1,720,971 research outputs found
Lo screening e il trattamento della depressione. Quali sono le strategie più convenienti?
No full textDisuguaglianze e salute mentale
No full textL’interesse per gli effetti della povertà e delle disuguaglianze sociali sulla salute degli individui sta sempre più diventando di primaria importanza. Chiunque si accosti allo studio di questa relazione deve affrontare il problema di definire il concetto di disuguaglianza e di povertà. Molti economisti e sociologi hanno cercato di dare una definizione precisa, e facilmente trasformabile in una misura, di disuguaglianza sociale e le teorie di riferimento sono diverse
Epidemiologia della Psichiatria Territoriale
No full textQuesto manuale nasce nel territorio ed è pensato per il territorio. La necessità di garantire agli utenti dei Servizi di Salute Mentale i migliori trattamenti possibili in termini di appropriatezza e di rigore metodologico è il denominatore comune dell’opera
Mental health care financing in Italy: current situation and perspectives.
No full textThrough a review of the studies conducted on the analysis of the costs of the Italian mental health provision of care, this study aimed at describing the current financing system for mental health care in Italy. From the deinstitutionalization to the present days, Italian mental health care financing has evolved in line with both national plans and the actual European directives. The description of the current situation of mental health care financing in Italy can be useful to inform service planning and resource allocation, and to offer a wider European perspective
Registri psichiatrici e geografia della salute mentale.
No full textI registri psichiatrici dei casi (RPC) sono oggi principalmente utilizzati in tre ambiti della ricerca epidemiologica: a) studi sui pattern di utilizzazione dei servizi per la salute mentale; b) studi sull’effetto che le variabili sociali hanno su utilizzazione e programmazione dei servizi ed, infine, c) studi che integrano le informazioni sulle caratteristiche del territorio ed informazioni di registro secondo l’approccio della geografia sanitaria.
Gli studi sull’utilizzazione suggeriscono di usare come indicatori della qualità delle cure fornite dai servizi territoriali di salute mentale alcune misure come le percentuali di pazienti che interrompono il trattamento o che hanno un solo contatto con il servizio.
La geografia sanitaria (o geografia della salute) è quella branca della geografia umana che si occupa dello studio degli aspetti coinvolti nel determinare la salute delle popolazioni, con attenzione particolare alle dinamiche spaziali e agli ambiti territoriali. Utilizzando i dati del Registro Psichiatrico dei Casi di Verona-Sud e del XIV censimento di popolazione e abitazioni (ISTAT, 2001) è stato realizzato un Atlante, costituito da 85 tavole, delle caratteristiche demografiche, socio-economiche e dell’utilizzazione dei servizi per la salute mentale del territorio di competenza dell’ULSS 20 del Veneto.
Un’altro importante ambito della ricerca condotta con i RPC è quello che si occupa dell’impatto che le disuguaglianze socio-economiche hanno sull’utilizzazione dei servizi di salute mentale. Molti studi hanno confermato che esiste un’associazione forte tra classi sociali svantaggiate e maggiore prevalenza dei disturbi psichiatrici trattati nei servizi specialistici
Confronti specifici con altre esperienze di ricerca
No full textIl capitolo affettua un confronto tra la ricerca riportata nel volume "Il cliente nella sanità" ed altre ricerche simil
DRGs and other patient-, service- and area-level factors influencing length of stay in acute psychiatric wards: the Veneto Region experience
No full textPurpose
This study aimed to identify services-related and area-based measures together with socio-demographic factors that could improve diagnosis-related groups in explaining length of stay variability in general hospital psychiatric units in Veneto Region (North East of Italy).
Methods
Data were collected from the regional hospital discharge records database. A hierarchical multiple regression model with only diagnosis-related groups as predictors of actual and ln-transformed length of stay was compared with a second model in which patient-, service- and area-level variables were included. Local health district was used as group-level in the hierarchical multiple regression analysis.
Results
The only diagnosis explains 6.4% of actual length of stay total variance (14.8% for ln-transformation). In the second model length of stay resulted related also to gender, age, severity of hospitalization, patient’s local health district, number of psychiatrists, psychologists, hospital attendants/nurses, social workers and educators in the general hospital psychiatric units, number of outpatients in each local health district and percentages of divorced and single people, with almost a 2% point increase on actual length of stay in explained variance (5% point increase for ln-transformation).
