Measuring costs of community mental health care in Italy: A prevalence-based study

AbstractBackground:Information on individual mental healthcare costs and utilization patterns in Italy is scant. We analysed the use and the annual costs of community mental health services (MHS) in an Italian local health authority (LHA). Our aims are to compare the characteristics of patients in the top decile of costs with those of the remaining 90%, and to investigate the demographic and clinical determinants of costs.Methods:This retrospective study is based on administrative data of adult patients with at least one contact with MHS in 2013. Costs of services were estimated using a microcosting method. We defined as high cost (HC) those patients whose community mental health services costs place them in the top decile of the cost distribution. The predictors of costs were investigated using multiple linear regression.Results:The overall costs borne for 7601 patients were 17 million €, with HC accounting for 87% of costs and 73% of services. Compared with the rest of the patients, HC were younger, more likely to be male, to have a diagnosis of psychosis, and longer and more intensive MHS utilization. In multiple linear regression, younger age, longer duration of contact with MHS, psychosis, bipolar disorder, personality disorder, depression, dementia and Italian citizenship accounted for 20.7% of cost variance.Conclusion:Direct mental health costs are concentrated among a small fraction of patients who receive intensive socio-rehabilitation in community services. One limitation includes the unavailability of hospital costs. Our methodology is replicable and useful for national and cross-national benchmarking

The impact of childhood glaucoma on psychosocial functioning and quality of life: a review of the literature

We present a novel comprehensive literature review of studies of the psychosocial functioning (PF) and quality of life (QoL) of patients with childhood glaucoma and their caregivers. Our findings demonstrate variable study quality and approach, as well as inconsistent results relating to the association of glaucoma-specific factors and sociodemographic variables with measured PF and QoL. Future studies should focus on the development of culturally cognizant and standardized assessment tools, execution of multi-center longitudinal studies with global representation, evaluation of PF and QoL among siblings and childhood glaucoma providers, and implementation of interventions to improve patient and caregiver PF and QoL

Language production impairments in patients with a first episode of psychosis

Language production has often been described as impaired in psychiatric diseases such as in psychosis. Nevertheless, little is known about the characteristics of linguistic difficulties and their relation with other cognitive domains in patients with a first episode of psychosis (FEP), either affective or non-affective. To deepen our comprehension of linguistic profile in FEP, 133 patients with FEP (95 non-affective, FEP-NA; 38 affective, FEP-A) and 133 healthy controls (HC) were assessed with a narrative discourse task. Speech samples were systematically analyzed with a well-established multilevel procedure investigating both micro- (lexicon, morphology, syntax) and macro-linguistic (discourse coherence, pragmatics) levels of linguistic processing. Executive functioning and IQ were also evaluated. Both linguistic and neuropsychological measures were secondarily implemented with a machine learning approach in order to explore their predictive accuracy in classifying participants as FEP or HC. Compared to HC, FEP patients showed language production difficulty at both micro- and macro-linguistic levels. As for the former, FEP produced shorter and simpler sentences and fewer words per minute, along with a reduced number of lexical fillers, compared to HC. At the macro-linguistic level, FEP performance was impaired in local coherence, which was paired with a higher percentage of utterances with semantic errors. Linguistic measures were not correlated with any neuropsychological variables. No significant differences emerged between FEP-NA and FEP-A (p≥0.02, after Bonferroni correction). Machine learning analysis showed an accuracy of group prediction of 76.36% using language features only, with semantic variables being the most impactful. Such a percentage was enhanced when paired with clinical and neuropsychological variables. Results confirm the presence of language production deficits already at the first episode of the illness, being such impairment not related to other cognitive domains. The high accuracy obtained by the linguistic set of features in classifying groups support the use of machine learning methods in neuroscience investigations

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services

Measuring costs of community mental health care in Italy: A prevalence-based study

Background Information on individual mental healthcare costs and utilization patterns in Italy is scant. We analysed the use and the annual costs of community mental health services (MHS) in an Italian local health authority (LHA). Our aims are to compare the characteristics of patients in the top decile of costs with those of the remaining 90%, and to investigate the demographic and clinical determinants of costs. Methods This retrospective study is based on administrative data of adult patients with at least one contact with MHS in 2013. Costs of services were estimated using a microcosting method. We defined as high cost (HC) those patients whose community mental health services costs place them in the top decile of the cost distribution. The predictors of costs were investigated using multiple linear regression. Results The overall costs borne for 7601 patients were 17 million \u20ac, with HC accounting for 87% of costs and 73% of services. Compared with the rest of the patients, HC were younger, more likely to be male, to have a diagnosis of psychosis, and longer and more intensive MHS utilization. In multiple linear regression, younger age, longer duration of contact with MHS, psychosis, bipolar disorder, personality disorder, depression, dementia and Italian citizenship accounted for 20.7% of cost variance. Conclusion Direct mental health costs are concentrated among a small fraction of patients who receive intensive socio-rehabilitation in community services. One limitation includes the unavailability of hospital costs. Our methodology is replicable and useful for national and cross-national benchmarking

Healthcare resource utilization and direct medical costs in patients with dual diagnosis in Italy

