Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Legnano 1987-1990

1992 ◽  
Vol 1 (2) ◽  
pp. 85-99 ◽  
Author(s):  
Antonino Mastroeni ◽  
Maria Grazia Colombo
Keyword(s):  
Catchment Area ◽  
Psychiatric Service ◽  
Similar Rate ◽  
Case Register ◽  
Community Agencies ◽  
Community Psychiatric ◽  
The Mean ◽  
Community Psychiatric Service ◽  
The Cost

RiassuntoSono descritte, con la stessa metodologia impiegata in altre aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-area, del RPC, della struttura e dei principi dell'Unità Operativa di Psichiatria di Legnano. II monitoraggio della domanda su 4 anni evidenzia che i tassi di prevalenza annua (530/100000 residenti adulti) e un giorno (226/100000 residenti adulti) hanno valori inferiori ai RCP europei. I tassi di incidenza (152/100000 residenti adulti) sono diminuiti nel corso dei 4 anni considerati, mostrando la difficoltà dei servizi ad accogliere nuovi utenti. II rapporto tra prevalenza annua non ospedaliera ed ospedaliera è, mediamente, di 3,8 a 1. II tasso dei lungoassistiti è di 195/100000 residenti adulti, con un accumulo di quelli che vivono nel territorio, ma non di quelli che sono in Comunita. II costo dei servizi psichiatrici di Legnano è diminuito nella componente ospedaliera e semiresidenziale, mentre è aumentato in quella territoriale.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure. Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Legnano are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows that the mean year prevalence (530/100000 adult inhabitants) rates are lower than those of other European PCRs. Incidence rate (152/100000 adult inhabitants) have diminished, showing a difficulty of the psychiatric services in accepting new patients. The ratio between non-hospidalized and hospidalized users is 3.8 to 1. The rate of long-term patients is 195/100000 adult inhabitants; the rate of long-term patients living in the community is increasing over the years, whereas the similar rate of patients living in the community is increasing over the years, whereas the similar rate of patients living in the scheltered apartments is stable. The costs of the hospital-based and the semiresidential agencies decreased, while the cost of the community agencies increased.

Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Caltagirone 1987–1990

1992 ◽  
Vol 1 (1) ◽  
pp. 45-60 ◽  
Author(s):  
Gaetano Interlandi ◽  
Maria Grazia Sotera
Keyword(s):  
Psychiatric Service ◽  
Similar Rate ◽  
Outpatient Clinics ◽  
Case Register ◽  
Diagnostic Categories ◽  
Community Psychiatric ◽  
Multiple Structures ◽  
Community Psychiatric Service ◽  
Made In

RiassuntoSono descritte, con la stessa metodologia impiegata in altre 4 aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-aerea, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Caltagirone. II monitoraggio della domanda su 4 anni evidenzia che i tassi di prevalenza annua (763/100000 residenti adulti) e un giorno (223/100000 residenti adulti) hanno valori inferiori ai RPC europei. I tassi di incidenza (281/100000 residenti adulti) indicano un afflusso di nuovi casi appartenenti a tutte le categorie diagnostiche. II RPC di Caltagirone monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale: residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, domiciliare, ecc. II rapporto tra prevalenza annua non ospedaliera e ospedaliera è nel 1990 di 4,4 a 1. II tasso di lungoassistiti è di 122/100000 residenti adulti, con una tendenza ad un accumulo per quelli che vivono nel territorio, mentre vi è un calo di quelli che sono in Comunità. II costo del Dipartimento, che è andato riducendosi dal 1987 al 1990, è in buona parte da addebitare alle giornate di assistenza in Comunità.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure, Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Caltagirone are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows that the year prevalence (763'100000 adult inhabitants) and day prevalence (248'100000 adult inhabitants) rates are lower than those of other European PCRs. Incidence rate (248'100000 adult inhabitants) shows that new patients belong to all diagnostic categories. The PCR records data of the activities made in multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, care in outpatient clinics, domiciliary care, etc. The ratio between non-hospitalized and hospitalized users is 4.3 to 1. The rate of long-term patients is 122'100000 adult inhabitants; the rate of long-term patients living in the community is increasing over the years, whereas the similar rate of patients living in the sheltered apartments is decreasing. The costs of the Service (which have decrease from 1987 to 1990) have to be attributed mainly to the costs of the treatment in sheltered apartments.

Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Portogruaro 1987-1990

1992 ◽  
Vol 1 (2) ◽  
pp. 101-116 ◽  
Author(s):  
Domenico De Salvia ◽  
Diego Rocco
Keyword(s):  
Catchment Area ◽  
Psychiatric Service ◽  
Incidence Rates ◽  
Prevalence Rates ◽  
Case Register ◽  
Community Psychiatric ◽  
Multiple Structures ◽  
One Year ◽  
Community Psychiatric Service

RiassuntoSono descritte, con la stessa metodologia impiegata in quattro altre aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-area, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Portogruaro. II monitoraggio della domanda su 4 anni evidenzia tassi di prevalenza un anno (1045/100000 residenti adulti), di prevalenza un giorno (332/100000 residenti adulti) e di incidenza (250/100000 residenti adulti) inferiori a quelli dei RPC europei. II RPC di Portogruaro monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale (residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, socioambientale, domiciliare, ecc), secondo il principio della continuità dell'assistenza fornita ai pazienti. II rapporto tra prevalenza annua non ospedaliera ed ospedaliera è nel 1990 di 5,5 a 1. II tasso di lungoassistiti è di 161/100000 adulti. La spesa globale del Dipartimento è lievemente diminuita dal 1987 al 1990.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure, Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Portogruaro are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows one-year prevalence rates (1045/100000 adult inhabitants), one-day prevalence rates (332/100000 adult inhabitants) and incidence rates (250/100000 adult inhabitants) lower than those of other european PCRs. Portogruaro PCR records data of the activities made in a comprehensive psychiatric service, which has multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, in outpatient clinics, domiciliary, etc. The 1990 ratio between non-hospitalized and hospitalized users is 5.5 to 1. The rate of long-term patients is 161/100000 adult inhabitants. The costs of the Community Psychiatric Service slightly decreased during 1987-90 period.

Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Verona-Sud 1987-1990

1992 ◽  
Vol 1 (2) ◽  
pp. 117-132 ◽  
Author(s):  
Matteo Balestrieri ◽  
Giuliano Meneghelli ◽  
Michele Tansella
Keyword(s):  
Catchment Area ◽  
Psychiatric Service ◽  
Incidence Rates ◽  
Prevalence Rates ◽  
Case Register ◽  
Multiple Structures ◽  
One Year ◽  
Community Psychiatric Service ◽  
Made In

RiassuntoSono descritte con la stessa metodologia impiegata in quattro altre aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-area, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Verona-Sud. II monitoraggio della domanda su 4 anni evidenzia tassi di prevalenza un anno (1010/100000 residenti adulti), prevalenza un giorno (306/100000 residenti adulti) e di incidenza (219/100000 residenti adulti) inferiori a quelli dei RPC europei. II RPC di Verona-Sud monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale (residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, domiciliare, ecc), secondo il principio della continuità dell'assistenza fornita ai pazienti. II rapporto tra prevalenza annua non ospedaliera e ospedaliera è nel 1990 di 2,5 a 1. II tasso di lungoassistiti e di 130/100000 adulti. La spesa globale del Dipartimento è aumentata di circa il 25%, con un incremento da parte di tutte le componenti dell'assistenza.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure, Psychiatric Case Register (PcR) and catchment-area of the Community Psychiatric service of South-Verona are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows one-year prevalence rates (1010/100000 adult inhabitants), one-day prevalence rates (306/100000 adult inhabitants) and incidence rates (219/100000 adult inhabitants) lower than those of other European PCRs. South-Verona PCR records data of the activities made in a comprehensive psychiatric service, which has multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, in outpatient clinics, domiciliary, etc. The 1990 ratio between non-hospitalized and hospitalized users is 2.5 to 1. The rate of long-term patients is 130/100000 adult inhabitants. All the components of the treatment contributed to the 25% increment of the costs of the South-Verona Psychiatric Service.

Eighteen Years of Community Psychiatric Service in the Island of Samsø

1977 ◽  
Vol 131 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Johannes Nielsen ◽  
Jørgen Achton Nielsen
Keyword(s):  
Psychiatric Hospital ◽  
General Practitioners ◽  
Rural Population ◽  
Psychiatric Service ◽  
Home Visits ◽  
Referral Rate ◽  
Community Psychiatric ◽  
The Mean ◽  
Community Psychiatric Service

SummaryAn analysis has been made of patients aged 15 + referred to the community psychiatric service in a Danish rural population during 18 years. The mean referral rate per year was 17·9 per 1,000.The majority of the patients (79 per cent) were referred to the clinic by the general practitioners, and it is stressed that a close and good co-operation between the psychiatrists and the local physicians is one of the most important factors in establishing a good community psychiatric service.Only 11 per cent of all referrals were admitted to a psychiatric hospital. The admission frequency for psychoses was only 19 per cent, and it was estimated that it would have been approximately 44 per cent higher, if the service had been of the usual hospital-oriented type. Forty-three per cent of the patients were visited by the psychiatrist in their home at least once and 42 per cent of all 6,000 consultations were home visits.When evaluating the treatment possibilities it was considered that approximately 50 per cent of all patients referred could be treated by the local physicians after examination by psychiatrists and discussion of the cases with them.