Conclusions
For the first time the hospital discharge card regional survey of all public acute inpatient psychiatric facilities in Veneto Region were used. The innovative aspect of this study was the attempt to investigate the relationship between length of stay and other indexes, characterizing not only the inpatient facilities, but also the resident population structure in each area. The information about factors that influence length of stay can be useful to inform service planning and resource allocation
Is the implementation of assertive community treatment in a low-income country feasible? The experience of Tbilisi, Georgia
No full textBackground: In Georgia, difficult socioeconomic conditions have resulted in a drastic decrease in government financing for the health sector. State mental hospitals continue to be the main solution for the mentally ill, due to the severe lack of community-based services, and mental health services are inadequate to meet the needs of patients. Methods: An experimental intervention of assertive community care was implemented with the aim to engage socially isolated patients who lacked contact with outpatient services and to answer their different social and psychological needs. The intervention lasted 10 months and consisted of outpatient visits, visits at home, meetings outside and telephone calls to the services' facilities; all services were provided by a multidisciplinary team. The intervention was conducted in a psychiatric dispensary in the district of Tbilisi, Georgia. Results: This pilot study showed the economic sustainability of community care and its effectiveness to facilitate continuity of care and to improve clinical and social outcomes. Conclusions: High-quality community care costs less than usual treatment and inpatient care and seems to be effective to improve clinical and social outcomes; for these reasons, policymakers should consider, in their future mental health reforms, allocating more resources to community-based care
Mortality and cause of death among psychiatric patients: a twenty year case-register study in an area with a community-based system of care
No full textBACKGROUND: Most mortality studies of psychiatric patients published to date have been conducted in hospital-based systems of care. This paper describes a study of the causes of death and associated risk factors among psychiatric patients who were followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services. METHOD: All subjects in contact with the South Verona Community-based Mental Health Service (CMHS) over a 20-year period with an ICD-10 psychiatric diagnosis were included. Of these 6956 patients, 938 died during the study period. Standardized mortality ratios (SMRs) and Poisson multiple regressions were used to assess the excess of mortality in the sample compared with the general population. RESULTS: The overall SMR of the psychiatric patients was 1.88. Mortality was significantly high among out-patients [SMR 1.71, 95% confidence interval (CI) 1.6-1.8], and higher still following the first admission (SMR 2.61, 95% CI 2.4-2.9). The SMR for infectious diseases was higher among younger patients and extremely high in patients with diagnoses of drug addiction (216.40, 95% CI 142.5-328.6) and personality disorders (20.87, 95% CI 5.2-83.4). CONCLUSIONS: This study found that psychiatric patients in contact with a CMHS have an almost twofold higher mortality rate than the general population. These findings demonstrate that, since the closure of long-stay psychiatric hospitals, the physical health care of people with mental health problems is often neglected and clearly requires greater attention by health-care policymakers, services and professionals
I costi delle strutture residenziali psichiatriche italiane
No full textObjective - The aims of this study are: (1) to estimate patients' costs in Italian non hospital Residential Facilities (RF); (2) to analyse the relationship between the costs of care received by residents and patients' or facilities characteristics. Method - The PROGRES study included all Italian private and public RF (1370) with more than 4 beds. Of those, 265 were selected through stratified random sampling to be included in phase 2. Data were obtained through a schedule filled in by the facility manager. Additional information about costs related to the use of Community Psychiatric Service (CPS) by residents has also been collected. The cost components of residential accommodation include the costs of the RF, of the CPS, of general medical care, of the informal assistance provided by family or friends, and other non-medical costs. Results - The mean annual cost of stay in RFs was approximately 34,000 Euro, and it was related to the RF size and to staffing levels. Both RF and CPS are more expensive in the north of Italy, as compared to the center and the south. Costs were lower for older patients. CPS costs are lower when RF staffing levels are higher. Conclusions - In general, patients in RFs cost between 20,000 and 40,000 Euro per year; to this sum, additional 2,000-6,000 Euros per year should be added to include the costs of care provided outside the facility. Both RFs and CPS have different costs depending on the geographical area where the facilities are located, and staffing levels. Changes in CPS costs seem to be related to patients' characteristics
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