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The quality of mental health care delivered to patients with schizophrenia and related disorders in the Italian mental health system. The QUADIM project: a multi-regional Italian investigation based on healthcare utilisation databases. Epidemiol Psychiatr Sci 2022; 31:e15. [PMID: 35156603 PMCID: PMC8851066 DOI: 10.1017/s2045796022000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS To evaluate the quality of mental health care delivered to patients with schizophrenia and related disorders taken-in-care by mental health services in four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily). METHODS Thirty-one clinical indicators concerning accessibility, appropriateness, continuity and safety were defined and estimated using healthcare utilisation (HCU) databases, containing data on mental health treatments, hospital admissions, outpatient interventions, lab tests and drug prescriptions. RESULTS A total of 70 586 prevalent patients with schizophrenia and related disorders treated in 2015 were identified, of whom 1752 were newly taken-in-care by the facilities of regional mental health services. For most patients community care was accessible and moderately intensive. However, care pathways were not implemented based on a structured assessment and only half of the patients received psychosocial treatments. One patient out of ten had access to psychological interventions and psychoeducation. Activities specifically addressed to families involved a third of prevalent patients and less than half of new patients. One patient out of six was admitted to a community residential facility, and one out of ten to a General Hospital Psychiatric Ward (GHPW); higher values were identified in new cases. In general hospitals, few patients had a length of stay (LoS) of more than 30 days, while one-fifth of the admissions were followed by readmission within 30 days of discharge. For two-thirds of patients, continuity of community care was met, and six times out of ten a discharge from a GHPW was followed by an outpatient contact within 2 weeks. For cases newly taken-in-care, the continuity of community care was uncommon, while the readiness of outpatient contacts after discharge was slightly more frequent. Most of the patients received antipsychotic medication, but their adherence to long-term treatment was low. Antipsychotic polytherapy was frequent and the control of metabolic side effects was poor. The variability between regions was high and consistent in all the quality domains. CONCLUSIONS The Italian mental health system could be improved by increasing the accessibility to psychosocial interventions, improving the quality of care for newly taken-in-care patients, focusing on somatic health and mortality, and reducing regional variability. Clinical indicators demonstrate the strengths and weaknesses of the mental health system in these regions, and, as HCU databases, they could be useful tools in the routine assessment of mental healthcare quality at regional and national levels.
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Svendsen ML, Ellegaard T, Jeppesen KA, Riiskjær E, Nielsen BK. Family involvement and patient-experienced improvement and satisfaction with care: a nationwide cross-sectional study in Danish psychiatric hospitals. BMC Psychiatry 2021; 21:190. [PMID: 33849472 PMCID: PMC8042926 DOI: 10.1186/s12888-021-03179-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Randomised controlled trials suggest that family therapy has a positive effect on the course of depression, schizophrenia and anorexia nervosa. However, it is largely unknown whether a positive link also exists between caregiver involvement and patient outcome in everyday psychiatric hospital care, using information reported directly from patients, i.e. patient-reported experience measures (PREM), and their caregivers. The objective of this study is to examine whether caregiver-reported involvement is associated with PREM regarding patient improvement and overall satisfaction with care. METHODS Using data from the National Survey of Psychiatric Patient Experiences 2018, we conducted a nationwide cross-sectional study in Danish psychiatric hospitals including patients and their caregivers who had been in contact with the hospital (n = 940 patients, n = 1008 caregivers). A unique patient identifier on the two distinct questionnaires for the patient and their caregiver enabled unambiguous linkage of data. In relation to PREM, five aspects of caregiver involvement were analysed using logistic regression with adjustment for patient age, sex and diagnosis. RESULTS We consistently find that high caregiver-reported involvement is statistically significantly associated with high patient-reported improvement and overall satisfaction with care with odds ratios (OR) ranging from 1.69 (95% confidence interval (CI) 0.95-2.99) to 4.09 (95% CI 2.48-6.76). This applies to the following aspects of caregiver-reported involvement: support for the patient-caregiver relationship, caregiver information, consideration for caregiver experiences and the involvement of caregivers in decision making. No statistically significant association is observed regarding whether caregivers talk to the staff about their expectations for the hospital contact. CONCLUSION This nationwide study implies that caregiver involvement focusing on the patient-caregiver relationship is positively associated with patient improvement and overall satisfaction with care in everyday psychiatric hospital care.
