Does the mental health system provide effective coverage to people with schizophrenic disorder? A self-controlled case series study in Italy

Abstract

Purpose To measure indicators of timeliness and continuity of treatments on patients with schizophrenic disorder in ‘real-life’ practice, and to validate them through their relationship with relapse occurrences. Methods The target population was from four Italian regions overall covering 22 million beneficiaries of the NHS (37% of the entire Italian population). The cohort included 12,054 patients newly taken into care for schizophrenic disorder between January 2015 and June 2016. The self-controlled case series (SCCS) design was used to estimate the incidence rate ratio of relapse occurrences according to mental healthcare coverage. Results Poor timeliness (82% and 33% of cohort members had not yet started treatment with psychosocial interventions and antipsychotic drug therapy within the first year after they were taken into care) and continuity (27% and 23% of patients were persistent with psychosocial interventions, and antipsychotic drug therapy within the first 2 years after starting the specific treatment) were observed. According to SCCS design, 4794 relapses occurred during 9430 PY (with incidence rate of 50.8 every 100 PY). Compared with periods not covered by mental healthcare, those covered by psychosocial intervention alone, antipsychotic drugs alone and by psychosocial intervention and antipsychotic drugs together were, respectively, associated with relapse rate reductions of 28% (95% CI 4–46%), 24% (17–30%) and 44% (32–53%). Conclusion Healthcare administrative data may contribute to monitor and to assess the effectiveness of a mental health system. Persistent use of both psychosocial intervention and antipsychotic drugs reduces risk of severe relapse.

Change in healthcare during Covid-19 pandemic was assessed through observational designs

“…For this reason, we only investigated guidelines recommended healthcare. For example, reaching the continuity with territorial interventions of patients with schizophrenic disorders [ 20 , 21 ], performing at least one echocardiographic control every year of patients with heart failure [22] , timely starting therapy with inhaled bronchodilators after discharge for COPD [23] , surgery timeliness after diagnosis of breast cancer [ 24 , 25 ], and pre-partum gynaecologic visit in the same structure where the woman will give birth [ 26 , 27 ], should be considered as "core" interventions of community care, so that failure of adherence with each of them must be regarded with concerns. Second, approaches investigating trends in the aggregated volume of specific types of healthcare must be considered reductive, as it only informs on the entirety of procedures that are delivered, not on individual patients who received them.…”

From contact coverage to effective coverage of community care for patients with severe mental disorders: A real-world investigation from Italy

“…The QUADIM-MAP project is based on computerized Healthcare Utilization (HCU) databases from the Italian regions of Lombardy (northwest), Emilia-Romagna (northeast) and Lazio (central), and the province of Palermo (southern Italy) ( 15 ). Overall, data covered nearly 37% of the entire Italian population.…”

“…Due to privacy issues, each identification code is automatically anonymized and the inverse process is only allowed to the Regional Authority upon request of judicial Authorities. Further details on HCU database in the field of MHC have been reported elsewhere ( 15 , 17 – 19 ). Diagnostic and drug therapy codes used for drawing records and fields from the considered databases are reported in the Supplementary Table 1 .…”

Bringing Psychology Students Closer to People with Schizophrenia at Pandemic Time: A Study of a Distance Anti-stigma Intervention With In-presence Opportunistic Control Group

“…Despite the key role of psychologists in the development of evidence-based psychosocial interventions for schizophrenia (McDonagh et al 2022 ; Mc Glanaghy et al 2021 ; Mueser et al 2013 ; Reddy et al 2010 ), the involvement of these professionals in the care of persons with this disorder is still limited (O'Connor and Yanos 2021 ). This is one of the reasons why the availability of non-pharmacological interventions for people with schizophrenia (PWS) remains insufficient in routine clinical settings (Corrao et al 2022 ; Ince et al 2016 ). Poor involvement of psychologists in schizophrenia can be partially explained by limited training in psychosocial approaches to this disorder in the psychology studies (Buck et al 2014 ; Ince et al 2016 ; Mojtabai et al 2011 ; Roe et al 2006 ) and negative attitudes towards PWS among psychologists (Servais & Saunders 2007 ; Valery & Prouteau 2020 ).…”

“…Poor involvement of psychologists in schizophrenia can be partially explained by limited training in psychosocial approaches to this disorder in the psychology studies (Buck et al 2014 ; Ince et al 2016 ; Mojtabai et al 2011 ; Roe et al 2006 ) and negative attitudes towards PWS among psychologists (Servais & Saunders 2007 ; Valery & Prouteau 2020 ). The prevalence of biogenetic causal models of schizophrenia in the psychological field (Deacon 2013 ) further directs treatment toward an almost exclusively medical-pharmacological pathway (Corrao et al 2022 ; Magliano et al 2017a ; Read et al 2013 ). Biogenetic models also feed into the view of schizophrenia as an incurable disorder whose symptoms are poorly controllable by the will of the affected person, reinforcing professionals' perception of PWS as dangerous, unpredictable and to be kept at a distance (Harangozo et al 2014 ; Read et al 2013 ).…”