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Biomedical subjects

M Tansella

Publications and source records attributed to M Tansella.

At least 19 recordsLinked to original sources
PubMed2006

Evaluating a community-based mental health service focusing on severe mental illness. The Verona experience.

OBJECTIVE: To describe the development of a community-based mental health service, the patterns of care provided by this new service established in 1978 and its costs. METHOD: The South-Verona Psychiatric Case Register, the South-Verona Outcome Project and studies designed to assess costs provided process and outcome data. RESULTS: This paper summarizes descriptive statistics as well as the results of some evaluative studies conducted over the last 25 years in Verona, Italy. It reports patterns of care provided over the years by this new, comprehensive community-based service, targeted to the severely mentally ill but available also to all other residents in the area who need mental health care. CONCLUSION: Developing community-based mental health care requires a series of coordinated actions that need to be pursued over a long period of time. Service evaluation, including costs assessment, is an important part of this exercise.

Bed Occupancy↗
PubMed2005

Does socioeconomic status affect the use of community-based psychiatric services? A South Verona case register study.

OBJECTIVE: To assess the effect of socioeconomic status (SES) on psychiatric service use in an Italian area with a well-developed community-based psychiatric service. METHOD: An index of SES was calculated from nine census variables and grouped into four categories, ranging from SES-I-affluent to SES-IV-deprived, for each of 328 census blocks (CB). Fifteen indicators of psychiatric service use were collected using the psychiatric case register. All patients resident in the catchment area, who had at least one psychiatric contact in 1996 (n=989), were included in the study. RESULTS: Indicators of in-patient, day-patient, out-patient and community service use showed an inverse association with SES. Only first-ever and long-term psychotic patients were equally distributed in the four SES groups. CONCLUSION: The inverse association between SES and most indicators of psychiatric service use suggests that the planning of community-based services and resource allocation should take into account the SES of residents.

Adolescent↗
PubMed2004

The effect of previous psychiatric history on the cost of care: a comparison of various regression models.

OBJECTIVE: Many studies conducted in Europe have reported high variance of costs estimated at the individual level. The objectives of the present study were to estimate costs of patients and to evaluate the performance of various regression models. METHOD: All patients who in the period 1992-1995 had at least one contact with the psychiatric services in South Verona were included in the study and were followed for 1 year after the index contact (n = 1725). Four different groups, classified on the basis of their previous services utilization, were analysed. RESULTS: First-ever patients and patients with a new episode of care after 3 years were less costly than patients with an ongoing episode of care and patients having a new episode, after an interval between 3 months and 3 years. CONCLUSION: The regression models allow us to predict cost for a patient with a given set of characteristics. Great care in the interpretation of the values of the individual coefficients should be taken in order to have a broader understanding of the expenditure dynamic.

Europe↗
PubMed2004

Off-label and non-classical prescriptions of antipsychotic agents in ordinary in-patient practice.

OBJECTIVE: To estimate the proportion of off-label prescriptions of antipsychotics (APs) in ordinary in-patient practice. METHOD: From the South-Verona Psychiatric Case Register all admissions to the in-patient unit during 2001-02 were extracted. Prescriptions of APs were defined off-label when dispensed outside the licensed indications. In addition, the proportion of "non-classical prescriptions" was calculated. RESULTS: During the 2 years surveyed AP agents were prescribed in 311 cases. Nearly 50% of second-generation AP prescriptions were for an off-label indication. In contrast, <15% of first-generation AP prescriptions were for an off-label indication. About 30% of first- and second-generation agents were prescribed for a non-classical indication. CONCLUSION: Approved labels for second-generation AP agents cover a much narrower range of indications than any of the first-generation agents, and this explains the higher proportion of off-label prescriptions. In contrast, the everyday use of first- and second-generation APs cover a similar range of clinical indications.

Antipsychotic Agents↗
PubMed2003

How often do patients with psychosis fail to adhere to treatment programmes? A systematic review.

