[Therapeutic itineraries shared by users of specialized mental health services: a cluster analysis]

This study aimed to identify the existence of therapeutic itineraries shared by users of specialized mental health services in a medium-sized municipality. This is a cross-sectional study, carried out from August to November 2019 including 341 users of specialized mental health services in the municipality of Itatiba, São Paulo State, Brazil. To identify the itineraries, based on a set of variables, the users were grouped with clustering. The best measure of silhouette of cohesion and separation (> 0.3) for the clusters was achieved based on four variables: situation in which the mental health problem was identified, place of first care, origin of referral to the current service, and bond maintenance with primary health care (PHC). The clusters identified in the study demonstrated: (1) low participation of PHC in welcoming new cases, with most of the care taking place in specialized services; (2) high proportion of cases identified in crisis situations; (3) low participation of PHC in the referral of cases, with high access to specialized services by spontaneous demand; (4) lack of continuity in PHC services after entering the specialized service. The study highlighted significant weaknesses in the studied healthcare network, evincing the need to develop strategies that foster the services integration, especially regarding PHC, both to favor access to specialized care in a timely manner and to enable the continuity of care between different healthcare facilities.