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Affiliation(s)
| | - Trine Ellegaard
- Aarhus University Hospital, Psychiatry, Psychosis Research Unit, Palle Juul-Jensens Boulevard 175, 8200, Aarhus, Denmark
- The Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Bartholins Allé 2, 8000, Aarhus, Denmark
| | | | - Erik Riiskjær
- DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus, Denmark
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Baandrup L, Rasmussen JØ, Mainz J, Videbech P, Kristensen S. Patient-Reported Outcome Measures in Mental Health Clinical Research: A Descriptive Review in Comparison with Clinician-Rated Outcome Measures. Int J Qual Health Care 2021; 34:ii70-ii97. [PMID: 33404610 DOI: 10.1093/intqhc/mzab001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 11/11/2020] [Accepted: 01/06/2021] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To review how patient-reported outcomes measures in mental health clinical research complement traditional clinician-rated outcomes measures. DATA SOURCES Medline, Embase, PsycInfo and Scopus. STUDY SELECTION Latest update of the literature search was conducted in August 2019, using a specified set of search terms to identify controlled and uncontrolled studies (published since 1996) of pharmacological or non-pharmacological interventions in adults (≥18 years) in hospital-based mental health care. DATA EXTRACTION Two authors extracted data independently using a pre-designed extraction form. RESULTS OF DATA SYNTHESIS Among the 2962 publications identified, 257 were assessed by full text reading. A total of 24 studies reported in 26 publications were included in this descriptive review. We identified subjective and objective outcome measures, classified these according to the pharmacopsychometric triangle and compared them qualitatively in terms of incremental information added to the clinical study question. The data reviewed here from primarily depression and schizophrenia intervention studies show that results from patient-reported outcome measures and clinician-rated outcome measures generally point in the same direction. There was a relative lack of patient-reported outcome measures on functioning and medication side effects compared with patient-reported outcome measures on symptom burden and health-related quality of life. CONCLUSION Patient-reported outcomes and clinician-rate outcomes supplement each other and at most times support identical study conclusions. Future studies would benefit from a more systematic approach towards use of patient-reported outcomes and a clearer rationale of how to weigh and report the results in comparison with clinician-rated outcomes.
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Affiliation(s)
- Lone Baandrup
- Mental Health Center Copenhagen, Gentofte Hospitalsvej 15, 4., 2900 Hellerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | | | - Jan Mainz
- Aalborg University Hospital, Psychiatry Aalborg, Denmark, DACS, Danish Center for Health Services Research, Aalborg University.,Clinical Institute, Aalborg University, Aalborg, Denmark.,Department for Community Mental Health, University of Haifa, Haifa, Israel
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research, Mental Health Centre Glostrup, Copenhagen, Denmark
| | - Solvejg Kristensen
- Aalborg University Hospital, Psychiatry Aalborg, Denmark, DACS, Danish Center for Health Services Research, Aalborg University
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Mainz J, Hess MH, Johnsen SP. The Danish unique personal identifier and the Danish Civil Registration System as a tool for research and quality improvement. Int J Qual Health Care 2020; 31:717-720. [PMID: 31220255 DOI: 10.1093/intqhc/mzz008] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/13/2018] [Accepted: 01/25/2019] [Indexed: 11/12/2022] Open
Abstract
All countries want to improve the health of their populations and to improve the quality of care and patient safety. Consequently, there is an ongoing need to assess and document population health, the quality of care and patient safety using valid and reliable data. This requires the ability to monitor the same individuals over time as they receive prevention, diagnostics, treatments, care and rehabilitation and experience improvements or deteriorations in their health or healthcare. This is, however, a challenge for most healthcare systems. A prerequisite to such data is the unique personal identifier. This perspective on quality paper describes the experience with the unique personal identifier in Denmark, based on the Danish Civil Registration System (DCRS) as a tool for research in epidemiology, health services research, quality improvement and patient safety. DCRS has been celebrating its 50 years anniversary.
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Affiliation(s)
- Jan Mainz
- Psychiatry Management, Region North Denmark, Aalborg, Denmark.,Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Community Mental Health, Haifa University, Israel.,Department of Health Economics, University of Southern Denmark
| | - Mikkel Hagen Hess
- Invest in Denmark, Consulate General of Denmark, Ministry of Foreign Affairs of Denmark, New York, USA
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Ratner Y, Zendjidjian XY, Mendyk N, Timinsky I, Ritsner MS. Patients' satisfaction with hospital health care: Identifying indicators for people with severe mental disorder. Psychiatry Res 2018; 270:503-509. [PMID: 30347377 DOI: 10.1016/j.psychres.2018.10.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/14/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patients' perception of psychiatric healthcare is a critical indicator in measuring service quality. The aim of the study was to determine patient's level of satisfaction with the quality of health care delivered at the inpatient departments, and to identify the service quality factors that were important to patients. METHOD The Satisfaction with Psychiatry Care Questionnaire-22 was administered to 125 consecutive inpatients with schizophrenia or schizoaffective disorder in a stable condition. Sociodemographic and background variables, illness and symptom severity, insight, social anhedonia, self-esteem, perceived social support, and satisfaction with quality of life were collected. RESULTS Although the participants generally expressed satisfaction with the inpatient services, they indicated that the weakest aspects of the service were in the domains of 'personal experience', 'information' and 'activity'. Women were significantly more dissatisfied than men with 'staff', 'care', and by general satisfaction. Multiple regression analysis revealed that satisfaction with hospital health care was associated with five indicators: insight, satisfaction with physical health, self-efficacy, family support, and social anhedonia. CONCLUSION Personality related factors rather than psychopathological symptoms were associated with a satisfaction with care of admitted patients with severe mental illness. These factors could be targets for interventions aimed to improve treatment and hospital services.
