiatric hospitals (the deinstitutionalization movement). Rio Grande do Sul, the southeast state in Brazil, adopted this policy in 1992, but still suffers from a shortage of psychiatric beds in both general hospitals (GHs) and psychiatric hospitals (PHs), despite advances in the provision of community care. As a result, Rio Grande do Sul (RS) can be studied as an example of "what actually happens" in mental health care in the developing world.

METHODS

The study analyzed online administrative data from 2000 to 2007 for three main parameters of mental health care (i.e. hospital use rate, length of stay, and hospital bed capacity). These were used to evaluate differences in psychiatric care among GHs and PHs. The number of existing and required psychiatric beds in RS was also calculated.

RESULTS

GHs had very low hospital use rates, while PHs had a very high length of stay (200% higher than GH). The number of admissions to GHs grew by 170% over the 8 year period, and psychiatric bed availability was 1.5 per 10,000 inhabitants.

CONCLUSIONS

The study provided evidence for the need of 30-50% more psychiatric beds in GHs. Also, additional staff training is needed to increase use rates in GHs and decrease the length of stay in PHs. Additional studies covering national data must be carried out to assess the extent of these problem in other Brazilian mental health care services.

Electroconvulsive therapy clinical database: a standardized approach in tertiary care psychiatry

Across health care disciplines research reflects the usefulness of integrating computer technology into administrative and clinical practices. Electroconvulsive therapy (ECT) researchers are often interested in examining 3 primary areas: patient characteristics, treatment characteristics, and treatment outcomes. Generating reports and conducting research analysis via the traditional patient chart review are a time-consuming and costly method. At Riverview Hospital, a tertiary care psychiatric hospital, the active use of a clinical database for patients receiving ECT allows for detailed treatment tracking and evaluation of pretreatment and posttreatment patient outcome measures. Initially, designed as part of a quality improvement process to readily access patient information and generate periodic reports, the ECT clinical database is now a central resource for ECT-specific patient, treatment, and outcome tracking. The relevance, design, content variables, and subsequent functions of the entry and storage of ECT-related administrative, treatment, outcome, and patient factors are clearly outlined and discussed. Strengths and limitations to the existing database are shared. Recommendations to other ECT services to implement this valuable documentation strategy are addressed. This approach can be an invaluable tool in providing the field of psychiatry with further contributions to ECT clinical outcomes.