BACKGROUND: Studies that assess the rates of psychotic patients who fail to adhere to treatment programmes have generated heterogeneous results, with estimates ranging from 24 to 90%. This paper presents findings from a systematic review on adherence to treatment by patients with psychosis. Its purpose is to provide an overall estimate of treatment non-adherence in community psychiatric services, and to analyse and study patient characteristics explaining the between-study heterogeneity in rates of non-adherence. METHOD: A systematic review of published studies that report rates of non-adherence with medication and scheduled appointments by psychotic patients in community settings has been undertaken. RESULTS: A total of 103 studies were included in this systematic review. Eighty-six of these studies were suitable for data re-analysis. The overall weighted mean rate of non-adherence, calculated in a sample of 23 796 patients, was 25.78%. A linear regression analysis of non-adherence rates on background characteristics showed that sample size was negatively associated with non-adherence rates, while first-contact cases and low-adherence cases, in comparison with ongoing cases, were associated with higher non-adherence rates. Factors associated with poor compliance included: lack of insight; positive symptoms; younger age; male gender; history of substance abuse; unemployment; and low social functioning. CONCLUSIONS: Approximately one in four patients with psychosis fails to adhere with treatment programmes. Preventive evidence-based clinical interventions should be routinely implemented in community settings to reduce patient non-adherence.

Antipsychotic Agents↗
PubMed2002

Provision of services for people with schizophrenia in five European regions.

BACKGROUND: An increasing diversity of public, voluntary sector and private providers offer services for the mentally ill in the ongoing process of psychiatric reform. Good service description is one important prerequisite for mental health service research. Aims 1) To describe service provision for the mentally ill in five European centres using the European Service Mapping Schedule (ESMS); and 2) to discuss the use of the instrument in describing service provision. METHODS: All services providing care for people with severe mental illness in five European catchment areas (in Amsterdam, the Netherlands; Copenhagen, Denmark; London, UK; Santander, Spain; Verona, Italy) were identified through various sources. The identified services were classified, and service provision was quantified in accordance with the ESMS manual. Descriptive information was obtained. RESULTS: We identified from 10 to 45 different services for catchment areas of between 50,000 (Copenhagen) and 560,000 (Santander) population run by three to 16 providers. They varied in aims, staffing and functioning. Hospital and non-hospital residential services, community-based services, and social support agencies were available in all sites. There was substantial variation across centres in the range, number and activities of services. Collecting comparable data sets on all service types, particularly for day and structured activity services and outpatient and community services required substantial effort. CONCLUSION: Operationalised description of mental health services across Europe is possible but requires further refinement.

Adolescent↗
PubMed2002

Determinants of subjective quality of life in patients attending community-based mental health services. The South-Verona Outcome Project 5.

OBJECTIVE: Investigate the relationship of various domains of quality of life (QoL) with socio-demographics, clinical and social characteristics, service use and satisfaction in a representative sample of patients in contact with the South-Verona community mental health service. METHOD: Measures included: Lancashire Quality of Life Profile (LQOLP), demographics, diagnosis and service utilization data from the Case Register, Brief Psychiatric Rating Scale (BPRS), Disability Assessment Schedule (DAS), Global Assessment of Functioning (GAF) and Verona Service Satisfaction Scale (VSSS). Analyses were conducted using a block-stratified multiple regression model. RESULTS: Demographics, diagnosis, psychopathology, disability, functioning and service use together explained different amounts of variance in each LQOLP domain, but always less than 14%. VSSS explained more variance than any other indicator in health (13.1%), social relations (12.1%), leisure/participation (9.1%), and general wellbeing (9.0%). CONCLUSION: Different domains of QoL are predicted by different indicators. In some important domains, self-perceived satisfactory and effective care might have an impact on the QoL of patients.

Adult↗
PubMed2001

Accessibility and pathways to psychiatric care in a community-based mental health system.