Confronti e prospettive nella utilizzazione dei Registri Psichiatrici dei Casi

1992 ◽  
Vol 1 (2) ◽  
pp. 133-148 ◽  
Author(s):  
Matteo Balestrieri ◽  
Rocco Micciolo ◽  
Domenico De Salvia ◽  
Michele Tansella
Keyword(s):  
Psychiatric Treatment ◽  
Psychiatric Service ◽  
Community Services ◽  
Incidence Rates ◽  
Psychiatric Admissions ◽  
Community Psychiatric ◽  
Urban Rural ◽  
One Year ◽  
Community Psychiatric Service

RiassuntoDopo una breve rassegna sui dati di confronto tra Registri Psichiatrici dei Casi (RPC) disponibili nella letteratura internazionale, vengono analizzati gli indici sociodemografici e i tassi standardizzati (per età e sesso) relativi alle attività assistenziali (anni 1987–90) svolte in cinque aree italiane di RPC. Gli indici socio-anagrafici sono risultati correlati con le caratteristiche urbano-rurali del territorio. In ognuna delle cinque aree di registro esisteva, alia fine del 1990, una rete di servizi considerata adeguata rispetto alle esigenze della popolazione. I tassi totali di prevalenza un giorno sono in lieve aumento in tutte le aree di RPC, mentre quelli di prevalenza un anno e incidenza hanno avuto un andamento piuttosto differenziato nelle varie aree. II ricorso al day-hospital è diventato mediamente piu frequente e l'attività territoriale è aumentata dappertutto. Sono diminuiti parallelamente i ricoveri. II fenomeno della lungodegenza è tuttora presente, anche se in forma ridotta, in alcune aree di RPC. I soggetti lungoospitati in comunità sono aumentati in un'area (Arezzo), diminuiti in un'altra (Caltagirone), mentre sono stabili nelle altre aree. I lungoassistiti sono aumentati in quattro aree e in lieve flessione nella quinta (Arezzo). Non e emersa una relazione tra livelli di assistenza psichiatrica erogata e caratteristiche della popolazione di riferimento. Secondo un punteggio assistenziale ponderato di costo lo sviluppo dell'attività assistenziale ha determinato un aumento dei costi a Verona-Sud e ad Arezzo, una diminuzione a Caltagirone e a Legnano e nessuna variazione a Portogruaro.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryAfter a brief review of the literatur on comparison between Psychiatric Case Registers (PCR), this paper analyzes sociodemografic data and 1987-1990 age/sex standardised rates of psychiatric treatment in five Italian areas with a PCR. There was a correlation between sociodemografic indices and urban-rural characteristics of the areas. At the end of 1990 the comprehensive community psychiatric service of each area was considered able to meet the needs of the population. During the four years of our survey, one-day prevalence rates were consistently slighty increasing, while one-year prevalence and incidence rates showed different trend in the five areas. Overall, there was a development of the community services and a decrease of psychiatric admissions. There were still few hospital long-stay patients in some areas, but what is more evident was the increase of the number of long-term patients (hostel long-stay patients and communiy long-term patients). No correlations were evident between levels of psychiatric treatment and characteristics of the populations in the five areas. The development of a comprehensive network of community services required an increase of the costs in Verona-Sud and Arezzo, a decrease in Caltagirone and Legnano, while there was no variation of costs in Portogruaro.

