Does the mental health system provide effective coverage to people with schizophrenic disorder? A self-controlled case series study in Italy
Giovanni Corrao, Angelo Barbato, Barbara D’Avanzo, Teresa Di Fiandra, Lucia Ferrara, Andrea Gaddini, Matteo Monzio Compagnoni, Alessio Saponaro, Salvatore Scondotto, Valeria D. Tozzi, Flavia Carle, Antonio Lora, the “QUADIM project”, “Monitoring, assessing care pathways (M. A. P.)” working groups of the Italian Ministry of Health, Teresa Di Fiandra, Natalia Magliocchetti, Antonio Lora, Miriam Barri, Alessio Saponaro, Andrea Gaddini, Valentina Di Mattia, Salvatore Scondotto, Walter Pollina Addario, Marco Berardi, Monica Di Giorgi, Giovanni Corrao, Matteo Monzio Compagnoni, Angelo Barbato, Barbara D’Avanzo, Igor Monti, Valeria D. Tozzi, Lucia Ferrara, Flavia Carle, Andrea Bucci, C. Casoli, Marianxhela Dajko, Donata Bellentani, Simona Carbone, Carla Ceccolini, Angela De Feo, Cristina Giordani, Lucia Lispi, Rosanna Mariniello, Federica Medici, Paola Pisanti, Modesta Visca, Rinaldo Zanini, Anna Cantarutti, Giovanni Corrao, Pietro Pugni, Federico Rea, Marina Davoli, Mirko Di Martino, Patrizia Vittori, Giuliana Vuillermin, Alfonso Bernardo, Anna Fusciante, Laura Maria Beatrice Belotti, Rossana De Palma, Enza Di Felice, Andrea Di Lenarda, Marisa Prezza, Danilo Fusco, Adele Lallo, Chiara Marinacci, Roberto Blaco, Olivia Leoni, Antonio Lora, Liana Spazzafumo, Simone Pizzi, Maria Simiele, Giuseppe Massaro, Ettore Attolini, Vito Lepore, Vito Petrarolo, Salvatore Scondotto, Giovanni De Luca, Paolo Francesconi, C. Rizzuto, Francesco Avossa, Silvia Vigna, Letizia Dondi, Nello Martini, Antonella Pedrini, Carlo Piccinni, Mimma Cosentino, Maria Grazia Marvulli, Aldo P. Maggioni
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.