Adherence to treatment in collective multiprofessional activities and factors associated with adherence in a specialized center for psychosocial care.

Letícia P Tergolina,Airton T Stein,Evelise R De Faria

doi:10.1590/2237-6089-2019-0053

Abstract

IntroductionSpecialized psychosocial care centers (Centros de Atenção Psicossocial [CAPS]) are mental health services focused on social rehabilitation and reducing hospitalization of patients with severe and persistent mental illness. Collective multiprofessional activities (CMPA) are the main therapeutic tools used at CAPS. This study aimed to determine rates of adherence to CMPA and identify factors associated with adherence.MethodsThis is a cross-sectional study in which 111 CAPS users were evaluated using questionnaires covering patient characteristics, clinical status, and treatment and incorporating the Functioning Assessment Short Test (FAST), the Clinical Global Impression – Severity scale (CGI-S), and the Clinical Global Impression – Improvement scale (CGI-I). Adherence was defined as attendance at 50% or more CMPA during the previous 3 months. Data were analyzed using descriptive statistics, bivariate analysis, and Poisson logistic regression with robust variance to estimate prevalence ratios.ResultsCPMA adherence was 43%. Having children aged 14 years or younger was significantly associated with non-adherence (71%, p = 0.001). Poor or partial adherence to psychotropic drugs tended to be associated (p = 0.066) with poor adherence (33% higher risk), as was the number of psychiatric hospitalizations during CAPS (p = 0.076), with a cumulative association of 5% non-adherence per hospitalization.ConclusionsCMPA adherence was low in the study. It is necessary to consider the environment in which the individual lives and invest in support networks, providing patients and family members with explanations about the importance of CMPA to rehabilitation and attempting to tailor the care provided to each patient’s needs. There was an association between greater number of psychiatric hospitalizations and non-adherence, suggesting that CAPS are fulfilling a preventive role.

Highlights

Specialized psychosocial care centers (Centros de Atenção Psicossocial [CAPS]) are mental health services focused on social rehabilitation and reducing hospitalization of patients with severe and persistent mental illness
The expected profile of patients seen at CAPS is those with severe and persistent mental illness (SPMI),[2,3] represented by psychotic disorders.[4]
The findings suggest that groups and workshops can reduce hospitalizations in those patients who attend 50% or more of the meetings offered, providing analytical data indicative of CAPS’ effectiveness for prevention of psychiatric hospitalizations

Summary

Introduction

Specialized psychosocial care centers (Centros de Atenção Psicossocial [CAPS]) are mental health services focused on social rehabilitation and reducing hospitalization of patients with severe and persistent mental illness. Specialized psychosocial care centers (Centro de Atenção Psicossocial [CAPS]) are regionalized mental health centers providing secondary care, with the main objective of promoting psychosocial rehabilitation and reducing psychiatric hospitalizations and institutionalizations They have interdisciplinary teams and are known for their therapeutic groups and workshops, here referred to as collective multiprofessional activities (CMPA).[1,2,3] The expected profile of patients seen at CAPS is those with severe and persistent mental illness (SPMI),[2,3] represented by psychotic disorders.[4] A previous study, conducted in northeastern Brazil, found a 64% prevalence of psychotic disorders among CAPS patients and a 36% prevalence of mood disorders.[5] SPMI are characterized by chronicity and clinical severity and by incapacity to perform social functions, with impaired autonomy, poor social support, isolation, and poor prognosis.[6,7] These patients tend to lack financial independence, housing, and work and have poor social interaction, motivation, and cognition, with high social costs.[4]

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