The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project
Abstract Background The assessment of the quality of care pathways delivered to people with severe mental disorders in a community-based system remains uncommon, especially using healthcare utilization databases. The aim of the study was to evaluate the quality of care provided to people with bipola...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | BMC Psychiatry |
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| Online Access: | https://doi.org/10.1186/s12888-023-04921-7 |
| _version_ | 1797557390446428160 |
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| author | Barbara D’Avanzo Angelo Barbato Matteo Monzio Compagnoni Giulia Caggiu Liliana Allevi Flavia Carle Teresa Di Fiandra Lucia Ferrara Andrea Gaddini Michele Sanza Alessio Saponaro Salvatore Scondotto Valeria D Tozzi Cristina Giordani Giovanni Corrao Antonio Lora |
| author_facet | Barbara D’Avanzo Angelo Barbato Matteo Monzio Compagnoni Giulia Caggiu Liliana Allevi Flavia Carle Teresa Di Fiandra Lucia Ferrara Andrea Gaddini Michele Sanza Alessio Saponaro Salvatore Scondotto Valeria D Tozzi Cristina Giordani Giovanni Corrao Antonio Lora |
| author_sort | Barbara D’Avanzo |
| collection | DOAJ |
| description | Abstract Background The assessment of the quality of care pathways delivered to people with severe mental disorders in a community-based system remains uncommon, especially using healthcare utilization databases. The aim of the study was to evaluate the quality of care provided to people with bipolar disorders taken-in-care by mental health services of four Italian areas (Lombardy, Emilia-Romagna, Lazio, province of Palermo). Methods Thirty-six quality indicators were implemented to assess quality of mental health care for patients with bipolar disorders, according to three dimensions (accessibility and appropriateness, continuity, and safety). Data were retrieved from healthcare utilization (HCU) databases, which contain data on mental health treatments, hospital admissions, outpatient interventions, laboratory tests and drug prescriptions. Results 29,242 prevalent and 752 incident cases taken-in-care by regional mental health services with a diagnosis of bipolar disorder in 2015 were identified. Age-standardized treated prevalence rate was 16.2 (per 10,000 adult residents) and treated incidence rate 1.3. In the year of evaluation, 97% of prevalent cases had ≥ 1 outpatient/day-care contacts and 88% had ≥ 1 psychiatric visits. The median of outpatient/day-care contacts was 9.3 interventions per-year. Psychoeducation was provided to 3.5% of patients and psychotherapy to 11.5%, with low intensity. 63% prevalent cases were treated with antipsychotics, 71.5% with mood stabilizers, 46.6% with antidepressants. Appropriate laboratory tests were conducted in less than one-third of prevalent patients with a prescription of antipsychotics; three quarters of those with a prescription of lithium. Lower proportions were observed for incident patients. In prevalent patients, the Standardized Mortality Ratio was 1.35 (95% CI: 1.26–1.44): 1.18 (1.07–1.29) in females, 1.60 (1.45–1.77) in males. Heterogeneity across areas was considerable in both cohorts. Conclusions We found a meaningful treatment gap in bipolar disorders in Italian mental health services, suggesting that the fact they are entirely community-based does not assure sufficient coverage by itself. Continuity of contacts was sufficient, but intensity of care was low, suggesting the risk of suboptimal treatment and low effectiveness. Care pathways were monitored and evaluated using administrative healthcare databases, adding evidence that such data may contribute to assess the quality of clinical pathways in mental health. |
| first_indexed | 2024-03-10T17:16:24Z |
| format | Article |
| id | doaj.art-9335672e43bb412f87ec5ef26ef29f62 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-03-10T17:16:24Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-9335672e43bb412f87ec5ef26ef29f622023-11-20T10:29:54ZengBMCBMC Psychiatry1471-244X2023-06-0123111310.1186/s12888-023-04921-7The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM projectBarbara D’Avanzo0Angelo Barbato1Matteo Monzio Compagnoni2Giulia Caggiu3Liliana Allevi4Flavia Carle5Teresa Di Fiandra6Lucia Ferrara7Andrea Gaddini8Michele Sanza9Alessio Saponaro10Salvatore Scondotto11Valeria D Tozzi12Cristina Giordani13Giovanni Corrao14Antonio Lora15Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCSDepartment of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCSNational Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-BicoccaNational Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-BicoccaDepartment