BACKGROUND: The careful analysis of pathways to specialist mental health care, within the context of community-based services, is important because it allows a detailed understanding of the inter-relationship between the component parts of the whole system of care. Moreover, it permits a comparison of service functioning to made over time, and is one way to operationalise the measurement of accessibility to services. The aims of this study are to describe: (i) the pathways followed by patients with new episodes of care to community-based mental health services, (ii) the time intervals from onset of the problem to first contact with services, and then to onward referral to specialist care (accessibility), and (iii) to explore the short-term costs associated with different pathways. METHODS: Using data from the South-Verona Psychiatric Case Register, all new patients referred to any of the facilities which are part of the South-Verona Community Psychiatric Service (CPS) over a 6-month period (November 1999 - May 2000) were eligible to enter the study. Patients were interviewed by telephone using the Italian translation of the WHO Encounter Form. The costs of care provided in the 3 months following the index contact were assessed for all patients. RESULTS: The most common route to mental health services is via a GP (40%), followed by a referral from a hospital doctor (26%) and self-referral (23%). The median interval from onset to direct contact with the South-Verona CPS (12 weeks) was shorter than the intervals from onset to direct contact with other service providers (the median interval for contact with GPs and hospital doctors was 24 weeks). The intervals varied considerably from 1 week (for attempted suicide), to 1.5 years (for disturbed behaviour). The results of backward regression modelling revealed a significant relationship between patients' characteristics and community costs or total psychiatric costs (44% and 53% of the variance explained respectively). CONCLUSION: When the results are compared with a directly comparable earlier study in South-Verona, it is apparent that between 1991 and 1999 an increasing proportion of patients with insomnia and somatic disorders presented first to GPs, while a decreasing proportion of patients over the years sought care directly from specialist care. An increase in the role of local GPs as gatekeepers has, therefore, emerged. A prompt assessment by the South-Verona CPS of the patients' presenting problems was also confirmed, and this can be explained by the 'drop-in' approach at the Mental Health Centre, where patients can seek specialist care directly, without previously attending GPs. This method of measuring time intervals along pathways is proposed as a way to operationalise accessibility to services in future.

Adolescent↗
PubMed2001

A comparison of needs of patients with schizophrenia in five European countries: the EPSILON Study.

OBJECTIVE: To compare the occurrence of needs of patients with schizophrenia in Amsterdam, Copenhagen, London, Santander and Verona. METHOD: Patients with schizophrenia were interviewed with the Camberwell Assessment of Need. The mean numbers of total, met and unmet needs were compared across the sites. Ratings for individual domains were also examined. Means were adjusted, using multiple regression analysis, to control for patient differences between sites. RESULTS: The highest levels of unmet need were in Amsterdam and London. The number of met needs were similar. Adjusting for patient differences reduced the estimated number of unmet needs and total needs in Copenhagen, but made little difference elsewhere. There were many site differences for individual domains. CONCLUSION: Needs vary between different countries. Unmet needs are greater in large urban areas like London and Amsterdam. Differences in the pattern of individual needs may be partly explained in terms of service provision.

Adolescent↗
PubMed2000

Using health production functions to evaluate treatment effectiveness: an application to a community mental health service.

The randomized controlled trial (RCT) is the recommended means of evaluating health care effectiveness and cost-effectiveness. Whilst representing a 'gold-standard' in health services research, RCT evidence on the clinical and economic desirability of services and treatments is often absent. Where RCT evidence is lacking, or where it is infeasible to implement randomized controlled comparisons, longitudinal observational and naturalistic data sources when analysed appropriately can yield useful insights regarding the clinical effectiveness and economic efficiency of treatments. In this paper we demonstrate the utility of applying panel estimation methods to data from an Italian psychiatric case register as a means of modelling the mental health outcomes of patients referred to a community-based mental health service. Emphasis is placed on quantifying the clinical effectiveness of consultations with different mental health professionals (including in-patient days) and whether service outcomes are affected by psychiatric diagnosis. The impact of service consultations and their interaction with different types of psychiatric diagnosis on a measure of patient mental health are found to be statistically significant, although the size of these effects are not substantial from a clinical perspective.