Episodes of Care for First-Ever Psychiatric Patients a Long-Term Case-Register Evaluation in a Mainly Urban Area

1995 ◽  
Vol 167 (2) ◽  
pp. 220-227 ◽  
Author(s):  
Michele Tansella ◽  
Rocco Micciolo ◽  
Annibale Biggeri ◽  
Giulia Bisoffi ◽  
Matteo Balestrieri
Keyword(s):  
Cox Regression ◽  
Psychiatric Patients ◽  
Psychiatric Service ◽  
Mental Illnesses ◽  
Rank Test ◽  
First Episode ◽  
Case Register ◽  
Episode Of Care ◽  
Episodes Of Care ◽  
Community Psychiatric Service

BackgroundPsychiatric case registers (PCRs) are particularly useful for studying patterns of care over time. Methods of ‘survival analysis’ have rarely been used for assessing such data.MethodA longitudinal study was conducted over 10 years (1 January 1982 to 31 December 1991) on 1423 first-ever psychiatric patients, using the PCR of South Verona, Italy. The product-limit method, the log-rank test, the Cox regression model and the Poisson regression analysis were used to analyse episodes of care and relapses.ResultsThe duration of the episodes of care increased consistently from the first to the fifth episode. The probability of opening a new episode of care after the first one increased consistently from the second to the sixth episode. The only variable significantly associated with the length of the first episode of care was diagnosis (highest probability of having longer episodes for schizophrenic patients), while the length of the breaks following the first episode of care was associated with diagnosis, sex and occupational status (highest probability of opening a second episode of care for schizophrenic subjects and those with alcohol and personality disorders, for males, and for unemployed patients). The probability of opening a new episode of care decreased with time since last contact and increased with number of previous contacts.ConclusionsThe community psychiatric service in South Verona is fulfilling its original aim, that is, to give priority to the continuity of care for patients with chronic and severe mental illnesses. Survival analyses proved to be useful methods for assessing episodes of care.

Deinstitutionalisation for Long-Term Mental Illness: A 2-Year Clinical Evaluation

2000 ◽  
Vol 34 (3) ◽  
pp. 476-483 ◽  
Author(s):  
Coletta Hobbs ◽  
Christopher Tennant ◽  
Alan Rosen ◽  
Lesley Newton ◽  
Helen M. Lapsley ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Social Behaviour ◽  
Rating Scale ◽  
Longitudinal Design ◽  
Psychiatric Service ◽  
Clinical Effectiveness ◽  
Psychotic Symptoms ◽  
Service Support ◽  
Community Psychiatric Service

Objective: The closure of a long-stay psychiatric hospital in Sydney caused the transfer of an initial 40 very long-term patients to four community residences, each with 10 beds, for a continuing process of deinstitutionalisation. Community psychiatric service support and 24-h supervision were provided. This paper describes the residents' clinical progress which was assessed over a 2-year period. Method: This study employed a quasi-experimental longitudinal design. Evaluation commenced prior to discharge and continued for 2 years following community relocation using the Brief Psychiatric Rating Scale, Life Skills Profile, Social Behaviour Scale, Montgomery Asberg Depression Rating Scale and Quality Of Life measures. Readmission, demographic, case history and medication data were also collected. Results: Of the 40 patients initially transferred to the community, seven required long-term readmission to hospital (either prior to or after amalgamation) and one patient died of medical causes. Additional patients transferred from the hospital to the community following the readmissions. Three of these additional patients had achieved a 2-year community tenure during the study period and were included in the clinical evaluation. The 35 residents in total who remained in the community for 2 years, demonstrated a significant improvement in psychotic symptoms, without significant change in the level of neuroleptic medication. Importantly, the 2 years of community living resulted in a significant increase in the residents' life satisfaction. There were no statistically significant changes in residents' living skills, depressive symptoms or social behaviour problems over the 2 years, indicative of the need for supervision and community service support following deinstitutionalisation. Over the 2-year period, some 37% of the residents required temporary readmission. Conclusion: This study demonstrates the clinical effectiveness of deinstitutionalisation, when planned within a mental health system with adequate community resources.

Factors Influencing Referrals to a Community Psychiatric Service

1969 ◽  
Vol 3 (3) ◽  
pp. 170-174
Author(s):  
I. Pilowsky ◽  
W. Childs
Keyword(s):  
Mental Health Problems ◽  
Psychiatric Service ◽  
Demographic Variables ◽  
Demographic Characteristics ◽  
Referral Rate ◽  
Referral Patterns ◽  
Class Composition ◽  
Factors Influencing ◽  
Community Psychiatric ◽  
Community Psychiatric Service

Referral patterns to a community psychiatric service have been correlated with demographic variables relating to the population (120,000) served. The total suburban referral rate correlated significantly with social class composition and general practitioner sensitivity. Diagnosis has been considered in relation to referral rates and the demographic characteristics of individual suburbs. These findings suggest that studies of this sort can play an important part in delineating the mental health problems to which a service is sensitive and in helping to discover areas in the region to which special attention might be paid.

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