of Mental Health and Addiction Services, ASST LeccoNational Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-BicoccaNational Institute of HealthCentre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi UniversityAgency for Public Health, Lazio RegionDepartment of Mental Health and Substance Abuse, Local Health Trust of RomagnaGeneral Directorate of Health and Social Policies, Emilia-Romagna RegionNational Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-BicoccaCentre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi UniversityDepartment of Health Planning, Italian Health MinistryNational Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-BicoccaNational Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-BicoccaAbstract Background The assessment of the quality of care pathways delivered to people with severe mental disorders in a community-based system remains uncommon, especially using healthcare utilization databases. The aim of the study was to evaluate the quality of care provided to people with bipolar disorders taken-in-care by mental health services of four Italian areas (Lombardy, Emilia-Romagna, Lazio, province of Palermo). Methods Thirty-six quality indicators were implemented to assess quality of mental health care for patients with bipolar disorders, according to three dimensions (accessibility and appropriateness, continuity, and safety). Data were retrieved from healthcare utilization (HCU) databases, which contain data on mental health treatments, hospital admissions, outpatient interventions, laboratory tests and drug prescriptions. Results 29,242 prevalent and 752 incident cases taken-in-care by regional mental health services with a diagnosis of bipolar disorder in 2015 were identified. Age-standardized treated prevalence rate was 16.2 (per 10,000 adult residents) and treated incidence rate 1.3. In the year of evaluation, 97% of prevalent cases had ≥ 1 outpatient/day-care contacts and 88% had ≥ 1 psychiatric visits. The median of outpatient/day-care contacts was 9.3 interventions per-year. Psychoeducation was provided to 3.5% of patients and psychotherapy to 11.5%, with low intensity. 63% prevalent cases were treated with antipsychotics, 71.5% with mood stabilizers, 46.6% with antidepressants. Appropriate laboratory tests were conducted in less than one-third of prevalent patients with a prescription of antipsychotics; three quarters of those with a prescription of lithium. Lower proportions were observed for incident patients. In prevalent patients, the Standardized Mortality Ratio was 1.35 (95% CI: 1.26–1.44): 1.18 (1.07–1.29) in females, 1.60 (1.45–1.77) in males. Heterogeneity across areas was considerable in both cohorts. Conclusions We found a meaningful treatment gap in bipolar disorders in Italian mental health services, suggesting that the fact they are entirely community-based does not assure sufficient coverage by itself. Continuity of contacts was sufficient, but intensity of care was low, suggesting the risk of suboptimal treatment and low effectiveness. Care pathways were monitored and evaluated using administrative healthcare databases, adding evidence that such data may contribute to assess the quality of clinical pathways in mental health.https://doi.org/10.1186/s12888-023-04921-7Healthcare utilization databasesBipolar disordersQuality of mental health careTreatment gapClinical pathwaysMental health care |
| spellingShingle | Barbara D’Avanzo Angelo Barbato Matteo Monzio Compagnoni Giulia Caggiu Liliana Allevi Flavia Carle Teresa Di Fiandra Lucia Ferrara Andrea Gaddini Michele Sanza Alessio Saponaro Salvatore Scondotto Valeria D Tozzi Cristina Giordani Giovanni Corrao Antonio Lora The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project BMC Psychiatry Healthcare utilization databases Bipolar disorders Quality of mental health care Treatment gap Clinical pathways Mental health care |
| title | The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project |
| title_full | The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project |
| title_fullStr | The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project |
| title_full_unstemmed | The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project |
| title_short | The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project |
| title_sort | quality of mental health care for people with bipolar disorders in the italian mental health system the quadim project |
| topic | Healthcare utilization databases Bipolar disorders Quality of mental health care Treatment gap Clinical pathways Mental health care |
| url | https://doi.org/10.1186/s12888-023-04921-7 |
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