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Verso un nuovo sistema di finanziamento dei servizi psichiatrici. [Towards a new funding system for psychiatric services]
No full text[no abstract available
Monitoraggio delle attività dei servizi psichiatrici, valutazioni di efficacia, valutazioni dei costi. Fogli di Informazione, 25-35.
No full textLa valutazione economica in psichiatria
No full textLA valutazione economica nei servizi di salute mental
L’esito clinico e sociale dell’assistenza psichiatrica territoriale: Valutazione multidimensionale e di routine dei pazienti in carico al Servizio Psichiatrico di Verona-Sud
No full textMortality among patients with psychiatric illness. A ten-year case register study in an area with a community-based system of care
No full textBackground. Most studies which showed an excess mortality in psychiatric patients have been conducted on hospitalised samples. Method. This was a case register study. All South Verona patients with an ICD diagnosis who had psychiatric contacts with specialist services in 1982-1991 were included. Mortality was studied in relation to sex, age, diagnosis, pattern of care and interval from registration. Standardised Mortality Rates (SMRs) and Poisson regression analysis were calculated. Results. The overall SMR was 1.63 (95% Cl = 1.5-1.8), which is the lowest value reported so far. Mortality was higher among men (SMR = 2.24; 95% Cl = 1.9-2.6), among patients who were admitted to hospital (SMR = 2.23; 95% Cl = 1.9-2.6), among younger age groups (SMR = 8.82; 95% Cl = 4.9-14.6) and in the first year after registration (SMR = 2.32; 95% Cl = 1.3-2.9). Higher mortality was found in patients with a diagnosis of alcohol and drug dependence (SMR = 3.87; 95% Cl = 3.0-4.9). The SMR for suicide was 17.41. Using a Poisson regression model, diagnosis, pattern of care and interval from registration were all found to be significantly associated with mortality. When all these variables were entered together in the model, each maintained its predictive role. Conclusions. The overall mortality of psychiatric patients treated in a community-based system of care was higher than expected, but lower than the mortality reported in other psychiatric settings. The highest mortality risk was found in the first year after registration
Collecting psychiatric resources utilisation data to calculate costs of care: a comparison between a service receipt interview and a case register
No full textBackground: Economic assessment of inter-ventions and policies is becoming increasingly common,in large measure because of the growing emphasis oncost containment within health care. Comprehensiveand reliable outcome and cost data are required to ad-vise policy makers and clinicians as to the best use oftheir limited resources. The process of costing can bebroken down into three connected tasks: the collectionof service receipt or utilisation data relative to individualclients or patients over a de®ned period; the costing ofeach of the services used; and the combination of thesetwo sets of information in order to calculate individualcosts. The aim of this study was to compare two meth-odologies of collecting data on individual service use ± acustomised interview schedule, ICAP, and the psychi-atric case register (PCR) ± and to calculate costs, testingthe extent of agreement between them. Method: Theagreement between the ICAP and the PCR costs mea-surement was evaluated using the concordance correla-tion coe cient qc. From all patients (n = 543) who hadatleast one contact with a psychiatrist or a psychologistduring the period October±December 1996, 339 patientswere interviewed using the ICAP. The overall number ofpatients in contact with the South-Verona CPS in thesame period was 630. Results: The agreement betweenthe two sources was very di€erent for each diagnosticgroup and each professional category. However, theoverall agreement on total costs was satisfactory(qc < 0.95). This result is probably due to the e€ect ofthe good agreement observed on more costly services:inpatient care and sheltered accommodation. Conclu-sion: The results suggested practical implications for theuse of the service receipt interview: interviewers shouldbe trained in order to avoid misinterpretation of thede®nitions given in the form; the sources of informationshould be clearly de®ned to tease out all the items ofservices provided for the users; the professionals (i.e.psychiatrists) could in ̄uence the reliability of data col-lection by underestimating services provided by di€erentprofessionals (nurses, social workers, etc.). The ®ndingscon®rm that it is possible to use this approach when theaim is to estimate the whole cost of the services; how-ever, the importance of adopting adequate proceduresfor analysing the complexity of cost components shouldbe pointed out. Only a trained interviewer whothoroughly knows each component of the health andsocial services provided could guarantee an accuratedata collection
Exploring the relationships between patients' characteristics and costs of community-based mental health care
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