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Primary care consultation liaison and the rate of psychiatric hospitalizations: a countrywide study in Chile

OBJECTIVES: To assess the quality of consultation liaison across all primary health care centers in Chile, and its potential relationship with the psychiatric hospitalization rate. METHODS: We carried out a countrywide ecological cross-sectional study on 502 primary health centers in 275 municipalit...

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Autores principales: Sepúlveda, Rafael, Zitko, Pedro, Ramírez, Jorge, Markkula, Niina, Alvarado, Rubén
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Organización Panamericana de la Salud 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386200/
https://www.ncbi.nlm.nih.gov/pubmed/31093166
http://dx.doi.org/10.26633/RPSP.2018.138
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author Sepúlveda, Rafael
Zitko, Pedro
Ramírez, Jorge
Markkula, Niina
Alvarado, Rubén
author_facet Sepúlveda, Rafael
Zitko, Pedro
Ramírez, Jorge
Markkula, Niina
Alvarado, Rubén
author_sort Sepúlveda, Rafael
collection PubMed
description OBJECTIVES: To assess the quality of consultation liaison across all primary health care centers in Chile, and its potential relationship with the psychiatric hospitalization rate. METHODS: We carried out a countrywide ecological cross-sectional study on 502 primary health centers in 275 municipalities (87.3% of total primary health centers in Chile) during 2009. We characterized the presence of consultation liaison using four criteria: availability, frequency, continuity of participants, and continuity across care levels. We also created a dichotomous variable called “optimal consultation liaison” for when all four criteria were met. A quasi-Poisson regression model was used to estimate the rate of hospitalization due to different psychiatric disorders, adjusting by population attributes. RESULTS: Of the primary health centers, 28.3% of them had had optimal consultation liaison during the preceding year, concentrated in the poorest and richest municipalities. Continuity of care was the criterion that was met least often (38.3%). The presence of optimal consultation liaison at the municipal level was associated with fewer psychiatric discharges, with the following incidence rate ratios and 95% confidence intervals (CIs): schizophrenia, 0.65 (95% CI: 0.49–0.85); other psychoses, 0.68 (95% CI: 0.52–0.89); and personality disorders, 0.66 (95% CI: 0. 49–0.89). Municipalities with optimal consultation liaison showed 2.44 fewer total psychiatric discharges per 10 000 inhabitants, although without reaching statistical significance (-0.85 to 5.70). CONCLUSIONS: Using a nationally representative sample, we found that consultation liaison in primary care was associated with having fewer psychiatric hospitalizations. More studies are required to understand the role of each component of consultation liaison.
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spelling pubmed-63862002019-05-15 Primary care consultation liaison and the rate of psychiatric hospitalizations: a countrywide study in Chile Sepúlveda, Rafael Zitko, Pedro Ramírez, Jorge Markkula, Niina Alvarado, Rubén Rev Panam Salud Publica Original Research OBJECTIVES: To assess the quality of consultation liaison across all primary health care centers in Chile, and its potential relationship with the psychiatric hospitalization rate. METHODS: We carried out a countrywide ecological cross-sectional study on 502 primary health centers in 275 municipalities (87.3% of total primary health centers in Chile) during 2009. We characterized the presence of consultation liaison using four criteria: availability, frequency, continuity of participants, and continuity across care levels. We also created a dichotomous variable called “optimal consultation liaison” for when all four criteria were met. A quasi-Poisson regression model was used to estimate the rate of hospitalization due to different psychiatric disorders, adjusting by population attributes. RESULTS: Of the primary health centers, 28.3% of them had had optimal consultation liaison during the preceding year, concentrated in the poorest and richest municipalities. Continuity of care was the criterion that was met least often (38.3%). The presence of optimal consultation liaison at the municipal level was associated with fewer psychiatric discharges, with the following incidence rate ratios and 95% confidence intervals (CIs): schizophrenia, 0.65 (95% CI: 0.49–0.85); other psychoses, 0.68 (95% CI: 0.52–0.89); and personality disorders, 0.66 (95% CI: 0. 49–0.89). Municipalities with optimal consultation liaison showed 2.44 fewer total psychiatric discharges per 10 000 inhabitants, although without reaching statistical significance (-0.85 to 5.70). CONCLUSIONS: Using a nationally representative sample, we found that consultation liaison in primary care was associated with having fewer psychiatric hospitalizations. More studies are required to understand the role of each component of consultation liaison. Organización Panamericana de la Salud 2018-10-10 /pmc/articles/PMC6386200/ /pubmed/31093166 http://dx.doi.org/10.26633/RPSP.2018.138 Text en https://creativecommons.org/licenses/by-nc-nd/3.0/igo/legalcode This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. No modifications or commercial use of this article are permitted. In any reproduction of this article there should not be any suggestion that PAHO or this article endorse any specific organization or products. The use of the PAHO logo is not permitted. This notice should be preserved along with the article's original URL.
spellingShingle Original Research
Sepúlveda, Rafael
Zitko, Pedro
Ramírez, Jorge
Markkula, Niina
Alvarado, Rubén
Primary care consultation liaison and the rate of psychiatric hospitalizations: a countrywide study in Chile
title Primary care consultation liaison and the rate of psychiatric hospitalizations: a countrywide study in Chile
title_full Primary care consultation liaison and the rate of psychiatric hospitalizations: a countrywide study in Chile
title_fullStr Primary care consultation liaison and the rate of psychiatric hospitalizations: a countrywide study in Chile
title_full_unstemmed Primary care consultation liaison and the rate of psychiatric hospitalizations: a countrywide study in Chile
title_short Primary care consultation liaison and the rate of psychiatric hospitalizations: a countrywide study in Chile
title_sort primary care consultation liaison and the rate of psychiatric hospitalizations: a countrywide study in chile
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386200/
https://www.ncbi.nlm.nih.gov/pubmed/31093166
http://dx.doi.org/10.26633/RPSP.2018.138
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