Telepsiquiatria no Brasil durante a pandemia de covid-19: construção, validação e aplicação de questionário de conhecimento, atitude e prática

Abstract

Introdução: telepsiquiatria é definida como o uso de comunicação eletrônica para fornecer ou apoiar cuidados psiquiátricos à distância. Em mais de dois anos de pandemia de COVID-19 e do surgimento das leis de regulamentação da telemedicina no Brasil, a telepsiquiatria vem ganhando evidência. Questionários CAP (Conhecimento, Atitude e Prática) são ferramentas utilizadas para medir o que um determinado grupo de pessoas sabe, pensa e como atua diante de um cenário, tendo sido o meio escolhido neste estudo para avaliar como os psiquiatras brasileiros têm feito uso da telepsiquiatria. Objetivo: construir, validar e aplicar um instrumento para determinar o nível de conhecimento, atitude e prática dos psiquiatras e residentes médicos em psiquiatria brasileiros em relação ao atendimento em telepsiquiatria no último ano, bem como os fatores associados com conhecimento, atitude e prática adequados. Método: estudo metodológico para construção e validação de instrumento seguido de estudo transversal tipo questionário de Conhecimento, Atitude e Prática (CAP) com componente analítico. Para obter as informações, foi elaborado um questionário estruturado acerca de leis e literatura científica sobre telepsiquiatria. Em seguida, o questionário foi submetido para a validação junto a experts em psiquiatria (juízes) através do método Delphi. Após validação, o questionário foi enviado a psiquiatras de todo o Brasil através de redes sociais e de divulgação no site da Associação Brasileira de Psiquiatria. Os psiquiatras que aceitaram participar do estudo responderam um questionário (Google Forms). Os dados foram exportados do Google Forms para um banco de dados no programa Excel e foram analisados no software Stata 12.1. As variáveis categóricas foram apresentadas em frequências absolutas e relativas e, as variáveis numéricas, pela média e Desvio Padrão. Para análise dos fatores associados a cada um dos três desfechos: conhecimento, atitude e prática, foi realizada análise multivariada de Poisson. As variáveis que alcançaram o valor p< 0,001) e atender crianças (p = 0,001). A prática foi adequada para 81,2% dos participantes e, permaneceram no modelo final da análise multivariada como estatisticamente significantes atender idosos (p = 0,001) e adolescentes (p = 0,043). Conclusão: o questionário CAP foi validado e pode ser aplicado em outros estudos com psiquiatras, estudantes e residentes. A atitude adequada ocorre mais entre os psiquiatras que não atendem em consultórios e entre os que atendem crianças e, a prática adequada, entre os psiquiatras que atendem idosos e adolescentes. O estudo aponta para as diferenças encontradas na prática e na atitude adequadas a depender do grupo etário em atendimento envolvido. ABSTRACT: Introduction: telepsychiatry is defined as the use of electronic communication to provide or support psychiatric care at a distance. More than two years after the emergence of the COVID 19 pandemic and the telemedicine regulation laws in Brazil, telepsychiatry is becoming more relevant. KAP (knowledge, attitude, practice) surveys are tools used in measuring what certain groups of people know, think and act in a scenery. A KAP survey was the chosen means to evaluate how Brazilian psychiatrists have been using telepsychiatry. Objectives: to develop, validate and apply an instrument to determine the level of knowledge, attitude and practice of Brazilian psychiatrists and medical residents in psychiatry regarding telepsychiatry care in the last year, as well as the factors associated with adequate knowledge, attitude and practice. Method: a methodological study for the construction and validation of an instrument followed by a cross-sectional study of the Knowledge, Attitude and Practice (KAP) survey with an analytical component. To obtain the information, a structured survey of pre-coded questions was prepared, according to the laws that regulate telemedicine and published scientific evidence about telepsychiatry. Then, the survey was submitted for validation by experts in psychiatry (judges), using the Delphi method. After the test’s validation, the survey was sent to psychiatrists via social media and via the Brazilian Association of Psychiatry’s website. The psychiatrists that accepted to participate in the study answered the survey (Google Forms). Data was exported from Google Forms to a database in Excel and was analyzed in Stata 12.1 software. Categorical variables were presented in absolute and relative frequencies and numerical variables were presented with mean and standard deviation. To analyze the factors associated with the three outcomes: knowledge, attitude and practice, a multivariate logistic regression analysis was performed. Variables that reached p value < 0.20 in the univariate analysis were selected to participate in the final stage of construction of the multivariate models, considering as statistically significant when p < 0.05. The study was approved by IMIP’s Research Ethics Committee (CEP), CAAE 52584521.20000.5201, number 5,124,348. Results: the appearance and content validation of the KAP survey was carried out by ten experts in three different moments with a convergence of 97.7% in the first moment, 96.3% in the second moment and 100% (grade 5 (maximum agreement)) in the third moment. The average age of the judges was 38 years (SD ± 10). The female gender prevailed (60%), with an average 10 years of experience (SD ± 10.8). For the KAP survey, 101 responses from psychistrists and medical residents in psychiatry were collected. Knowledge was adequate for 68.3% of the participants and, in the multivariate analysis, none of the socioeconomial, professional and educational variables were statistically significant. Attitude was adequate for 80.1% of the participants and, in the multivariate analysis’ final model, not consulting in an office (p < 0.001) and assisting children (p = 0.001) remained as statistically significant. The practice was adequate for 81.2% of the participants and, in the multivariate analysis’ final model, assisting the elderly (p = 0.001) and adolescents (p = 0.043) remained as statistically significant. Conclusion: the KAP survey was validated, and it can be applied in other studies with psychiatrists, students and medical residents. The adequate attitude occurs more among psychiatrists who do not work in offices and among those who work with children, while adequate practice occurs more among psychiatrists who work with the elderly and adolescents. The study points to the differences found in the adequate practice and attitude depending on the assisted age group.