Prevalência e perfil de usuários de álcool, tabaco e outras drogas na consultoria do serviço de psiquiatria e medicina legal em hospital geral universitário do Sul do Brasil

Abstract

Estima-se que 25% das pessoas que ocupam leitos hospitalares têm problemas por uso de álcool e drogas. Essa população não é identificada na grande maioria dos atendimentos prestados, levando ao surgimento de complicações associadas ao uso, tanto de caráter agudo ou crônico, nos diversos setores do Hospital. O diagnóstico precoce dos mesmos, através de consultoria especializada em álcool e drogas, é uma das medidas preventivas possíveis de serem implementadas nas instituições. Objetivo: Avaliar a prevalência e o perfil de usuários de álcool, tabaco e outras drogas atendidos em consultoria pelo Serviço de Psiquiatria e Medicina Legal do Hospital Geral Universitário (HGU), no sul do país. População: Todos os pacientes internados nas unidades de assistência de um Hospital Geral Universitário (HGU), avaliados pela consultoria do Serviço de Psiquiatria e Medicina Legal, no período de junho 2017 a junho 2018. Método: Trata-se de um estudo transversal retrospectivo, com obtenção de dados através de Query e busca ativa dos prontuários. Dos 33.000 pacientes que foram internados no HGU no período do estudo, apenas 1.101 (3,33%) tiveram solicitadas consultorias ao Serviço de Psiquiatria de Adultos. A população total ajustada ficou em 1.049 pacientes, que foram estratificados em grupos que receberam supervisão da consultoria em álcool e drogas (GAD n = 251) e que não receberam (GNAD n= 798). Resultados: Houve predomínio do sexo feminino, com uma média de idade de 45,8 (+/- 20,1), trabalhando na informalidade, primeiro grau incompleto, branco, solteiro e provenientes de Porto Alegre. Prevalência de uso de álcool, tabaco e drogas: 62,3 % fizeram uso de drogas lícitas (álcool e tabaco) e 36 % de drogas ilícitas (maconha, cocaína/crack e outras drogas) pelo menos uma vez na vida. Houve predominância do sexo masculino tanto para drogas lícitas quanto ilícitas. A idade de maior frequência de experimentação nessa população para o álcool foi entre 30 a 59 anos (65,8%) e para o tabaco (68,8%) acima de 60 anos. Entre as drogas ilícitas, o uso na vida de maconha (54,4%) foi o mais frequente entre os 16 e 29 anos. Perfil da consultoria: a medicina interna (MEI) (51,8%) foi a especialidade que mais pedidos fez de consultoria, seguida pela obstetrícia (14,4%) e cirurgia (11,7%). Conclusão: Há a necessidade de programas multidisciplinares de capacitação de alunos, residentes e profissionais da área de assistência, a fim de melhorar a identificação precoce dos indivíduos com TUS.

It is estimated that 25% of people occupying hospital beds have alcohol and drug use problems. This population is not identified in the vast majority of care provided, leading to the emergence of complications associated with the use, either acute or chronic, in the various sectors of the hospital. Early diagnosis through expert advice on alcohol and drugs is one of the preventive measures that can be implemented in institutions. Objective: To study the prevalence and profile of users of alcohol, tobacco and other drugs consulted by the Psychiatric and Forensic Medicine Service of the General University Hospital (HGU) in Southern Brazil. Population: All patients admitted to the general university hospital (HGU) units of care, evaluated by the consultancy of the Psychiatric and Forensic Medicine Service from June 2017 to June 2018. Method: This is a retrospective cross-sectional study, with data obtained through electronic medical data and active search of medical records. Of the 33,000 patients who were admitted to the HGU during the study period, only 1,101 (3.33%) had consultations with the Adult Psychiatry service. The total adjusted population was 1,049 patients who were stratified into groups that were supervised by the alcohol and drug consultancy team (GAD n = 251) and who did not receive (GNAD n = 798). Results: There was a predominance of females, with a mean age of 45.8 (+/- 20.1), working informally, incomplete first grade, white, single and from Porto Alegre. . When stratified into groups in the GAD, there was a predominance of males (66.1%), lower education (44.5%), mixed race (9.8%) and black (18.8%) and single. Prevalence of alcohol, tobacco and drug use: 62.3% used licit drugs (alcohol and tobacco) and 36% illicit drugs (marijuana, cocaine / crack and other drugs) at least once in their lives. There was a male predominance for both licit and illicit drugs. The most frequent age of experimentation in this population for alcohol was between 30 and 59 years (65.8%) and for tobacco (68.8%) over 60 years. Among illicit drugs the use in life of marijuana (54.4%) was the most frequent between 16 to 29 years. In GAD, lifetime use (93.8%) and alcohol use disorder (72.3%) were more prevalent in men aged 30 to 59 years. Lifetime use of cocaine (91.3%) and marijuana (90.5%); current use of cannabis (66.7%); marijuana use disorder (60.8%) and cocaine use disorder (52.9%) were more frequent among young adults aged 16 to 29 years. Clinical conditions: Cardioneurovascular conditions (15.8%) were the most frequent in the total sample. In GAD, acute clinical conditions (16.3%) and those related to pregnancy and puerperium (16.3%) were prevalent. Psychiatric conditions: Depression was the most common psychiatric condition in both GNAD (37.5%) and GAD (15.8%). Consultancy Profile: Internal Medicine (MEI) (51.8%) was the most requested, followed by obstetrics (14.4%) and surgery (11.7%). In GAD, MEI accounted for 40% of requests, 18.4% for obstetrics and 15.1% for psychiatry. Length of stay and reason for discharge: On average it was 14.8 days (+/- 8.0-30.4). The proportion of treatment dropout (1.6%) and dropout (5.3%) was significantly higher in GAD. GAD Profile and readmissions: Those who readmitted more than 3 times within one year were significantly older (51.0 +/- 16) than the non-readmission group (p = 0.005). They also had higher morphine prescription (p <0.001) and with MEI as a service requesting consultancy (p = 0.001). Conclusion: There is a need for multidisciplinary training programs for students, residents and care professionals in order to improve the early identification of individuals with TUS.