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      ESAMEN: Descripción y medida de la estructura de los servicios de atención comunitaria en salud mental Translated title: ESAMEN: Description and assessment of the structure of community-oriented mental health services

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          Abstract

          Resumen: La estructura básica de los servicios de salud mental orientados a la comunidad se compone de cuatro tipos de dispositivos: las unidades de salud mental en los hospitales generales, los hospitales de día, los centros de salud mental y los centros de rehabilitación psicosocial, complementados con el apoyo social aportado por los servicios sociales especializados. Debido a que los dispositivos pueden acoger actividades muy diversas que pueden implicar a varios sectores de la Administración y del Tercer Sector simultánea o sucesivamente, y también debido a su implantación geográfica irregular, la gestión de los servicios de salud mental es un asunto complejo sobre el que todavía no se ha alcanzado un acuerdo. En el momento actual disponemos de varios instrumentos de medida y clasificación de los servicios para facilitar su evaluación, pero ninguno de ellos ha logrado popularizarse. El objetivo de este trabajo consiste en dar cuenta de un nuevo instrumento, ESAMEN, para describir y medir la estructura de los servicios de salud mental comunitaria, y someterlo a un estudio de viabilidad. Este método no se basa en la clasificación de los dispositivos como se ha hecho hasta ahora, sino en la clasificación de las 32 actividades o módulos de atención que se practican en ellos. Para este estudio de viabilidad, se remitió una encuesta a los coordinadores de 380 dispositivos de salud mental de Andalucía, Euskadi y Madrid, solicitándoles información sobre el área de cobertura y el número de profesionales de cada uno de los módulos dispensados en su dispositivo. Con estos datos se elaboraron indicadores de capacidad (expresada como el tiempo máximo de dedicación por habitante y unidad de tiempo) y alcance (proporción del total de habitantes que es potencialmente beneficiaria del módulo). Las tablas de resultados muestran con claridad y sencillez la estructura de los servicios, valorando cada módulo según su capacidad y alcance poblacional, evidenciando desequilibrios en su distribución, permitiendo comparaciones entre áreas y comunidades, y dejando la puerta abierta al refinamiento de los indicadores y a la inclusión de nuevos módulos de actividad que se puedan desarrollar en el futuro.

          Translated abstract

          Abstract: The basic structure of community-oriented mental health services consists of four types of facilities: mental health units in general hospitals, day hospitals, mental health centres, and psychosocial rehabilitation centres, complemented by social support provided by specialized social services. Due to the fact that these facilities can host very diverse health activities that may involve several sectors of the Administration and the Third Sector, simultaneously or successively, and also due to their irregular geographical implementation, the management of mental health services is a complex issue on which no agreement has yet been reached. At present, we have several instruments for measuring and classifying services to facilitate their management, but none of them has become popular. The aim of this work is to report on ESAMEN, a tool to classify and measure the structure of community mental health services, and to subject it to a feasibility study. This instrument is not based on the classification of facilities as has been done so far, but on the classification of the 32 activities or modules of care that are practiced in them. For this feasibility study, a survey was sent to the coordinators of 380 mental health facilities from Andalusia, Euskadi and Madrid, requesting information on the area of coverage and the number of professionals in each of the modules dispensed in their facility. With these data, indicators of capacity (expressed as the maximum time of professional dedication per inhabitant and unit of time) and scope (proportion of the total number of inhabitants who are potentially beneficiaries of the module) were elaborated. Results tables show with clarity and simplicity the structure of the services, evaluating each module according to its capacity and population scope, showing imbalances in its distribution, allowing comparisons between areas and Communities, and leaving the door open to the refinement of the indicators and the inclusion of new activity modules that may be developed in the future.

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          Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

          Background The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS). Methods The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal). Results DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making. Conclusion DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison.
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            Use of an integrated Atlas of Mental Health Care for evidence informed policy in Catalonia (Spain).

            This paper aims to present the Integrated Atlas of Mental Health of Catalonia (2010) focusing on: (a) the importance of using a taxonomy-based coding and standard system of data collection when assessing health services; and (b) its relevance as a tool for evidence-informed policy.
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              The REFINEMENT Glossary of Terms: An International Terminology for Mental Health Systems Assessment.

              Comparing mental health systems across countries is difficult because of the lack of an agreed upon terminology covering services and related financing issues. Within the European Union project REFINEMENT, international mental health care experts applied an innovative mixed "top-down" and "bottom-up" approach following a multistep design thinking strategy to compile a glossary on mental health systems, using local services as pilots. The final REFINEMENT glossary consisted of 432 terms related to service provision, service utilisation, quality of care and financing. The aim of this study was to describe the iterative process and methodology of developing this glossary.
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                Author and article information

                Journal
                neuropsiq
                Revista de la Asociación Española de Neuropsiquiatría
                Rev. Asoc. Esp. Neuropsiq.
                Asociación Española de Neuropsiquiatría (Madrid, Madrid, Spain )
                0211-5735
                2340-2733
                December 2019
                : 39
                : 136
                : 59-88
                Affiliations
                [3] orgnameServicio Andaluz de Salud España
                [6] Alcalá de Henares Madrid orgnameHospital Universitario Príncipe de Asturias España
                [4] Alcalá de Henares Madrid orgnameHospital Universitario Príncipe de Asturias orgdiv1Servicio de Psiquiatría España
                [5] Alcalá de Henares Madrid orgnameHospital Universitario Príncipe de Asturias España
                [2] Vitoria-Gasteiz orgnameDirección General de Osakidetza orgdiv1Servicio de Salud Mental y Asistencia Psiquiátrica España
                [1] Valencia orgnameUniversidad de Valencia orgdiv1CIBERSAM España
                Article
                S0211-57352019000200004 S0211-5735(19)03913600004
                10.4321/s0211-57352019000200004
                f3075dae-633d-47fe-baf8-c387409701d5

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 16 November 2019
                : 08 October 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 30
                Product

                SciELO Spain

                Categories
                Artículos

                evaluación de servicios de salud mental,política de salud mental,salud mental comunitaria,mental health service evaluation,mental health policy,community mental health

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