Hostname: page-component-76fb5796d-22dnz Total loading time: 0 Render date: 2024-04-26T14:35:44.325Z Has data issue: false hasContentIssue false
  • English
  • Français

Service utilisation: a pivotal measure in assessing service needs and service outcome

Published online by Cambridge University Press:  07 July 2014

Mirella Ruggeri
Mirella Ruggeri*
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Ospedale Policlinico, 37134 Verona, Italy
Get access

Extract

In past years the study of service utilization has given a great contribution to the evaluation of mental health services. Nowadays, the challenge that must be faced is to obtain from service utilization research useful knowledge for clinical practice and service planning.

Psychiatric care organization should be based on coherent and comprehensive assessments of the population's morbidity and needs for care, and take into account costs and benefits of different forms of treatments in relieving mental disorders and meeting mental health needs. While the former issue has been widely studied, the last two are mostly unexplored. Specifically, there is limited amount of information available on the significance that certain patterns of service utilization, or changes in service utilization, may have for the patient, his/her relatives and the community, and on the correlation between certain characteristics of service utilization and the overall quality of care.

In this perspective, service utilization must not be considered an isolated step in the patient's career; the causal link between needs, use, and outcome of services should be identified. A full understanding of the role of service utilization in psychiatry thus necessitates taking into consideration events occurring at various steps of a person's history:

step 1: a person develops a mental disorder;

step 2: in certain cases this will determine a mental health service need;

step 3: in certain cases the service need will determine mental health service utilization;

step 4: use of mental health services will have a certain outcome.

