Dipartimento di Salute Mentale dell'Azienda Ospedaliera "G, Salvini", Garbagnate Milanese, Italy.
Int J Ment Health Syst. 2008 Jul 5;2(1):10. doi: 10.1186/1752-4458-2-10.
The aim of this paper is to evaluate the effectiveness of community Mental Health Departments in Lombardy (Italy), and analyse the eventual differences in outcome produced by different packages of care. The survey was conducted in 2000 on 4,712 patients treated in ten Mental Health Departments. Patients were assessed at least twice in a year with HoNOS (Health of the Nation Outcome Scales). Data on treatment packages were drawn from the regional mental health information system, which includes all outpatient and day-care contacts, as well as general hospital and inpatient admissions provided by Mental Health Departments. Multilevel growth models were used for outcomes statistical analysis, expressed in terms of change of the total HoNOS score. On the whole, Mental Health Departments were effective in reducing HoNOS scores. The main predictor of improvement was treatment, while length of care, gender and diagnosis were weaker predictors. After severity adjustment, some packages of care proved more effective than others. Appropriate statistical methods, comprehensive treatment descriptions and routine outcome assessment tools are needed to evaluate the effectiveness of community mental health services in clinical settings.
本文旨在评估意大利伦巴第（Lombardy）社区心理健康部门的有效性，并分析不同护理方案所产生的结果差异。该调查于 2000 年对十家心理健康部门的 4712 名患者进行，患者在一年内至少接受两次 HoNOS（国民健康结果量表）评估。治疗方案的数据来自区域心理健康信息系统，其中包括所有门诊和日间护理接触、以及由心理健康部门提供的综合医院和住院治疗。使用多层次增长模型对治疗结果进行统计分析，以 HoNOS 总分变化表示。总的来说，心理健康部门在降低 HoNOS 评分方面非常有效。改善的主要预测因素是治疗，而护理时间、性别和诊断则是较弱的预测因素。经过严重程度调整后，一些护理方案比其他方案更有效。需要适当的统计方法、全面的治疗描述和常规的结果评估工具，以在临床环境中评估社区心理健康服务的有效性。
