Mental Health Centers. Preliminary evaluation of the pilot program implementation process. / Centra Zdrowia Psychicznego. Wstepna ocena procesu wdrazania modelu pilotazowego.

OBJECTIVES: The aim of the presented research is to characterize the operating Mental Health Centers (MHCs) and to provide a preliminary assessment of the implementation process of the pilot program model in the area of psychiatric care in Poland. METHODS: The study uses the Polish version of the German questionnaire, which covers four areas: (1) basic conditionsof the model project/pilot program; (2) characteristicsof the organizational structure of the treatment entity; (3) statistical characteristics of the services provided;(4) specific features of the psychiatric care system in model regions/pilot program Mental Health Centers. RESULTS: Nineteen of the 27 Mental Health Centers completed the survey. The centers have 428 beds in day units and 1,971 beds in inpatient units. Most of the centers (15 of 19) work with subcontractors and all are publicly funded. Eight centers were established by psychiatric hospitals and 11 centers were constituted at psychiatric wards within multi-specialist hospitals. The medical services provided by the centers mainly include psychiatry and psychotherapy. In 2019, the centers provided medical services to a total of 65,614 patients; 8,432 patients received at least three forms of treatment. CONCLUSIONS: The first full year of MHC operation in the pilot program indicates the expected direction of change in psychiatric care - achieving a significant level of implementation of community care standards. The survey needs to be repeated to verify this direction. A limitation of the study was the lack of survey responses from 30% of MHCs. In the future, we should aim for at least 90% of completed surveys.

Practice of prescribing antipsychotics in schizophrenia during 2013-2018 based on data from the National Health Fund. / Praktyka preskrypcyjna w zakresie leków przeciwpsychotycznych w schizofrenii w latach 2013­2018 na podstawie danych Narodowego Funduszu Zdrowia.

AIM: The aim of the study was to analyse the prescribing pattern of antipsychotic drugs in patients with schizophrenia during the years 2013-2018. METHOD: Schizophrenia is analysed as one of the diseases with the highest rate of Disability-Adjusted Life Years - DALY. In this study, the unitary data of the National Health Fund (NFZ) reported in the years 2013-2018 were used. Adult patients were identified by their Personal Identification Number (PESEL), and the antipsychotics were identified by the European Article Number (EAN). The study included 209,334 adults who were diagnosed with F20 to F20.9 (according to ICD-10) and were prescribed at least one antipsychotic within a year. The active substances of prescribed antipsychotic medication have been divided into typical (first generation), atypical (second generation) and long-acting injectable antipsychotics (both first and second generation). The statistical analysis contains descriptive statistics for selected sections. A linear regression, one-way analysis of variance and t-test were used in the study. All statistical analyses were performed using R, version 3.6.1 and Microsoft Excel. RESULTS: In the years 2013-2018, the number of patients in the public sector diagnosed with schizophrenia increased by 4%. The largest increase was recorded among persons diagnosed with other schizophrenia (F20.8). In the analysed years, the number of patients who were prescribed second-generation oral antipsychotics increased significantly as well as the number of patients who were prescribed long-acting antipsychotics, especially the secondgeneration agents (risperidone LAI, olanzapine LAI). The most prescribed first-generation antipsychotics included: perazine, levomepromazine and haloperidol with a downward trend for each; and the most common second-generation drugs included: olanzapine, aripiprazole and quetiapine. A noteworthy finding was an extremely high increase in the frequency of prescribing haloperidol in the form of depot. CONCLUSIONS: Extending the study to include information on applied prescriptive practice in the private sector would provide a fuller picture of the studied phenomenon.

Analysis of psychiatric services for patients diagnosed with schizophrenia, reported to the National Health Fund in the years 2009-2018. / Analiza swiadczen psychiatrycznych dla pacjentów z rozpoznaniem schizofrenii sprawozdanych do Narodowego Funduszu Zdrowia w latach 2009­2018.

AIM.: Analysis of psychiatric services for patients diagnosed with schizophrenia, reported to the National Health Fund in the years 2009-2018. MATERIAL AND METHODS: Schizophrenia is analyzed as one of the diseases with the highest rate of Disability-Adjusted Life Years - DALY. In the study, the unitary data of the National Health Fund (NFZ) was used, reported in the years 2009-2018. Patients were identified by the Personal Identity Number (PESEL). The services for adults were analyzed, i.e., people who were at least 18 years old in the year when the services were discontinued, for whom the main disease was schizophrenia classified by ICD-10 codes: F20 to F20.9. Provided services were analyzed according to those specified in the ordinance of the President of the National Health Fund of June 28, 2019 - organizational units and billing product codes. RESULTS: Between 2009 and 2018, the number of patients diagnosed with schizophrenia treated in the public sector increased by 5%. In the analyzed years, the number of in-patients decreased by 9%, while the number of people using out-patient services and community treatment increased by 6%. In forensic psychiatry departments, a very high increase (by 212%) in the number of hospitalized patients was observed. In 2018, the average number of hospitalization days in a general psychiatric ward was 43, in the forensic ward 279. A very low percentage of patients (less than 3%) used day therapy. In out-patient treatment, the mainstay of therapy was a medical consultation; less than 10% of patients used other types of services. In 2018, an average of four visits/consultations per patient was reported. There has been a very high decrease in the number of patients (by 77%) using group therapy, family therapy and support. CONCLUSIONS: In 2009-2018, most patients diagnosed with schizophrenia in the public sector were treated using the traditional model of care: medical consultation and psychiatric hospitalization. It is advisable to reorganize the system - implementation and development of comprehensive care coordinated within the community care model. Extending the study with information from the non-public sector would give a full picture of system functioning and facilitate service needs estimation for this group of patients.

Flexible and Integrative Psychiatric Care Based on a Global Treatment Budget: Comparing the Implementation in Germany and Poland.

Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany. Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models (n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural and statistical parameters of service delivery were collected and compared. Results: The qualitative results showed that the German FIT-specific components are in principle applicable to the polish context. This allowed the comparative assessment of components grading and degree of implementation, which showed only subtle discrepancies between German and Polish FIT models. The little discrepancies point to specific aspects of care such as home treatment, peer support, and cooperation with non-clinical and social welfare institutions that should be further integrated in the components' definition. Conclusions: The specific program components of FIT as first defined from the German experience, serves as a powerful tool to measure, and evaluate implementation of integrated psychiatric care both within and between health systems.