The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project.

Autor: D'Avanzo B; Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy., Barbato A; Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy., Monzio Compagnoni M; National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy. matteo.monziocompagnoni@unimib.it.; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy. matteo.monziocompagnoni@unimib.it., Caggiu G; 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, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy.; Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy., Allevi L; Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy., Carle F; National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.; Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy., Di Fiandra T; National Institute of Health, Rome, Italy., Ferrara L; Centre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University, Milan, Italy., Gaddini A; Agency for Public Health, Lazio Region, Rome, Italy., Sanza M; Department of Mental Health and Substance Abuse, Local Health Trust of Romagna, Cesena, Italy., Saponaro A; General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy., Scondotto S; 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., Tozzi VD; Centre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University, Milan, Italy., Giordani C; Department of Health Planning, Italian Health Ministry, Rome, Italy., Corrao G; 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, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy., Lora A; National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.; Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy.
Jazyk: angličtina
Zdroj: BMC psychiatry [BMC Psychiatry] 2023 Jun 13; Vol. 23 (1), pp. 424. Date of Electronic Publication: 2023 Jun 13.
DOI: 10.1186/s12888-023-04921-7
Abstrakt: Background: The assessment of the quality of care pathways delivered to people with severe mental disorders in a community-based system remains uncommon, especially using healthcare utilization databases. The aim of the study was to evaluate the quality of care provided to people with bipolar disorders taken-in-care by mental health services of four Italian areas (Lombardy, Emilia-Romagna, Lazio, province of Palermo).
Methods: Thirty-six quality indicators were implemented to assess quality of mental health care for patients with bipolar disorders, according to three dimensions (accessibility and appropriateness, continuity, and safety). Data were retrieved from healthcare utilization (HCU) databases, which contain data on mental health treatments, hospital admissions, outpatient interventions, laboratory tests and drug prescriptions.
Results: 29,242 prevalent and 752 incident cases taken-in-care by regional mental health services with a diagnosis of bipolar disorder in 2015 were identified. Age-standardized treated prevalence rate was 16.2 (per 10,000 adult residents) and treated incidence rate 1.3. In the year of evaluation, 97% of prevalent cases had ≥ 1 outpatient/day-care contacts and 88% had ≥ 1 psychiatric visits. The median of outpatient/day-care contacts was 9.3 interventions per-year. Psychoeducation was provided to 3.5% of patients and psychotherapy to 11.5%, with low intensity. 63% prevalent cases were treated with antipsychotics, 71.5% with mood stabilizers, 46.6% with antidepressants. Appropriate laboratory tests were conducted in less than one-third of prevalent patients with a prescription of antipsychotics; three quarters of those with a prescription of lithium. Lower proportions were observed for incident patients. In prevalent patients, the Standardized Mortality Ratio was 1.35 (95% CI: 1.26-1.44): 1.18 (1.07-1.29) in females, 1.60 (1.45-1.77) in males. Heterogeneity across areas was considerable in both cohorts.
Conclusions: We found a meaningful treatment gap in bipolar disorders in Italian mental health services, suggesting that the fact they are entirely community-based does not assure sufficient coverage by itself. Continuity of contacts was sufficient, but intensity of care was low, suggesting the risk of suboptimal treatment and low effectiveness. Care pathways were monitored and evaluated using administrative healthcare databases, adding evidence that such data may contribute to assess the quality of clinical pathways in mental health.
(© 2023. The Author(s).)
Databáze: MEDLINE
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