Adult↗
PubMed2000

Six-month and 12-month mental health outcome of medical and surgical patients admitted to general hospital.

BACKGROUND: We have recently reported a two-phase study on psychiatric morbidity in a sample of general hospital patients. This paper reports the results of the 6-month and 12-month follow-up of these patients. METHODS: The screening questionnaire was the GHQ-12. The main diagnostic instrument used in the second phase was the CIDI-PHC. All patients who had been interviewed with CIDI-PHC (N = 363) were followed-up and the baseline assessment was compared with the scoring on questionnaires administered in the 6-month postal enquiry and with the psychopathological status at 12-month, elicited with a telephone structured interview. RESULTS: Sixty-two and 87% of patients completed the 6- and 12-month follow-up assessment respectively. The first follow-up indicated no significant decrease in the level of symptoms. The 12-month follow-up interview showed that 23% of males and 40% of females had poor/mostly poor mental health. The logistic model showed that females with a definite ICD-10 diagnosis, admitted to a medical department, who had consumed psychotropic drugs in the previous year, had the most unfavourable outcome. The risk of a poor/mostly poor outcome steadily increased with the severity of the psychopathology during hospitalization. CONCLUSION: In medical and surgical general hospital patients the risk factors associated with a poor mental health outcome are similar to those found in primary care patients. Greater attention should be paid in assessing routinely mental health status of general hospital patients during hospitalization.

Adolescent↗
PubMed2000

The Personal Health Questionnaire: a new screening instrument for detection of ICD-10 depressive disorders in primary care.

BACKGROUND: The next generation of studies on antidepressant drug prescriptions in general practice needs to assess both the patterns of prescription and its appropriateness. This study aimed to assess the performance of the Personal Health Questionnaire (PHQ), a new questionnaire for detecting individuals with ICD- 10 depressive disorders, to be used in association with companion instruments for assessing the 'quality' of antidepressant prescriptions in primary care settings. METHODS: The PHQ was completed by 1,413 primary care attenders (100 were re-tested after 7-14 days) and 139 were selected and interviewed using the SCAN-2 and the 17-item HDRS. All data were analysed using appropriately weighted procedures to control for two-phase sampling design and non-response bias. Individual weights were estimated by logistic regression analysis and trimming strategy. RESULTS: PHQ internal consistency and test-retest on both Likert score and number of symptoms were high. The PHQ discriminated well between individuals with and without depressive disorders. A Likert score > or = 9 provided a good trade-off between sensitivity (0.78) and specificity (0.83). The screening accuracy of the PHQ in detecting subjects likely to benefit from antidepressant drug treatment (SCAN cases with a HDRS total score of 13 or higher) was satisfactory (ROC area 0.87: sensitivity 0.84; specificity 0.78). CONCLUSIONS: The PHQ can be strongly suggested as an accurate and economic screener to identify primary care attenders at high risk of being clinically depressed. However, in order to identify patients requiring antidepressant drug treatment, a second-phase assessment of PHQ high scorers (total score of > or = 10), using the HDRS, is needed.

Adult↗
PubMed2000

Community-based mental health care: to what extent are service costs associated with clinical, social and service history variables?

BACKGROUND: The growing movement in many European countries towards capitation-based systems for financing mental health care has generated increasing interest in developing appropriate models capitation formulae. The aims of the study were: to detect and compare any differences in service costs between patients with different diagnoses; and to analyse the associations between patient characteristics and service costs. METHODS: All patients in contact with the South-Verona Community Mental Health Service during the last quarter of 1996 were included in the study. Clinical and service-related variables were collected at first index contact; 3 months later, patients were interviewed using the Client Services Recipient Interview. For those who completed both the clinical assessments and the services receipt schedule (N = 339), 1-year psychiatric and non-psychiatric direct care costs were calculated. Weighted backward regression analyses were performed. RESULTS: The most significant variables associated with psychiatric costs were: admission to hospital in the previous year; intensity and duration of previous contacts with South-Verona CMHS; being unemployed; having a diagnosis of affective disorder; and, Global Assessment of Functioning score. The final model explained 66% of the variation in costs of psychiatric care and 13 % of variation in non-psychiatric medical costs. CONCLUSIONS: The model presented in this study explains a higher degree of cost variance than previously published studies. In community-based services more resources are targeted towards the most disabled patients. Previous psychiatric history (number of admissions in the previous year and intensity of psychiatric contacts lifetime) is strongly associated with psychiatric costs.

