[Costs and outcome of care in subjects with severe mental disorders]. / Costi ed esito dell'assistenza nei soggetti con disturbo mentale grave.

OBJECTIVE: The objectives of the paper are the following: i) to describe the activities and the costs of care for patients with severe mental disorders; ii) to evaluate the association between costs, clients' characteristics and outcome measures. METHODS: Patients were administered the following instruments twice a year: BPRS, GAF, HoNOS, DAS II, VSSS-54, QPF. Use of psychiatric services and other resources were collected for each patient over a two-year period. RESULTS: The average yearly cost per patient is Euro 3,300. First-contact patients cost twice as much as patients already in treatment. Service costs are associated to patients' age, marital status and working condition. Annual costs are also associated with the initial score of BPRS, GAF, DAS and HoNOS. In multiple regression analysis age, initial BPRS and DAS scores, as well as being a first-contact patient, are strongly positively associated to annual costs. CONCLUSIONS: These results highlight the importance of monitoring routine activities of psychiatric services and the flow of funds for psychiatric care in the Italian public health system.

Service utilisation and costs of first-contact patients in a community psychiatric service in Italy.

This study describes service utilisation under routine clinical activity and the costs of providing mental health care for 24 months for the whole population of 330 subjects who had first contact with the Magenta Community Mental Health Centre during one year. The mean age of patients was 42.5 years, and 61% were females. According to ICD 10 criteria, 7% were diagnosed as having schizophrenia, 22% mood disorders, 37% neurotic disorders, 15% personality disorders and 19% other diagnoses. The clinical routine activity was monitored for 24 months from the first contact for each patient. The mean cost for a schizophrenic patient is more than double that of other patients. In-patient activity and community services accounted, respectively, for 49.7% and 50.3% of the total costs. Total health care costs per patient differ widely according to whether patients had been hospitalised during the observation period. Patients with a previous psychiatric contact and a longer duration of illness were more costly than the other patients. Multiple regression analysis was used to assess the association between all the individual variables and costs. For the whole population, the model explains 50% of the cost variation. Higher treatment costs were positively associated with the presence of previous psychiatric contacts and referral to the CPS by other sources than a general practitioner, and negatively associated with age.

Monitoring community psychiatric services in Italy: differences between patients who leave care and those who stay in treatment.

BACKGROUND: Continuity of care has been monitored rarely in Italian community mental health centres. AIMS: To estimate the long-term probability of leaving care in first-contact patients attending an out-patient service, and to identify patients most likely to drop out. METHOD: All patients who had a first contact with the community mental health centre of Magenta during a 1-year recruitment period were followed up for 24 months. Patients who failed to return after the last out-patient visit were regarded as 'drop-outs'. RESULTS: During the 1-year recruitment period 330 subjects were at their first contact. The 1-year incidence of first-contact patients was nearly 33 per 10 000 inhabitants. At follow-up, 46% of patients had dropped out. In comparison with patients with psychoses, subjects suffering from neurotic (P =0.004) and personality disorders (P=0.029) were more likely to drop out. CONCLUSIONS: In the Italian system of community psychiatric care nearly half of the patients are no longer in contact after 2 years. Those who stay in treatment are more likely to suffer from psychosis, suggesting a commitment of Italian out-patient facilities to tackling the needs of patients with more severe disorders.