The quality of mental health care delivered to patients with schizophrenia and related disorders in the Italian mental health system. The QUADIM project: a multi-regional Italian investigation based on healthcare utilisation databases

Abstract

Aims To evaluate the quality of mental health care delivered to patients with schizophrenia and related disorders taken-in-care by mental health services in four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily). Methods Thirty-one clinical indicators concerning accessibility, appropriateness, continuity and safety were defined and estimated using healthcare utilisation (HCU) databases, containing data on mental health treatments, hospital admissions, outpatient interventions, lab tests and drug prescriptions. Results A total of 70 586 prevalent patients with schizophrenia and related disorders treated in 2015 were identified, of whom 1752 were newly taken-in-care by the facilities of regional mental health services. For most patients community care was accessible and moderately intensive. However, care pathways were not implemented based on a structured assessment and only half of the patients received psychosocial treatments. One patient out of ten had access to psychological interventions and psychoeducation. Activities specifically addressed to families involved a third of prevalent patients and less than half of new patients. One patient out of six was admitted to a community residential facility, and one out of ten to a General Hospital Psychiatric Ward (GHPW); higher values were identified in new cases. In general hospitals, few patients had a length of stay (LoS) of more than 30 days, while one-fifth of the admissions were followed by readmission within 30 days of discharge. For two-thirds of patients, continuity of community care was met, and six times out of ten a discharge from a GHPW was followed by an outpatient contact within 2 weeks. For cases newly taken-in-care, the continuity of community care was uncommon, while the readiness of outpatient contacts after discharge was slightly more frequent. Most of the patients received antipsychotic medication, but their adherence to long-term treatment was low. Antipsychotic polytherapy was frequent and the control of metabolic side effects was poor. The variability between regions was high and consistent in all the quality domains. Conclusions The Italian mental health system could be improved by increasing the accessibility to psychosocial interventions, improving the quality of care for newly taken-in-care patients, focusing on somatic health and mortality, and reducing regional variability. Clinical indicators demonstrate the strengths and weaknesses of the mental health system in these regions, and, as HCU databases, they could be useful tools in the routine assessment of mental healthcare quality at regional and national levels.

Optimization of Disaster Management by the Rapid Response Team at The Gorontalo Province Regional Disaster Management Agency

“…Apart from that, analysis of documents related to disaster management regulations and policies will also be an important part of data collection. Data analysis will use an inductive approach [14], where the findings that emerge from the data will be interpreted to understand the dynamics and factors that influence the professionalism of the rapid response team. With this research design, it is hoped that an in-depth and comprehensive understanding of the challenges and opportunities in efforts to improve disaster response through the professionalism of the rapid reaction team in Gorontalo Province will be obtained.…”

From contact coverage to effective coverage of community care for patients with severe mental disorders: A real-world investigation from Italy

“…Due to privacy issues, each identification code is automatically anonymized and the inverse process is only allowed to the Regional Authority upon request of judicial Authorities. Further details on HCU database in the field of MHC have been reported elsewhere ( 15 , 17 – 19 ). Diagnostic and drug therapy codes used for drawing records and fields from the considered databases are reported in the Supplementary Table 1 .…”

“…The target population consisted of all NHS beneficiaries resident in Lombardy, Emilia-Romagna, Lazio, and Palermo, aged 18–65 years (13.5 million inhabitants) ( 15 , 19 ). NHS beneficiaries resident in these areas, who during the recruitment period had at least one contact with a mental health service (MHS) and had a diagnosis of depression, schizophrenia, bipolar disorder, or personality disorder, were identified, and labeled as prevalent cases.…”

Implementation of early intervention clinical services within the National Health System in Italy: Third wave survey with focus on structures, resources, and fidelity to the evidence‐based model

“…Limited resources and the lack of an acknowledged standard of care in the face of growing needs in the mental health field made the system somehow rigid; indeed, in most cases the organization of services has hardly changed over the last decades (Amaddeo & Barbui, 2018; Carta et al, 2020). The strengths and weaknesses of the Italian mental health system (MHS) are especially evident in the care of people with severe mental disorders (Lora et al, 2016; Lora et al, 2022).…”