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Psychiatric bed usage under different systems of care. A comparison of South Verona (Italy) and Canberra (Australia)

Published online by Cambridge University Press:  11 October 2011

Stephen Rosenman
Stephen Rosenman*
Affiliation:
NH & MRC Social Psychiatry Research Unit, Australian National University, Canberra, Australia
*
Indirizzo per la corrispondenza: Dr. S. Rosenman, ACT Health, P.O. Box 825, Canberra ACT 2601 (Australia). Fax: (+61) 6-205.1042
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Summary

Objective - To compare psychiatric bed usage for major psychiatric illness in a fully community-centred psychiatric service (South Verona, Italy) with usage in a more conventional hospital-centred service (Canberra, Australia). Design - Registers of hospital admissions for schizophrenia and major affective illness in the three years 1986, 1987, 1988 were examined at each site. The characteristics, socio-demography and rates of admission, the duration of index admission and the rate of readmission in the subsequent twelve months were compared. Results - The community-centred service (South Verona) admitted fewer patients with schizophrenic and major affective illness but they appeared more severely ill, stayed longer and were more likely to be readmitted. The hospital-centred system (Canberra) used hospitals for a wider range of severity of major illness including good prognosis illness. Hospitalisation in Canberra was briefer and readmission less frequent. It appears that the hospital centred service was more willing to use beds for the initiation or stabilisation of treatment. The community based service did not lead to shorter hospital stay or less frequent readmission. Differences in the treated psychiatric morbidity in the populations overshadowed the effect of design of the service on usage. This difference in morbidity, concentrated in the younger age group, remains unexplained.

Riassunto

Scopo - Confrontare l'uso dei servizi ospedalieri per le principali malattie psichiatriche in una struttura che offre un «servizio psichiatrico territoriale» (Verona-Sud, Italia) con l'uso di questi servizi in una struttura più «tradizionale», dove l'ospedale è il centro dell'attività (Canberra, Australia). Disegno - Sono stati esaminati i registri dei ricoveri per i malati da psicosi schizofreniche e distimiche negli anni 1986, 1987 e 1988. Sono state comparate le seguenti caratteristiche: la mappa socio-demografica ed i tassi dei ricoveri per i pazienti, la durata del ricovero iniziale ed i tassi di ri-ricovero per questi pazienti nei dodici mesi seguenti. Risultati - Il servizio psichiatrico territoriale (Verona-Sud) ha ricoverato meno pazienti con psicosi schizofreniche e distimiche ma questi risultavano più gravi, restavano degenti più a lungo ed avevano una probabilità maggiore di essere ricoverati nuovamente. Il servizio psichiatrico «tradizionale» (Canberra) ha usato l'ospedale per una gamma più ampia di malattie, incluse le malattie con buona prognosi. La degenza in Canberra è stata più breve ed il ri-ricovero meno frequente. Sembra che il servizio «tradizionale» sia più orientato ad usare l'ospedale per l'inizio o per la stabilizzazione della terapia. Il servizio psichiatrico territoriale non portava ad una degenza più breve o ad un numero minore di ricoveri successivi al primo. Le differenze nella morbilità psichiatrica incontrata nelle popolazioni ha nascosto l'effetto della struttura del servizio sull'uso. Questa differenza nella distribuzione della morbilitù psichiatrica concentrata nel gruppo di più giovane età, rimane senza spiegazione.

Keywords

valutazione dei serviziospedalizzazionepsichiatrica territorialeservice evaluationbed usagecommunity psychiatry
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 3 , Issue 3 , December 1994 , pp. 163 - 170
Copyright
Copyright © Cambridge University Press 1994

