A public early intervention approach to first-episode psychosis: treated incidence over 7 years in the Emilia-Romagna region.

Aim: To estimate the treated incidence of individuals with first-episode psychosis (FEP) who contacted the Emilia-Romagna public mental healthcare system (Italy); to examine the variability of incidence and user characteristics across centres and years. Methods: We computed the raw treated incidence in 2013–2019, based on FEP users aged 18–35, seen within or outside the regional program for FEP. We modelled FEP incidence across 10 catchment areas and 7 years using Bayesian Poisson and Negative Binomial Generalized Linear Models of varying complexity. We explored associations between user characteristics, study centre and year comparing variables and socioclinical clusters of subjects. Results: Thousand three hundred and eighteen individuals were treated for FEP (raw incidence: 25.3 / 100.000 inhabitant year, IQR: 15.3). A Negative Binomial location-scale model with area, population density and year as predictors found that incidence and its variability changed across centres (Bologna: 36.55; 95% CrI: 30.39–43.86; Imola: 3.07; 95% CrI: 1.61–4.99) but did not follow linear temporal trends or density. Centers were associated with different user age, gender, migrant status, occupation, living conditions and cluster distribution. Year was associated negatively with HoNOS score (R = 0.09, p < .001), duration of untreated psychosis (R = 0.12, p < .001) and referral type. Conclusions: The Emilia-Romagna region presents a relatively high but variable incidence of FEP across areas, but not in time. More granular information on social, ethnic and cultural factors may increase the level of explanation and prediction of FEP incidence and characteristics, shedding light on social and healthcare factors influencing FEP

Sistema Integrato Multicentrico di Indicatori. Rapporto 2005. Provincia di Parma.

The SIMI (Integrated System of Indicators multicenter) Project contributes to the development of an integrated management of informative data streams related to drug addicted persons. This report analyzes the phenomenon of addiction on the territory of the Parma Province through a description of the network services that provide care and rehabilitation of those addicted. Besides the characteristics of users of local services for addictions, has been developed the analysis of the subjects reported to the prefectures for use of illegal drugs and any action taken. Standard methods of estimation were also applied to quantify the proportion of users of substances that do not relate to services and to identify certain characteristics.Il Progetto SIMI (Sistema Integrato Multicentrico di Indicatori) intende contribuire allo sviluppo di una gestione integrata e sinergica dei flussi informativi relativi ai consumatori di sostanze stupefacenti afferenti alle diverse amministrazioni dello Stato. In linea con quanto proposto dall\u27Osservatorio europeo di Lisbona, per la descrizione e analisi del fenomeno connesso all\u27uso/abuso di sostanze, risulta di fondamentale importanza la possibilit? di ottenere informazioni esaustive e comparabili sulle persone che usano e/o abusano di sostanze psicotrope. Il presente rapporto analizza il fenomeno delle dipendenze sul territorio della provincia di Parma attraverso la descrizione della rete dei servizi preposti alla cura e riabilitazione dei soggetti tossicodipendenti. Accanto alle caratteristiche degli utenti dei servizi territoriali per le dipendenze, ? stata sviluppata l\u27analisi dei soggetti segnalati alle Prefetture per uso di sostanze illegali e degli eventuali provvedimenti adottati. Sono state inoltre applicate metodologie standard di stima per quantificare la quota parte di utilizzatori di sostanze che non afferiscono ai servizi e per identificarne alcune caratteristiche

Rapporto 2007. Quadro degli interventi di prevenzione, cura e riabilitazione sul consumo di droghe nella provincia di Rimini.

Report on the state of legal and illegal substances use in the territory of Rimini province.La relazione ? articolata in 3 parti. Nella prima - diffusione delle sostanze - vengono riportati gli ultimi dati relativi alla stima dei consumatori di sostanze psicotrope nella provincia di Rimini attraverso la sintesi di due indagini sulla popolazione generale (indagine Ipsad?) e sulla popolazione studentesca di et? 15-19 anni (indagine Espad-Italia?). Una seconda parte - attivit? dei servizi - in cui vengo descritte non solo le caratteristiche delle persone che accedono ai servizi per le dipendenze pubblici e privati, compresa il Carcere di Rimini, ma anche le risposte fornite in termini di cura e riabilitazione. Una terza parte - interventi sul territorio - in cui vengono descritte le attivit? sia di prevenzione sia di contrasto all\u27uso. Risulta particolarmente interessante una prima valutazione delle attivit? realizzata all\u27interno dei piani di zona dei comuni di Rimini e Riccione

Rapporto 2007 su consumo e dipendenze da sostanze in Emilia-Romagna.