Type
Section B: From Service Description to Service Evaluation
Information
Epidemiologia e psichiatria sociale. Monograph Supplement , Volume 6 , Issue S1: Monograph Supplement 1: Making Rational Mental Health Services , April 1997 , pp. 105 - 112
Copyright
Copyright © Cambridge University Press 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Audini, B., Marks, I.M., Lawrence, R.E., Connolly, J. & Watts, V. (1994). Home-based versus out-patient/in-patient care for people with serious mental illness. Phase II of a Controlled Study. British Journal of Psychiatry 165, 204–210.Google Scholar
Balestrieri, M., Micciolo, R. & Tansella, M. (1987a). Long-stay and long-term psychiatric patients in an area with a community-based system of care. A register follow-up study. International Journal of Social Psychiatry 33, 251–262.Google Scholar
Balestrieri, M., Williams, P., Micciolo, R. & Tansella, M. (1987b). Monthly variation in the pattern of extramural psychiatric care. Social Psychiatry 22, 160–166.Google Scholar
Balestrieri, M., Sytema, S., Gavioli, I. & Micciolo, R. (1989). Patterns of psychiatric care in South-Verona and Groningen. A case-register follow-up study. Acta Psychiatrica Scandinavica 80, 437–444.CrossRefGoogle Scholar
Dew, M.A., Bromet, E.J. & Schulberg, H.C. (1988). Factors affecting help-seeking during depression in a community sample. Journal of Affective Disorders 14, 223–234.CrossRefGoogle Scholar
Faccincani, C., Mignolli, G. & Platt, S. (1990). Service utilization, social support and psychiatric status in a cohort of patients with schizophrenic psychoses. A seven-year follow-up study. Schizophrenia Research 3, 139–146.Google Scholar
Flannigan, C.B., Glover, G.R., Wing, J.K., Lewis, S.W., Bebbington, P.E. & Feeney, S.T. (1994). Inner London collaborative audit of admission in two health districts. III: reasons for acute admission to psychiatric wards. British Journal of Psychiatry 165, 750–759.Google Scholar
Gater, R. & Goldberg, D. (1991). Pathways to psychiatric care in South Manchester. British Journal of Psychiatric 159, 90–96.Google Scholar
Gater, R., Amaddeo, F., Tansella, M., Jackson, G. & Goldberg, D. (1995). A comparison of community based care for schizophrenia in South-Verona and South Manchester. British Journal of Psychiatry 166, 344–352.Google Scholar
Gater, R., de Almeida e Sousa, R., Barrientos, G., Chandrashekar, C., Dhadphale, M., Golgberg, D., al Kathiri, A.H., Mubbashar, M., Silhan, K., Thong, D., Torres-Gonzales, F. & Sartorius, N. (1991). The pathway to psychiatric care: a cross-cultural study. Psychological Medicine 21, 761–774.Google Scholar
Giel, R. & Sytema, S. (1993). Patterns of care in psychiatric case-register areas. Epidemiologia e Psichiatria Sociale 2, 79–82.Google Scholar
Goldberg, D. & Huxley, P. (1980). Mental Illness in the Community: the Pathway to Psychiatric Care. Tavistock: London.Google Scholar
Häfner, H. & an der Heiden, W. (1983). The impact of a changing system of care on patterns of utilization by schizophrenics. Social Psychiatry 18, 153–160.Google Scholar
Hansson, L. & Sandlund, M. (1992). Utilization and patterns of care in comprehensive psychiatric care organizations. A review of studies and some methodological considerations. Acta Psychiatrica Scandinavica 86, 255–261.Google Scholar
Hoffmann, H. (1994). Age and other factors relevant to the rehospitalization of schizophrenic outpatients. Acta Psychiatrica Scandinavica 89, 205–210.CrossRefGoogle Scholar
Jarman, B. (1996). Psychiatric admission rates: the relationship with health and social factors and the effects of confounding variables. In Mental Health Service Evaluation (ed. Knudsen, H.C. and Thornicroft, G.), pp. 245–258. Cambridge University Press: Cambridge.Google Scholar
Kent, S. & Yellowlees, P. (1994). Psychiatric and social reasons for frequent rehospitalization. Hospital and Community Psychiatry 45, 4, 347–350Google Scholar
Knudsen, H.C. & Thornicroft, G. (ed.) (1996). Mental Health Service Evaluation. Cambridge University Press: Cambridge.Google Scholar
Lavik, N.J. (1983). Utilization of mental health services over a given period. Acta Psychiatrica Scandinavica 67, 404–413.Google Scholar
Lethinen, V. (1996). Population needs for mental health services. Introduction to the theme. In Making Rational Mental Health Services (ed. Tansella, M.), pp. 3–12. Il Pensiero Scientifico Editore: Roma.Google Scholar
Lewis, G., David, A., Andreasson, S. & Allebeck, P. (1992). Schizophrenia and city life. Lancet 340, 137–140.Google Scholar
Marks, I.M., Connolly, J., Muijen, M., Audini, B., McNamee, G. & Lawrence, R.E.: (1994). Home-based versus hospital-based care for people with serious mental illness. British Journal of Psychiatry 165, 179–194.Google Scholar
Marriott, S., Malone, S., Onyett, S. & Tyrer, P. (1993). The consequences of an open referral system to a community mental health service. Acta Psychiatrica Scandinavica 88, 93–97.Google Scholar
Mignolli, G., Faccincani, C. & Platt, S. (1991). Psychopathology and social performance in a cohort of patients with schizophrenic psychoses. A seven-year follow-up study. In Community-based Psychiatry: Long-term Patterns of Care in South-Verona (ed. Tansella, M.), Psychological Medicine Monograph Supplement 19, pp. 27–33. Cambridge University Press: Cambridge.Google Scholar
Mortensen, P.B. & Eaton, W.W. (1994). Predictors for readmission risk in schizophrenia. Psychological Medicine 24, 223–232.CrossRefGoogle ScholarPubMed
Rabinowitz, J., Modai, I. & Inbar-Saban, N. (1994). Understanding who improves after psychiatric hospitalization. Acta Psychiatrica Scandinavica 89, 152–158.Google Scholar
Rogler, L.H. & Cortes, D.E. (1993). Help-seeking pathways: a unifying concept in mental health care. American Journal of Psychiatry 150, 554–561.Google Scholar
Simon, G.E., Von Korff, M. & Durham, M.L. (1994). Predictors of outpatient mental health utilization by primary care patients in a health maintenance organization. American Journal of Psychiatry 151, 908–913.Google Scholar
Sytema, S. (1996). Service utilization research: goals and prospects. In Making Rational Mental Health Services (ed. Tansella, M.), pp. 127–136. Il Pensiero Scientifico Editore: Roma.Google Scholar
Sytema, S. & Oldehinkel, T. (1996). Dynamic analysis of patterns of care. In Mental Health Service Evaluation (ed. Knudsen, H.C. and Thornicroft, G.), pp.213–227. Cambridge University Press: London.Google Scholar
Sytema, S., Giel, R. & ten Horn, G.H.M.M. (1989). Patterns of care in the field of mental health. Conceptual definition and research methods. Acta Psychiatrica Scandinavica 79, 1–10.Google Scholar
Tansella, M. (ed.) (1991). Community-based Psychiatry. Long-term Patterns of Care in South-Verona. Psychological Medicine Monograph Supplement 19, pp. 1–54. Cambridge University Press: Cambridge.Google Scholar
Tansella, M. & Ruggeri, M. (1996). Monitoring and evaluating a community-based mental health service: the epidemiological approach. In The Scientific Basis of Health Services (ed. Smith, R. and Peckham, M..). British Medical Journal Publishing Group: London.Google Scholar
Tansella, M., Micciolo, R., Balestrieri, M. & Gavioli, I. (1986). High and long-term users of the mental health services. A case-register study in Italy. Social Psychiatry 21, 96–103.Google Scholar
Tansella, M., Micciolo, R. & Ch., Zimmermann-Tansella (1989). The demand for extramural psychiatric intervention in a community-based service. European Archives of Psychiatry and Neurological Sciences 238, 220–224.Google Scholar
Tansella, M., Bisoffi, G. & Thornicroft, G. (1993). Are social deprivation and psychiatric service utilization associated in neurotic disorders? A case-register study in South-Verona. Social Psychiatry and Psychiatric Epidemiology 28, 225–230.Google Scholar
Tansella, M., Micciolo, R., Biggeri, A., Bisoffi, G. & Balestrieri, M. (1995). Episodes of care in first-ever psychiatric patients. A long-term case-register evaluation in a mainly urban area. British Journal of Psychiatry 167, 220–227.Google Scholar
Thornicroft, G. (1991). Social deprivation and rates of treated mental disorder. Developing statistical models to predict psychiatric service utilisation. British Journal of Psychiatry 158, 475–484.Google Scholar
Thornicroft, G., Bisoffi, G., De Salvia, D. & Tansella, M. (1993). Urban-rural differences in the associations between social deprivation and psychiatric service utilization in schizophrenia all diagnoses: a case-register study in Northern Italy. Psychological Medicine 23, 487–496.Google Scholar
Tricot, L. (1986). An example of the standardization of terminology: defining episodes of care. In Psychiatric Case Registers in Public Health: a Worldwide Inventory 1960–1985 (ed. Horn, G.H.M.M. ten, Giel, R., Gulbinat, W.H. and Henderson, J.H.). Elsevier: Amsterdam/New York.Google Scholar