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"titulo" => "Variability in outpatient resource use in mental health services for children and adolescents"
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2 => "Infancia y adolescencia"
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2 => "Child and adolescent"
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"resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">Conocer la variabilidad en las respuestas asistenciales que se ofrecen en la atención psiquiátrica ambulatoria a los menores de 18 años, medidas por el número de consultas y el tiempo de duración de los tratamientos.</p> <span class="elsevierStyleSectionTitle">Método</span><p class="elsevierStyleSimplePara elsevierViewall">Estudio observacional, analítico, prospectivo con datos históricos y longitudinal de seguimiento de 298 sujetos que consultan por primera vez en las unidades de atención ambulatoria de Leganés y Fuenlabrada (Madrid).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La mediana del número de consultas por paciente en Leganés fue de 6, mientras que en Fuenlabrada fue de 3 (p < 0,001). La mediana de la duración del tratamiento fue más del doble en Leganés (276 días) que Fuenlabrada (119 días) (p < 0,001). El análisis estratificado muestra que los tratamientos del distrito de Fuenlabrada suponen un menor número de consultas, ya sea el profesional responsable psiquiatra o psicólogo, se lleve a cabo psicoterapia individual, de otro tipo, o no se indique tratamiento de modo explícito, se realice alta concertada o ésta se produzca por abandono. Similares resultados se aprecian para la duración del tratamiento.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Las diferencias encontradas de estilos de práctica clínica ilustran las dificultades para desarrollar un sistema de ajustes de riesgos útil en salud mental, puesto que las diferencias en uso de recursos no son fácilmente atribuibles a variables relacionadas con el paciente, sino al tipo de intervención prestada, que depende de la discrecionalidad del facultativo.</p>"
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"en" => array:2 [
"titulo" => "Abstract"
"resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">To assess possible variability in the therapeutic approaches provided to patients aged less than 18 years old in community mental health centres (CMHC) in terms of the number of visits and length of treatment.</p> <span class="elsevierStyleSectionTitle">Method</span><p class="elsevierStyleSimplePara elsevierViewall">An observational, analytical, prospective, longitudinal study was performed in a clinical cohort of 298 subjects attending the CMHC of Leganés and Fuenlabrada (Madrid) for the first time.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The median number of visits per patient was six in Leganés and three in Fuenlabrada (p < 0.001). The mean length of treatment was more than twice as long in Leganés (276 days) than in Fuenlabrada (119 days) (p < 0.001). Stratified analysis showed that the treatments provided in Fuenlabrada involved fewer visits, irrespective of the health professional in charge (psychiatrist or psychologist), the treatment modality prescribed (individual psychotherapy, other psychotherapies or no explicit treatment prescribed), or whether the patient abandoned treatment or the discharge was agreed. Similar results were found for the length of treatment.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The different clinical styles illustrate the difficulty of developing useful risk adjustment systems in mental health. The differences in resource consumption and costs cannot easily be attributed to patient-related variables, but are due rather to the intervention provided, which depends on the staff.</p>"
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"identificador" => "bib1"
"etiqueta" => "1."
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"colaboracion" => "Department of Health and Human Services, Substance Abuse and Mental Health Services"
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"titulo" => "Psychotropic practice patterns for youth: a 10-year Perspective"
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0 => array:2 [
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0 => "J.M. Zito"
1 => "D.J. Safer"
2 => "S. DosReis"
3 => "J.F. Gardner"
4 => "L. Magder"
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"tituloSerie" => "Arch Pediatr Adolesc Med"
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"titulo" => "Use of health and mental health services by adolescents across multiple delivery sites"
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"etal" => false
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0 => "L. Juszczak"
1 => "P. Melinkovich"
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"tituloSerie" => "J Adolesc Health"
"fecha" => "2003"
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"titulo" => "Utilization of medical and health-related services among school-age children and adolescents with special health care needs (1994 National Health Interview Survey on Disability [NHIS-D] Baseline Data)"
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1 => "C. Minkovitz"
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0 => "C. Glisson"
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"titulo" => "Perception of need for child psychiatry services among parents and general practitioners"
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0 => "S. Evans"
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"tituloSerie" => "Health Trends"
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"etal" => false
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0 => "R.M. Semansky"
1 => "C. Koyanagi"
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"tituloSerie" => "Psychiatr Serv"
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"titulo" => "Ontario Child Health Study. Implications for clinical services, research and training"
"autores" => array:1 [
0 => array:2 [
"etal" => false
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0 => "N.R. Grant"
1 => "D.R. Offord"
2 => "H.M. Blum"
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"identificador" => "bib10"
"etiqueta" => "10."
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0 => array:2 [
"titulo" => "Planificación terapéutica de los trastornos psiquiátricos de niños y adolescents"
"autores" => array:1 [
0 => array:2 [
"etal" => false
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0 => "J.R. Gutiérrez Casares"
1 => "F. Rey Sánchez"
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"fecha" => "2000"
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"identificador" => "bib11"
"etiqueta" => "11."
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0 => array:2 [
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0 => array:2 [
"titulo" => "Psychoactive medication prescribing practices for US children: gaps between research and clinical practice"
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"etal" => false
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0 => "P.S. Jensen"
1 => "V.S. Bhatara"
2 => "B. Vitiello"
3 => "K. Hoagwood"
4 => "M. Feil"
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0 => array:2 [
"doi" => "10.1097/00004583-199905000-00017"
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"tituloSerie" => "J Am Acad Child Adolesc Psychiatry"
"fecha" => "1999"
"volumen" => "38"
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"url" => "https://www.ncbi.nlm.nih.gov/pubmed/10230187"
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0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "The cost-effectiveness of psychotherapy"
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0 => array:2 [
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"autores" => array:2 [
0 => "S.G. Lazar"
1 => "G.O. Gabbard"
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"tituloSerie" => "J Psychother Pract Res"
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"url" => "https://www.ncbi.nlm.nih.gov/pubmed/9292445"
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"etiqueta" => "13."
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