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Affiliation(s)
- Yael Ratner
- Shaar Menashe Mental Health Center, Hadera, Israel
| | - Xavier Y Zendjidjian
- Aix-Marseille Univ, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Marseille, France.
| | - Nina Mendyk
- Shaar Menashe Mental Health Center, Hadera, Israel.
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Hastrup LH, Haahr UH, Jansen JE, Simonsen E. Determinants of duration of untreated psychosis among first-episode psychosis patients in Denmark: A nationwide register-based study. Schizophr Res 2018; 192:154-158. [PMID: 28578812 DOI: 10.1016/j.schres.2017.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Information on determinants of duration of untreated psychosis (DUP) is still needed to inform campaigns targeting people with first episode psychosis (FEP). This nation-wide study analysed the association between demographic factors (age, sex, ethnicity, marital status, and geographic area), premorbid and illness-related factors (global functional level, substance misuse, and contact to police), healthcare factors (referral source and first FEP contact) and DUP. METHOD The study population of 1266 patients aged 15-25years diagnosed with FEP (ICD10 F20.0-F20.99) was drawn from the Danish National Indicator Project during 2009-2011. The study population was combined with data from national administrative registers. A multinomial regression model was estimated to analyse the impact of demographic, premorbid and illness-related, and healthcare factors on DUP. RESULTS One third of the population had a DUP below 6months. DUP longer than 12months was associated with older age at onset, being female, having cannabis misuse, and living in peripheral municipalities. Being charged by the criminal authorities during one year before FEP was associated with a DUP over 6months. CONCLUSION DUP is related to a number of demographic, premorbid and healthcare factors. These findings suggest that future information campaigns should focus on increasing the awareness of early signs of psychosis not only among mental health professionals but also other professionals in contact with adolescents such as the police. It may also be useful to consider how to target information campaigns towards persons living in peripheral areas.
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Affiliation(s)
| | | | | | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Denmark
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Mitchell AJ, Hardy S, Shiers D. Parity of esteem: Addressing the inequalities between mental and physical healthcare. BJPSYCH ADVANCES 2018. [DOI: 10.1192/apt.bp.114.014266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryParity of esteem means valuing mental health as much as physical health in order to close inequalities in mortality, morbidity or delivery of care. There is clear evidence that patients with mental illness receive inferior medical, surgical and preventive care. This further exacerbated by low help-seeking, high stigma, medication side-effects and relatively low resources in mental healthcare. As a result, patients with severe mental illness die 10–20 years prematurely and have a high rate of cardiometabolic complications and other physical illnesses. Many physical healthcare guidelines and policy recommendations address parity of esteem, but their implementation to date has been poor. All clinicians should be aware that inequalities in care are adversely influencing mental health outcomes, and managers, healthcare organisations and politicians should provide resources and education to address this gap.Learning Objectives• Understand the concept of parity of esteem• Be aware of the current inequalities in mental healthcare• Appreciate how parity of esteem may be improved
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Baandrup L, Cerqueira C, Haller L, Korshøj L, Voldsgaard I, Nordentoft M. The Danish Schizophrenia Registry. Clin Epidemiol 2016; 8:691-695. [PMID: 27843348 PMCID: PMC5098605 DOI: 10.2147/clep.s99488] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim of database To systematically monitor and improve the quality of treatment and care of patients with schizophrenia in Denmark. In addition, the database is accessible as a resource for research. Study population Patients diagnosed with schizophrenia and receiving mental health care in psychiatric hospitals or outpatient clinics. During the first year after the diagnosis, patients are classified as incident patients, and after this period as prevalent patients. Main variables The registry currently contains 21 clinical quality measures in relation to the following domains: diagnostic evaluation, antipsychotic treatment including adverse reactions, cardiovascular risk factors including laboratory values, family intervention, psychoeducation, postdischarge mental health care, assessment of suicide risk in relation to discharge, and assessment of global functioning. Descriptive data The recorded data are available electronically for the reporting clinicians and responsible administrative personnel, and they are updated monthly. The registry publishes the national and regional results of all included quality measures in the annual audit reports. External researchers may obtain access to the data for use in specific research projects by applying to the steering committee. Conclusion The Danish Schizophrenia Registry represents a valuable source of informative data to monitor and improve the quality of care of patients with schizophrenia in Denmark. However, continuous resources and time devoted is necessary to maintain the integrity of the registry and the validity of the data.
