Sanza Michele, Monzio Compagnoni Matteo, Caggiu Giulia, Allevi Liliana, Barbato Angelo, Campa Jeannette, Carle Flavia, D'avanzo Barbara, Di Fiandra Teresa, Ferrara Lucia, Gaddini Andrea, Saponaro Alessio, Scondotto Salvatore, Tozzi Valeria D, Lorusso Stefano, Giordani Cristina, Corrao Giovanni, Lora Antonio
Department of Mental Health and Addiction Disorders Forlì-Cesena, AUSL Romagna, Cesena, Italy.
Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
Int J Ment Health Syst. 2023 Oct 13;17(1):31. doi: 10.1186/s13033-023-00603-9.
Italy can be viewed as a laboratory to assess the quality of mental healthcare delivered in a community-oriented system, especially for severe mental disorders, such as personality disorders. Although initiatives based on clinical indicators for assessing the quality of mental healthcare have been developed by transnational-organisations, there is still no widespread practice of measuring the quality of care pathways delivered to patients with severe mental disorders in a community-oriented system, especially using administrative healthcare databases. The aim of the study is to evaluate the quality of care delivered to patients with personality disorders taken-in-care by mental health services of four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily).
A set of thirty-three clinical indicators, concerning accessibility, appropriateness, continuity, and safety of care, was implemented using regional healthcare utilization databases, containing data on mental health treatments and diagnosis, hospital admissions, outpatient interventions and exams and drug prescriptions.
31,688 prevalent patients with personality disorders treated in 2015 were identified, of whom 2,331 newly taken-in-care. One-in-10 patients received a standardized assessment, the treatment discontinuity affected half of the cases. 12.7% of prevalent patients received at least one hospitalization, 10.6% in the newly taken-in-care cohort. 6-out-of-10 patients had contact with community-services within 14 days from hospital discharge. Access to psychotherapy and psychoeducational treatments was low and delivered with a low intensity. The median of psychosocial interventions per person-year was 19.1 and 9.4, respectively, in prevalent and newly taken-in-care cases. Nearly 50% of patients received pharmacological treatments.
Healthcare utilization databases were used to systematically evaluate and assess service delivery across regional mental health systems; suggesting that in Italy the public mental health services provide to individuals with personality disorders suboptimal treatment paths.
意大利可被视为一个评估以社区为导向的系统中精神卫生保健质量的实验室，尤其是针对严重精神障碍，如人格障碍。尽管跨国组织已制定了基于临床指标来评估精神卫生保健质量的举措，但在以社区为导向的系统中，对于为患有严重精神障碍的患者提供的护理路径质量进行测量，仍未得到广泛实践，尤其是利用行政医疗保健数据库。本研究的目的是评估意大利四个地区（伦巴第、艾米利亚 - 罗马涅、拉齐奥、西西里）的精神卫生服务机构收治的人格障碍患者所接受的护理质量。
利用区域医疗保健利用数据库实施了一组33项临床指标，这些数据库包含有关精神卫生治疗与诊断、住院、门诊干预与检查以及药物处方的数据，涉及护理的可及性、适宜性、连续性和安全性。
确定了2015年接受治疗的31,688例人格障碍现患患者，其中2,331例为新收治患者。每10名患者中有1名接受了标准化评估，治疗中断影响了一半的病例。12.7%的现患患者至少住院一次，新收治患者队列中这一比例为10.6%。每10名患者中有6名在出院后14天内与社区服务机构有接触。心理治疗和心理教育治疗的可及性较低且强度不大。在现患病例和新收治病例中，每人每年心理社会干预的中位数分别为19.1次和9.4次。近50%的患者接受了药物治疗。
利用医疗保健利用数据库对各地区精神卫生系统的服务提供情况进行了系统评估；这表明在意大利，公共精神卫生服务为患有人格障碍的个体提供的治疗路径欠佳。
