Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-23T05:32:55.863Z Has data issue: false hasContentIssue false
  • English
  • Français

Which community care for patients with schizophrenic disorders? Packages of Care provided by Departments of Mental Health in Lombardy (Italy)

Published online by Cambridge University Press:  18 May 2011

Antonio Lora ,
Ugo Cosentino ,
Anna Gandini  and
Carlo Zocchetti
Antonio Lora*
Affiliation:
Health Care Directorate, Lombardy Region, Milano
Ugo Cosentino
Affiliation:
Environmental Science Department, University of Milano-Bicocca, Milano
Anna Gandini
Affiliation:
Health Care Directorate, Lombardy Region, Milano
Carlo Zocchetti
Affiliation:
Health Care Directorate, Lombardy Region, Milano
*
Address for correspondence: Dr. A. Lora, Unità Organizzativa: Servizi Sanitari Territoriali, Struttura: Psichiatria e Neuropsichiatria Infantile, Direzione Generale Sanità, Regione Lombardia, Via Pola 9/11, 20124 Milano (Italy). E-mail: antoniolora@virgilio.it
Get access Rights & Permissions [Opens in a new window]

Summary

Aims – The treatment of schizophrenic disorders is the most important challenge for community care. The analysis focuses on packages of care provided to 23.602 patients with a ICD-10 diagnosis of schizophrenic disorder and treated in 2001 by the Departments of Mental Health in Lombardy, Italy. Methods – Packages of care refer to a mix of treatments provided to each patient during the year by different settings. Direct costs of the packages were calculated. Linear Discriminant Analysis has been used to link socio-demographic and diagnostic sub-groups of the patients to packages of care. Results – People with schizophrenic disorders received relatively few care packages: only four packages involved more than 5%. Two thirds of the patients received only care provided by Community Mental Health Centres. In the other two packages with a percentage over 5%, the activity was provided by CMHCs, jointly with General Hospitals or Day Care Facilities. Complex care packages were rare (only 6%). As well as the intensity, also the variety of care provided by CMHCs increased with the complexity of care packages. In Lombardy more than half of the resources were spent for schizophrenia. The range of the costs per package was very wide. LDA failed to link characteristics of the patients to packages of care. Conclusions – Care packages are useful tools to understand better how mental health system works, how resources have been spent and to point out problems in the quality of care.

Declaration of Interest: None.

Keywords

schizophrenic disorderspattern of carecommunity caredirect costs
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 16 , Issue 4 , December 2007 , pp. 330 - 338
Copyright
Copyright © Cambridge University Press 2007

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

REFERENCES

Erlicher, A., Arrighi, E., Baj, G., Bezzi, R., Cavazza, M., Civenti, G., Di Maio, A., Farinazzo, C., Lora, A., Mapelli, V., Miragoli, P., Monzani, E., Panetta, B., Ravasio, R., Rossi, F., Von Morghen, D. & Torri, V. (2003). Pattern di Trattamento e Costi nei Dipartimenti di Salute Mentale delta Regione Lombardia. it Progetto di Ricerca HoNOS 2. Epidemiologia e Psichiatria Sociale, Monograph Supplement No. 5. II Pensiero Scientifico Editore: Roma.Google Scholar
Gaddini, A., Franco, E., Di Lallo, D. & Biscaglia, L. (2005). Hospitalisation for schizophrenia in acute psychiatric wards of the Lazio region: a 4-year follow-up study. Epidemiologia e Psichiatria Sociale 14, 227–234.CrossRefGoogle ScholarPubMed
Grigoletti, L., Amaddeo, F., Grassi, A., Boldrini, M., Chiappelli, M., Percudani, M., Catapano, F., Fiorillo, A., Bartoli, L., Bacigalupi, M., Albanese, P., Simonetti, S., Perali, F., De Agostini, P., Tansella, M. & Gruppo I-Psycost. (2006). Proposal for a new funding system for mental health departments. Results from an evaluative multicentre Italian study (I-psycost). Epidemiologia e Psichiatria Sociale 15, 295–306.CrossRefGoogle ScholarPubMed
James, A., Worral, A. & Kendall, T. (2005). Clinical Governance in Mental Health and Learning Disability Services. A Practical Guide. Gaskell: London.Google Scholar
Leff, J. (1997). Care in the Community: Illusion or Reality? Wiley:London.Google Scholar
Lora, A. (2006). Sistema Informativo e Governo Clinico. Psichiatria di Comunità 5(4), 217–221.Google Scholar
Lora, A., Bezzi, R., Di Vietri, R., Gandini, A., Spinogatti, F. & Zocchetti, C. (2002). I pacchetti di cura nei Dipartimenti di Salute Mentale della Regione Lombardia. Epidemiologia e Psichiatria Sociale 2, 100–115.CrossRefGoogle Scholar
Leginski, W.A., Croze, C., Driggers, J., Dumpman, S., Geertsen, D., Kamis-Gould, E., Namerow, M.J.Patton, R., Wilson, N.Z. & Wurster, C.R. (1989). Data Standards for Mental Health Decision Support Systems. A Report of the Task Force to Revise the Data Content and System Guidelines of the Mental Health Statistics Improvement Program. U.S. Department of Health and Human Services: Washington DC.Google Scholar
Magliano, L., Fiorillo, A., Marangone, C., De Rosa, C., Favata, G., Sasso, A., Prezioso, M., Pezzenti, L., Gentile, E., Casale, L., Bondi, E., Robustelli, G., Di Leila, M., Discussi, E., Degl'innocenti, F., Bellini, R., Di Nunzio, R., Martella, L., Salmeri, R., Cantone, R., Gargiulo, L., Esposito, A., Delcuratolo, V., Giannini, M., Maresca, L., Cavaliere, G., Scandone, B., Folia, M., Raffaeli, M., Innocente, P., Dagianti, F., Lucania, S., Scorsino, A., Bardicchia, F., Cerullo, G., Correli, R., Miscali, S., Scordato, M., Campo, G. &Maj, M. (2006). Family psychoeducational interventions for schizophrenia in routine settings: impact on patients' clinical status and social functioning and on relatives' burden and resources. Epidemiologia e Psichiatria Sociale 15, 219–227.CrossRefGoogle ScholarPubMed
NHS Executive (1997). Enabling Information Management and Technology Support for Community Focused Care Project. National Health Service: London.Google Scholar
Piccinelli, M., Politi, P. & Barale, F (2002). Focus on psychiatry in Italy. British Journal of Psychiatry 181, 538–544.CrossRefGoogle ScholarPubMed
Priebe, S., Badesconyi, A., Fioritti, A., Hansson, L., Kilian, R., Torres-Gonzales, F., Turner, T. & Wiersma, D. (2005). Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries. British Medical Journal 330, 123–126.CrossRefGoogle ScholarPubMed
Regione Lombardia (1996). Glossario delle Attività Territoriali delle Unità Operative di Psichiatria. Assessorato alia Sanità: Milano.Google Scholar
Regione Lombardia (2002). Progetto RESPIL. Studio sui costi delle strutture psichiatriche residenziali della Regione Lombardia. Assessorato alia Sanità: Milano.Google Scholar
Thornicroft, G. & Tansella, M. (1999). The Mental Health Matrix: A Manual to Improve Services. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
Wing, J.K., Beevor, A.S., Curtis, R.H., Park, S.B.G., Hadden, S. & Burns, A. (1998). Health of the Nation Outcome Scales (HoNOS): Research and development. British Journal of Psychiatry 172, 11–18.CrossRefGoogle ScholarPubMed
World Health Organization (1992). The ICQ 10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for the Research. WHO: Geneva.Google Scholar