Patterns of care in patients discharged from acute psychiatric inpatient facilities: A national survey in Italy

• Published in: Social Psychiatry and Psychiatric Epidemiology 2009-09, Vol.44 (9), p.767-776
• Main Authors: Preti, Antonio, Rucci, Paola, Gigantesco, Antonella, Santone, Giovanni, Picardi, Angelo, Miglio, Rossella, de Girolamo, Giovanni
• Format: Article
• Language: English
• Subjects: Adult; Antipsychotic Agents - therapeutic use; Anxiety Disorders - drug therapy; Anxiety Disorders - epidemiology; Anxiety Disorders - therapy; Benzodiazepines - therapeutic use; Biological and medical sciences; Community Mental Health Services - utilization; Community treatment. Ambulatory treatment. Home care; Diagnosis-Related Groups; Epidemiology; Female; Health Care Surveys - statistics & numerical data; Health Services Research - statistics & numerical data; Hospitalization - statistics & numerical data; Hospitals, Private - statistics & numerical data; Hospitals, Public - statistics & numerical data; Humans; Italy - epidemiology; Length of Stay; Male; Medical sciences; Medicine; Medicine & Public Health; Mental Disorders - drug therapy; Mental Disorders - epidemiology; Mental Disorders - therapy; Mental health; Mood Disorders - drug therapy; Mood Disorders - epidemiology; Mood Disorders - therapy; Organization of mental health. Health systems; Original Paper; Patient Discharge - statistics & numerical data; Psychiatric Department, Hospital - statistics & numerical data; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy; Referral and Consultation; Schizophrenia - drug therapy; Schizophrenia - epidemiology; Schizophrenia - therapy; Social psychiatry. Ethnopsychiatry; Treatments
• ISSN: 0933-7954; 1433-9285
• DOI: 10.1007/s00127-009-0498-2

Objective To analyze the characteristics of patients scheduled for discharge from acute psychiatric inpatient facilities in Italy, and their pattern of care. Methods Socio-demographic and clinical characteristics, and patterns of care of 1,330 patients discharged from public and private inpatient facilities in Italy were assessed with a standardized methodology during an index period in the year 2004. Results About one half of the sample had schizophrenia or bipolar disorder. However, the case-mix differed between public and private facilities, where in-patients had more frequently mood and anxiety disorders. The use of two or more drugs was very common, involving more than 90% of patients and including typically benzodiazepines and antipsychotics. Structured psychosocial treatments were rarely initiated during the hospital stay. Increasing age, male gender, long stay in the facility (>60 days), personality disorder and type of facility were associated with a higher likelihood of being discharged to a community residential facility. Predictors of discharge to another psychiatric facility were increasing age, being single, schizophrenia, personality disorder and organic mental disorder. Families were not involved in decisions about patients’ discharge in a significant proportion of cases. University psychiatric clinics and private facilities were less coordinated with the community system of care than General Hospital Psychiatric Units. Referral of patients with substance use disorder to drug addiction services occurred in just 30% of subjects. Conclusions This study provides information on the characteristics and the pattern of care of patients discharged from inpatient facilities in a country that has closed down all its mental hospitals. This information may be relevant for those countries that are affording now the downsizing of MHs, and the expansion of community-based models of care.