Assessing the quality of the care offer for people with personality disorders in Italy: the QUADIM project. A multicentre research based on the database of use of Mental Health services

International Journal of Mental Health Systems

Research

Jeannette Campa¹  Andrea Gaddini²  Lucia Ferrara³  Valeria D Tozzi³  Cristina Giordani⁴  Stefano Lorusso⁴  Barbara D’avanzo⁵  Angelo Barbato⁵  Michele Sanza⁶  Liliana Allevi⁷  Alessio Saponaro⁸  Flavia Carle⁹  Salvatore Scondotto^1,10  Antonio Lora^1,11  Teresa Di Fiandra^1,12  Giovanni Corrao^1,13  Matteo Monzio Compagnoni^1,13  Giulia Caggiu^1,14 

[1] Addiction Unit, AUSL Romagna, Cesena, Italy;Agency for Public Health, Lazio Region, Rome, Italy;Centre of Research on Health and Social Care Management, CERGAS SDA Bocconi School of Management (Bocconi University, Milan, Italy;Department of Health Planning, Italian Health Ministry, Rome, Italy;Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy;Department of Mental Health and Addiction Disorders Forlì-Cesena, AUSL Romagna, Cesena, Italy;Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy;General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy;National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy;Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy;National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy;Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy;National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy;Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy;Psychologist, previously General Directorate for Health Prevention, Ministry of Health, Rome, Italy;Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy;National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy;Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy;National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy;Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy;

关键词: Healthcare utilization databases;    Personality disorders;    Quality of mental healthcare;    Treatment gap;    Clinical pathways;    Mental healthcare;    Real-world;    Healthcare research;    Public health;    Healthcare services;   

DOI  :  10.1186/s13033-023-00603-9

 received in 2023-02-03, accepted in 2023-09-27,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundItaly 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).MethodsA 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.RESULTS31,688 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.ConclusionsHealthcare 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.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

12888_2023_5206_Article_IEq1.gif

Fig. 1