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References

Balestrieri, M. (1990). Il Registro dei Casi per il Monitoraggio e la Valutazione dei Servizi Psichiatrki. Died Anni (1979-1988) di Psichiatria Territoriale a Verona-Sud. Rivista Sperimentale di Freniatria 114, Supplemento al n. 1, pp. 201–350.Google Scholar
Balestrieri, M., Sytema, S., Oavioli, I. & Micciolo, R. (1989) Patterns of psychiatric care in South Verona and Groningen. Ada Psychiatrica Scandinavica 80, 437–444.CrossRefGoogle ScholarPubMed
British Medical Journal (1985). Editorial: Community care. British Medical Journal 17, 283–289.Google Scholar
Crepet, P. (1988). The Italian mental health reform nine years on. Ada Psychiatrica Scandinavica 11, 515–523.CrossRefGoogle Scholar
Der, G., Gupta, S. & Murray, R. (1990). Is schizophrenia disappearing? Lancet 335, 513–516.CrossRefGoogle Scholar
Faccincani, C., Mignolli, G. & Platt, S. (1990). Service utilisation, social support and psychiatric status in a cohort of patients with schizophrenic psychoses. A 7 year follow-up study. Schizophrenia Research 3, 139–146.CrossRefGoogle Scholar
Häfner, H. (1987). Do we still need beds for psychiatric patients? Ada Psychiatrica Scandinavica 75, 113–126.CrossRefGoogle ScholarPubMed
Häfner, H. & an der Heiden, W. (1985). Registri dei casi e schizofrenia. In L'Approccio Epidemiologico in Psichiatria (ed. Tansella, M.), pp.260–299. Boringhieri: Torino.Google Scholar
Hansson, L. (1989). Utilization of psychiatric hospital care: a study of changes related to the introduction of sectorized care organisation. Ada Psychiatrica Scandinavica 79, 571–578.CrossRefGoogle Scholar
Hoult, J., Rosen, A. & Reynolds, I. (1984). Community oriented treatment compared to psychiatric hospital oriented treatment. Social Science and Medicine 11, 1005–1010.CrossRefGoogle Scholar
Jablensky, A., Sartorius, N., Ernberg, G., Anker, M., Korten, A., Cooper, J.E., Day, R. & Bertelsen, A. (1992). Schizophrenia: Manifestations, Incidence and Course in Different Cultures. A World Health Organisation Ten-country Study. Psychological Medicine Monograph Supplement No.20.CrossRefGoogle Scholar
Jones, K., Wilkinson, G. & Craig, T.K.J. (1991). The 1978 Italian Mental Health Law. A personal evaluation. British Journal of Psychiatry 159,556–561.CrossRefGoogle Scholar
Kessel, N.. (1965). Are international comparisons timely? The Milbank Memorial Fund Quarterly 43, 199–204.CrossRefGoogle ScholarPubMed
Krupinski, J. (1984). Changing patterns of migration to Australia and their influence on the health of migrants. Social Science and Medicine 18, 927–937.CrossRefGoogle ScholarPubMed
Lesage, A.D. & Tansella, M. (1989). Mobility of schizophrenic patients, non-psychotic patients and the general population in a case register area. Social Psychiatry and Psychiatric Epidemiology 24, 271–274.CrossRefGoogle Scholar
Munk-Jørgensen, P. (1987). Why has the incidence of schizophrenia in Danish psychiatric institutions decreased since 1970? Ada Psychiatrica Scandinavica 75, 62–68.CrossRefGoogle ScholarPubMed
Munk-Jørgensen, P. & Tansella, M. (1986). Hospital and community based psychiatry: a comparative study between a Danish and an Italian psychiatric service. International Journal of Social Psychiatry 32, 6–15.CrossRefGoogle Scholar
Palermo, G.B. (1991). The 1978 Italian Mental Health Law. A personal evaluation. Journal of the Royal Society of Medicine 84, 99–102.CrossRefGoogle Scholar
Sanua, V.D. (1970). Immigration, migration and mental health: a review of the literature with special emphasis on schizophrenia. In Behaviour in New Environments (ed. Brody, E.B.). Sage Publications: New York.Google Scholar
Sartorius, N., Jablensky, A., Korten, A., Ernberg, G., Anker, M., Cooper, J.E. & Day, R. (1986). Early manifestations and firstcontact incidence of schizophrenia in different cultures. Psychological Medicine 16, 909–928.CrossRefGoogle ScholarPubMed
Stein, L.I. & Test, M.A. (1980). Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry 37, 392–397.CrossRefGoogle ScholarPubMed
Sytema, S., Giel, R., ten Horn, G.H.M.M., Balestrieri, M. & Davies, N. (1989). The reliability of diagnostic coding in psychiatric case registers. Psychological Medicine 19, 999–1006.CrossRefGoogle ScholarPubMed
Tansella, M. (1990). Psychiatric reform in Italy: implications for the treatment of long-term schizophrenic patients. In Recent Advances in Schizophrenia (ed. Kales, A., Stefanis, C.N. and J, J. Talbott). Springer Verlag: New York.Google Scholar
Tansella, M., Balestrieri, M., Meneghelli, G. & Micciolo, R. (1991). Trends in provision of psychiatric care 1979-1988. In Community Based Psychiatry: Long-term Patterns of Care in South Verona (ed. Tansella, M.), pp. 5–16. Psychological Medicine Monograph Supplement No. 19.Google Scholar
Torrey, E.F. (1987). Prevalence studies in schizophrenia. British Journal of Psychiatry 150, 598–608.CrossRefGoogle ScholarPubMed
Wijesinghe, C.P. & Clancy, D.J. (1991). Schizophrenia in migrants living in the western region of Melbourne. Australian and New Zealand Journal of Psychiatry 25, 350–357.CrossRefGoogle ScholarPubMed