Gigantesco Antonella, Miglio Rossella, Santone Giovanni, de Girolamo Giovanni, Bracco Renata, Morosini Pierluigi, Norcio Bruno, Picardi Angelo
Istituto Superiore di Sanità, Viale Regina Elena, Rome, Italy.
Aust N Z J Psychiatry. 2007 Jun;41(6):509-18. doi: 10.1080/00048670701341921.
To investigate the process of care in Italian public acute inpatient facilities.
Each facility's head psychiatrist (in all Italian regions except Sicily) completed a structured interview concerning provision of treatment and facility rules.
Twenty-three university psychiatric clinics with 399 beds (mean=17.3 beds), 16 24 h community mental health centers with 98 beds (mean=6.1 beds), and 262 general hospital psychiatric units with 3431 beds (mean=13.1 beds) were surveyed. Mean length of stay was 18.5+/-7.1 days, 37.0+/-55.3 days and 12.0+/-3.4 days, respectively. Pharmacotherapy was ubiquitous. Approximately 80% of facilities held regular clinical evaluations, supportive talks, and counselling. Dynamic focused psychotherapy was available in 29% of the facilities; 24% provided cognitive behavioural therapy; 32% family therapy; and 39% structured rehabilitative intervention. Vocational training and activities targeted at helping patient integration into their local communities were uncommon. Most facilities did not allow the possession of cutting utensils (96%), personally possessed medication (96%), or lighters (72%), and most had locked doors (75%). Fewer facilities (37%) prohibited the use of mobile phones (32%) and metal knives during meal times (37%). Frequency of physical restraint was associated with number of internal rules. Delivery of psychotherapy was associated with nurse provision.
The process of psychiatric inpatient care in Italy shows considerable variability. Future clinical practice guidelines should address the currently limited provision of evidence-based psychosocial intervention in these facilities. Efforts should also be devoted to improving the effectiveness of the hospital-community mental health service interface.
调查意大利公立急性住院设施中的护理过程。
除西西里岛外，意大利各地区的首席精神科医生完成了一项关于治疗提供和设施规定的结构化访谈。
对23家拥有399张床位（平均17.3张床位）的大学精神科诊所、16家拥有98张床位（平均6.1张床位）的24小时社区心理健康中心以及262家拥有3431张床位（平均13.1张床位）的综合医院精神科病房进行了调查。平均住院时间分别为18.5±7.1天、37.0±55.3天和12.0±3.4天。药物治疗普遍存在。约80%的设施进行定期临床评估、支持性谈话和咨询。29%的设施提供动态聚焦心理治疗；24%提供认知行为治疗；32%提供家庭治疗；39%提供结构化康复干预。职业培训和旨在帮助患者融入当地社区的活动并不常见。大多数设施不允许患者拥有切割器具（96%）、个人自备药物（96%）或打火机（72%），且大多数设施有锁门（75%）。较少设施（37%）禁止在就餐时间使用手机（32%）和金属刀具（37%）。身体约束的频率与内部规定的数量相关。心理治疗的提供与护士配备相关。
意大利精神科住院护理过程存在很大差异。未来的临床实践指南应解决这些设施中目前循证心理社会干预提供有限的问题。还应致力于提高医院 - 社区心理健康服务接口的有效性。
