Produção e validação do índice de oferta da atenção psicossocial no Brasil

Abstract

INTRODUCTION: In Brazil, the public health system is organized into thematic care networks, territorially arranged by the Health Regions. One of these thematic networks is the Psychosocial Care Network (RAPS), intended for the care / reception of those in severe and mental suffering. persistent or abusive use of alcohol and other drugs. The RAPS is composed of services of Primary Care, Specialized Psychosocial Care and Tertiary Care, with offer recommended for the entire Brazilian territory, according to the criteria of Health Regionalization. OBJECTIVE: To produce and validate the Psychosocial Care Offering Index in Brazil. METHODS: An ecological study, which analyzed 36 variables that reflect the structure and human resources of RAPS distributed by Immediate Urban Articulation Regions, for which Descriptive and Spatial Analysis were performed using Moran Global and Local techniques. For the production and validation of the indicator, the exploratory and confirmatory factor analysis technique was applied, based on criterion and construct validations. RESULTS: The spatial distribution of the variables UBS, General Hospital, Family Physicians, Psychiatrist, Psychologist, ACS and Occupational Therapists showed spatial autocorrelation (I> 0.4; p <0.05), registering higher concentrations in certain areas in the Central regions. West, Southeast and South, where the rates of these elements were higher. Bartlett's sphericity test obtained p <0.05, the KMO was 0.732, the commonalities had a load higher than 0.6. Seven factors were extracted: Factor 1 (RAPS Primary Care Profile); Factor 2 (RAPS Support Team Profile); Factor 3 (RAPS Psychiatric Care Profile); Factor 4 (Profile of Residential Regime in RAPS); Factor 5 (CAPS Profile); Factor 6 (Profile of Therapeutic Residences in RAPS) and Factor 7 (Hospital Care Profile of RAPS), explaining together 70.5% of the Total Variance. The spatial distribution of the indicator shows that psychosocial care is very precarious in the northern region; from Precarious to Regular in the Northeast Region; and Good or Very Good in the Midwest, Southeast and South Regions. Construct validation was achieved with 60% of the sample, for which the same factors were formed that explained 70.8% of the Total Variance. Criterion validation showed that the Good and Very Good offer categories were related to the best socioeconomic indicators. CONCLUSIONS: Based on the data collected and the methodological process used, it was possible to produce and validate the Psychosocial Care Supply Index in Brazil, whose spatial distribution shows the existence of inequality in the supply and organization of RAPS, with better levels of supply in the regions. most developed in the country. These findings may support public health management and planning regarding the equitable distribution of RAPS assistance points, also suggesting policies to optimize existing structural and human resources; or, also, training and financial incentive, especially in distant and inland regions.