O uso de indicadores na avaliação da estratégia de apoio matricial em saúde mental: o papel dos sistemas de informação em saúde

Abstract

Introduction - Mental disorders have a high prevalence and are responsible for a significant burden of disease and disability worldwide. The high prevalence of mental disorders versus the lack of provision for these patients is a public health issue and a challenge for health systems globally. Specialized mental health (MH) services alone do not ensure comprehensive care, indicating the need for a health network that includes primary health care (PHC). PHC is strategic for managing people with mental distress, provided it has adequate specialist support for integration. In Brazil, the official strategy for integrating MH into PHC is matrix support (MS), operationalized from the creation of Family Health Support Centers (NASF) in 2007. Implementing MS faces difficulties and varies widely across the country. Additionally, evaluation of MS is timid, primarily consisting of regional qualitative studies with limited generalizability. To advance this debate, our research investigated the use of secondary data from the National Health Information System (SNIS) to create useful indicators for evaluating MS in MH and analyzed these indicators' behavior over time in the 27 Health Regions (HRs) including each state capital. Methodology - A narrative review of studies published in the last 10 years evaluating MS, especially those using quantitative methods; exploratory study to identify SNIS data for creating MS evaluation indicators; descriptive and inferential analysis, through panel regression, of data concerning the 27 HRs. Results - Our review confirmed that most studies on MH evaluation in Brazil are qualitative and focused on CAPS. Research indicates MS is generally seen as positive but faces implementation difficulties and often focuses on flow and agenda management. Quantitative studies show a positive correlation between the presence of NASF and shared clinical actions with better MH care, with group activities being a sensitive indicator for this evaluation. Beyond these studies, there is a clear lack of objective indicators to evaluate MS. Research in SNIS identified data in SISAB and SIA-SUS allowing the proposal of structure, process, and outcome indicators for MS. Descriptive analysis shows an increase in PHC and NASF coverage over time, as well as an increase in NASF's MH actions, albeit with significant regional variability and a negative impact after 2020. Inferential analysis confirmed correlations between these indicators, especially between individual care production, group activities with MH users, case discussion, and continuing education actions by NASF, and their effect on Family Health teams' production. Conclusion - Despite study limitations, such as the use of aggregated secondary data and the absence of user-related outcome indicators, the need for further research on MS and more robust indicators reflecting practice complexity is emphasized. The importance of combining qualitative and quantitative research methods and local actors' participation is highlighted to improve the evaluation of MH care in Brazil.