Adult↗
PubMed2000

The ethical base of mental health service research. Recent developments in mental health service research in the UK.

After the developments in mental health services in the UK in the last 40 years there has been an increasing focus on identifying and targeting the needs of the severely mentally ill (SMI). Political concern about the possible risks of community care have resulted in an emphasis on administrative and legal means of ensuring continuity of care and close clinical supervision of this SMI group. A number of experimental community-oriented mental health services have been shown to be cost-effective compared to hospital-based treatment. The further development of comprehensive community mental health services will depend on demonstrating whether this can be generalised to routine clinical settings. In this context we shall present the design of the PRiSM study, a prospective controlled trial of the cost-effectiveness of community mental health teams for the SMI in South London.

Community Health Services↗
PubMed2000

Definition and prevalence of severe and persistent mental illness.

BACKGROUND: There is little consistency in how severe mental illness (SMI) is defined in practice, and no operational definitions. AIMS: To test two operationalized definitions, based on the National Institute of Mental Health (1987) definition: the first uses three criteria (diagnosis of psychosis; duration of service contact > or = 2 years; GAF score < or = 50), the second only the last two. METHOD: Annual prevalence rates of SMI in two European catchment areas for each criterion and the criteria combined were calculated. RESULTS: The first definition produced rates of 2.55 and 1.34/1000 in London and Verona, respectively; the second permitted an additional 0.98/1000 non-psychotic disorders to be included in Verona. CONCLUSIONS: The three-dimensional definition selects a small group of patients with SMI who have psychotic disorders. The two-dimensional approach allows estimates of SMI prevalence rates which include all forms of mental disorder.

Adult↗
PubMed2000

Aims, outcome measures, study sites and patient sample. EPSILON Study 1. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs.

BACKGROUND: Cross-national research into the care of people with severe mental illnesses is hampered by a lack of standardised measures. The European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study is a European Union funded project within the BIOMED-2 programme. The project aims to develop standardised instruments to facilitate future cross-national research. AIMS: To describe the aims, outcome measures, study sites and patient samples of the EPSILON Study. METHOD, RESULTS, CONCLUSIONS: See companion papers in this supplement.

Adolescent↗
PubMed2000

Development, internal consistency and reliability of the Verona Service Satisfaction Scale--European Version. EPSILON Study 7. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs.

BACKGROUND: Satisfaction with mental health services is an important quality and outcome variable. The Verona Service Satisfaction Scale (VSSS) is a well-established method for measuring service satisfaction. AIM: To report the development and reliability study of the European Version of the VSSS (VSSS-EU). METHOD: A sample of people with schizophrenia on the case-load of local mental health services in the five European participating countries was assessed. The VSSS-EU was administered at one site in each country at two points in time. Internal consistency and test-retest reliability were assessed and compared between the five sites. RESULTS: The alpha coefficient for the VSSS-EU total score in the pooled sample was 0.96 (95% CI 0.94-0.97) and ranged from 0.92 (95% CI 0.60-1.00) to 0.96 (95% CI 0.93-0.98) across the sites. Test-retest reliability for VSSS-EU total score, pooled over sites, was 0.82 (95% CI 0.78-0.85) and ranged from 0.73 (95% CI 0.6-0.86) to 0.93 (95% CI 0.89-0.97) across the sites. CONCLUSION: VSSS-EU is a reliable instrument for measuring service satisfaction in people with schizophrenia, for use in comparative cross-national research projects and in routine clinical practice in mental health services across Europe.

Adolescent↗