Diagnostic agreement between primary care workers and psychiatrists for specialized mental health care

Abstract

Background: Since 1997, in the city of Juiz de Fora, Brazil, a reformulation of the mental health care model used until then, was begun with the introduction of various health initiatives according to the complexity of each level of care. Objective: To assess the ability of Primary Care Teams (PCT) in identifying mental disorders and correctly referring them to secondary level care, according to criteria established in the systems´ guidelines of the Mental Health Service of Juiz de For a (SMSM-JF), and comparing the results of the two annual periods evaluated. Method: a real-life, natural experiment design was performed, using data collected from the medical records of the mental health system of the city. The Kappa index was used to evaluate the level of diagnostic agreement between the PCT workers and the psychiatrists at the secondary level during the two different periods. Results: The hypothesis of Disorders Related to Psychoactive Substance Use resulted in the highest percentage of agreement (Kappa 75,4% e 81,4%, respectively), reaching an excellent level in the second period evaluated. Minimal percentage agreement was observed for Mood Disorders (Kappa 21,1% e 25,1%). Conclusion: The results suggest a reasonable effectiveness of the mental health system studied, [diagnostic agreement between primary care workers and psychiatrists for specialized mental health care] with the PCT workers studied appropriately recognizing and referring the more serious mental disorders to the specialists.