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Affiliation(s)
- Lone Baandrup
- Centre for Neuropsychiatric Schizophrenia Research (CNSR) and Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup
| | - Charlotte Cerqueira
- Registry Support Centre (East) - Epidemiology and Biostatistics, Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen
| | - Lea Haller
- The Danish Clinical Registries, Registry Support Centre for Health Quality and Informatics (KCKS-West), Aarhus
| | - Lene Korshøj
- The Danish Clinical Registries, Registry Support Centre for Health Quality and Informatics (KCKS-West), Aarhus
| | - Inge Voldsgaard
- Psychosis Ward, Section P, Aarhus University Hospital, Risskov
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
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Bramesfeld A, Amaddeo F, Caldas-de-Almeida J, Cardoso G, Depaigne-Loth A, Derenne R, Donisi V, Jørgensen M, Lindelius B, Lora A, Mainz J, Mulder CL, Szecsenyi J, Killaspy H. Monitoring mental healthcare on a system level: Country profiles and status from EU countries. Health Policy 2016; 120:706-17. [PMID: 27178799 DOI: 10.1016/j.healthpol.2016.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 04/27/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
Abstract
AIMS Routinely collected data can be used to monitor the performance and improve the quality of mental healthcare systems. Data-based and system-level Quality Monitoring Programmes in Mental Health Care (QMP-MHC) are increasingly being implemented in EU countries. They are believed to be indispensable for the sustainable improvement of the quality of mental healthcare. However, there is a paucity of comparative research on national strategies in quality monitoring. This study explores the status of system-level Quality Monitoring Programmes in Mental Health Care (QMP-MHC) in EU countries. It aims to provide a descriptive overview, which is intended to be the first step for comparative research in this field. METHODS Case studies of system-level QMP-MHCs were gathered from eight EU countries. Experts from each country were asked to describe their approach using a template. These experts were all members of a Europe-wide network of researchers and members of public institutions involved in quality assessment and performance monitoring of mental healthcare. RESULTS Country profiles were gathered from England, Denmark, France, Germany, Italy, the Netherlands, Portugal, and Sweden. All these countries have - or are in the process of implementing - system-level QMP-MHCs. Implementation seems to be facilitated when a national performance monitoring programme for general healthcare is already in place, although in the Netherlands, a QMP-MHC was established without being attached to a general monitoring programme. All the monitoring programmes described use various quality and performance indicators; some systems enhance this methodology with the addition of qualitative assessment methods such as peer reviews linked to accreditation processes. CONCLUSIONS Research is needed to better understand the historical, political and technical backgrounds of the different national cases and to explore the effectiveness of different improvement mechanisms on the actual quality of healthcare. Policy makers and those designing performance measurement programmes are recommended to look across the borders of their own healthcare systems as there are many ways to assess performance and many ways to feedback results to service providers. No evidence is available whether one of these methods is superior to the others in improving the quality of mental healthcare.
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Affiliation(s)
- Anke Bramesfeld
- AQUA Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany; Institute for Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany.
| | - Francesco Amaddeo
- Department of Neurological, Biomedical and Movement Sciences, Section of Psychiatry, Ospedale Policlinico "G.B. Rossi", Verona, Italy
| | - José Caldas-de-Almeida
- CEDOC Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Graça Cardoso
- CEDOC Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Anne Depaigne-Loth
- Direction de l'Amélioration de la Qualité et de la Sécurité des Soins, Haute Autorité de Santé, Saint-Denis La Plaine Cedex, France
| | - Rose Derenne
- Direction de l'Amélioration de la Qualité et de la Sécurité des Soins, Haute Autorité de Santé, Saint-Denis La Plaine Cedex, France
| | - Valeria Donisi
- Department of Neurological, Biomedical and Movement Sciences, Section of Psychiatry, Ospedale Policlinico "G.B. Rossi", Verona, Italy
| | - Mette Jørgensen
- Aalborg University Hospital, Psychiatry Region North Denmark, Aalborg, Denmark
| | | | - Antonio Lora
- Department of Mental Health, Lecco General Hospital, Lecco, Italy
| | - Jan Mainz
- Aalborg University Hospital, Psychiatry Region North Denmark, Aalborg, Denmark
| | - Cornelis Lambert Mulder
- Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Joachim Szecsenyi
- AQUA Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany; Department of General Practice and Health Services Research, Heidelberg University Hospital, Germany
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom
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