Report on the state of legal and illegal substances use in the territory of Emilia-Romagna Region.Il report analizza il fenomeno delle dipendenze nel territorio della Regione Emilia-Romagna. La descrizione del fenomeno si sviluppa intorno all\u27analisi degli indicatori individuati dall\u27Osservatorio Europeo delle Dipendenze di Lisbona (OEDT): 1-uso di sostanze nella popolazione generale (questo indicatore va a rilevare i comportamenti nei confronti di alcol e sostanze psicoattive da parte della popolazione generale); 2-prevalenza d\u27uso problematico delle sostanze psicoattive; 3-domanda di trattamento degli utilizzatori di sostanze; 4-mortalit? degli utilizzatori di sostanze; 5-malattie infettive. Altri due importanti indicatori che si stanno sviluppando, e che vengono qui illustrati, sono l\u27analisi delle Schede di Dimissione Ospedaliera (SDO) e gli indicatori relativi alle conseguenza sociali dell\u27uso di droghe (criminalit? droga correlata). Inoltre sono state applicate diverse metodologie standard di stima sia per quantificare la quota parte sconosciuta di utilizzatori di sostanze che non afferiscono ai servizi, sia per identificarne alcune caratteristiche

The effects of the macro-environment on treatment retention for problem cocaine users

Client dropout is commonly used as an indicator of quality and effectiveness of drug treatment. Following increasing cocaine use in recent years, research has attempted to identify predictors of retention in treatment for cocaine users but there is no consensus about how individual characteristics and system variables (referral source, treatment setting), what we term here as the "macro-environment" - effect risk of dropout. This study sought to identify macro-environmental factors and examine the way these impact upon treatment retention

ROME4EU: A web service-based process-aware system for smart devices

Nowadays, process-aware information systems (PAISs) are widely used for the management of "administrative" processes characterized by clear andwell-defined structure. Besides such scenarios, PAISs can be used also in mobile and pervasive scenarios, such as in coordinating operators during emergency situations [1]. In these pervasive settings, due to highly mobility, operators have to be equippedwith small devices, such as PDAs, and to communicate through ad-hoc networks

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

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

Using big data and Population Health Management to assess care and costs for patients with severe mental disorders and move toward a value-based payment system

Abstract Background Mental health (MH) care often exhibits uneven quality and poor coordination of physical and MH needs, especially for patients with severe mental disorders. This study tests a Population Health Management (PHM) approach to identify patients with severe mental disorders using administrative health databases in Italy and evaluate, manage and monitor care pathways and costs. A second objective explores the feasibility of changing the payment system from fee-for-service to a value-based system (e.g., increased care integration, bundled payments) to introduce performance measures and guide improvement in outcomes. Methods Since diagnosis alone may poorly predict condition severity and needs, we conducted a retrospective observational study on a 9,019-patient cohort assessed in 2018 (30.5% of 29,570 patients with SMDs from three Italian regions) using the Mental Health Clustering Tool (MHCT), developed in the United Kingdom, to stratify patients according to severity and needs, providing a basis for payment for episode of care. Patients were linked (blinded) with retrospective (2014–2017) physical and MH databases to map resource use, care pathways, and assess costs globally and by cluster. Two regions (3,525 patients) provided data for generalized linear model regression to explore determinants of cost variation among clusters and regions. Results Substantial heterogeneity was observed in care organization, resource use and costs across and within 3 Italian regions and 20 clusters. Annual mean costs per patient across regions was €3,925, ranging from €3,101 to €6,501 in the three regions. Some 70% of total costs were for MH services and medications, 37% incurred in dedicated mental health facilities, 33% for MH services and medications noted in physical healthcare databases, and 30% for other conditions. Regression analysis showed comorbidities, resident psychiatric services, and consumption noted in physical health databases have considerable impact on total costs. Conclusions The current MH care system in Italy lacks evidence of coordination of physical and mental health and matching services to patient needs, with high variation between regions. Using available assessment tools and administrative data, implementation of an episodic approach to funding MH could account for differences in disease phase and physical health for patients with SMDs and introduce performance measurement to improve outcomes and provide oversight

Psychopathological symptoms in detoxified and non-detoxified heroindependent patients entering residential treatment

Background: In a previous study, by evaluating patients entering an Outpatient Agonist Treatment, or a residential Therapeutic Community, through the use of SCL-90, a 5-factor solution was identified: a depressive 'worthlessness and being trapped' dimension, a 'somatization' dimension, a 'sensitivity-psychoticism' dimension, a 'panic anxiety' dimension, and a 'violence-suicide' dimension. Aim of the present study is to compare these dimensions between heroin-addicted patients that have already been detoxified (DTX) and those not yet detoxified (NDTX) from heroin at the time of entering a Therapeutic Community Treatment. Methods: The demographic and clinical variables of NDTX patients and DTX patients were first compared; all patients were then assigned to the appropriate SCL-90-based dimension among the five just identified ones. Differences in psychopathological dimensions were analysed at univariate and multivariate level. Results: Out of 1,015 subjects included in the study, 374 (36.8%) were DTX patients, while 641 (63.2%) were NDTX patients. Distribution of demographic and heroin addiction history variables between NDTX and DTX heroin-addicted patients at residential treatment entry were very similar. In the univariate analysis, the SCL-90 total score and all the SCL-90 factors showed higher statistical significance in NDTX than in DTX patients. In the discriminant analysis, severity of ‘somatic symptoms’ was the factor differentiating NDTX from DTX-patients, with 64.4% of the originally grouped cases shown to be correctly classified. Differences in qualities of psychopathological symptoms between NDTX and DTX patients were found regarding ‘somatic symptoms’ ‘sensitivity psychoticism’ and ‘panic anxiety’, the last two features being better represented in DTX patients. Conclusions: All the five aggregations of symptoms resulting from the application of Principal Component Analysis to the SCL-90 of opioid addicts were present in subjects actively involved with opioids as well as already detoxified ones. Although the severity of psychiatric damage was lower in the DTX than in the NDTX patients, the only dimension that successfully discriminated between the two groups of patients was that of ‘somatic symptoms’