Objectives This study is aimed at analyzing the patterns of care and annual costs of services in patients with dual diagnosis treated in an Italian Mental Health and Pathological Dependency Department (MH-PDD). Methods In this retrospective prevalence-based study, healthcare accesses of 331 patients with dual diagnosis being treated at the MH-PDD were obtained through a linkage of 7 administrative databases (Tab. I). All adult patients with at least one contact with the MH-PDD are recorded in the database, which includes demographic characteristics, the ICD-9-CM diagnosis and information on each type of service provided. The ICD-9-CM are grouped into diagnostic categories, defined in Table II. Costs were assigned using different drivers and cost objects (national, regional tariffs and ad hoc estimated MH costs). Results The study population consisted of 331 patients with a diagnosis of substance abuse and a mental health disorder who had at least one contact with the MH-PDD in 2013. Patients were 68% male, with a mean age of 45 years and 93% Italian (Tab. III). A large proportion (n = 228, 68.6%) had a > 2 year duration of contact with MH-PDD. The substance of abuse or dependence was alcohol in the large majority (n = 196, 59.2%), followed by drugs (n = 99, 29.9%) and other substances (n = 16, 4.8%). Among the MH-PDD services that patients received, psychiatric-clinical treatment and initial assessment/reassessment and were the most frequent interventions, while vocational training, psychosocial rehabilitation and day center services were uncommon (Tab. IV). Total MH-PDD costs were 867,080\u20ac and costs per patient ranged from 25\u20ac (three psychiatric follow-up visits) to 239,125\u20ac in one outlier patient with psychosis and alcohol use disorder, who received 1,100 MH services and 22 home visits (Tab. V). The median cost was 279\u20ac and the mean cost 2,620\u20ac. The amount of non-MH-PDD costs almost equaled that of MH-PDD costs, and was largely ascribable to hospitalization in psychiatric and non-psychiatric wards (Fig. 1). Overall costs per patient ranged from 45\u20ac (first MH-PDD assessment) to \u20ac239,287 (the same outlier patient, with 1,100 MH services, 22 home visits and 4 specialty services). Median cost was 1,423\u20ac, mean cost 5.381\u20ac and the overall total was 1,780,958\u20ac. Classification of patients in cost tertiles revealed that one third of patients accounted for 88.1% of overall costs (Fig. 2). The costs borne by the MH-PDD increased from the first to the third tertile while the vice versa was true for non-MH-PDD costs. Median costs by psychiatric diagnosis ranged from 205\u20ac for other mental disorders to 2,085\u20ac for dementia (Tab. V, Fig. 3). Conclusions An integrated healthcare system based on outpatient management of patients with substance abuse/dependence costs less than other countries with different healthcare systems. In the absence of outcome data, cost-effectiveness studies are warranted

Identification of young people at “Ultra-High Risk” (UHR) of developing psychosis: validation of the “Checklist per la valutazione dell’esordio psicotico” for use in primary care setting

Objective. The study aims to establish the concordant validity of the “Checklist per la valutazione dell’Esordio Psicotico” (CVEP) in an Italian help-seeking population. The CVEP is the Italian adaptation of the early detection Primary Care Checklist (PCCL), a 20 item tool specifically designed to assist primary care practitioners in identifying young people in the early stages of psychosis (Table I). Methods. The checklist was completed by the referring practitioners of 102 young people referred to the “Reggio Emilia At Risk Mental States” Project (ReARMS) in the Reggio Emilia Department of Mental Health and Addiction. The concordant validity of the CVEP was established by comparing screen results with the outcome of the Comprehensive Assessment of At Risk Mental States (CAARMS), a gold standard assessment for identifying young people who may be at risk of developing psychosis. Results. The simple checklist as originally conceived had excellent sensitivity (97.9%), but lower specificity (55.6%) (Table II). Using only a CVEP total score of 20 or above as cut-off, the tool showed a substantial improvement in specificity (87%) (Table II). Simple cross-tabulations of the individual CVEP item scores against CAARMS outcome to identify the more discriminant items in terms of sensitivity and specificity were carried out (Table III). Conclusions. In comparison to other much longer screening tools, the CVEP performed well to identify young people in the early stages of psychosis. Therefore, the CVEP is well suited to optimize appropriate referrals to specialist services, building on the skill and knowledge already available in primary care settings

Validation of the "early detection Primary Care Checklist" in an Italian community help-seeking sample: The "checklist per la Valutazione dell'Esordio Psicotico"

BACKGROUND: To establish the concordant validity of the "Checklist per la Valutazione dell'Esordio Psicotico" (CVEP) in an Italian help-seeking population. The CVEP is the Italian adaptation of the "early detection Primary Care Checklist," a 20-item tool specifically designed to assist primary care practitioners in identifying young people in the early stages of psychosis. METHODS: The checklist was completed by the referring practitioners of 168 young people referred to the "Reggio Emilia At Risk Mental States" Project, an early detection infrastructure developed under the aegis of the Regional Project on Early Detection of Psychosis in the Reggio Emilia Department of Mental Health. The concordant validity of the CVEP was established by comparing screen results with the outcome of the "Comprehensive Assessment of At Risk Mental States" (CAARMS), a gold standard assessment for identifying young people who may be at risk of developing psychosis. RESULTS: The simple checklist as originally conceived had excellent sensitivity (98%), but lower specificity (58%). Using only a CVEP total score of 20 or above as cut-off, the tool showed a slightly lower sensitivity (93%) with a substantial improvement in specificity (87%). Simple cross-tabulations of the individual CVEP item scores against CAARMS outcome to identify the more discriminant item in terms of sensitivity and specificity were carried out. CONCLUSIONS: In comparison to other, much longer, screening tools, the CVEP performed well to identify young people in the early stages of psychosis. Therefore, the CVEP is well suited to optimize appropriate referrals to specialist services, building on the skills and knowledge already available in primary care settings

Reliability of the italian version of the 16-item Prodromal Questionnaire (iPQ-16) for psychosis risk screening in a young help-seeking community sample

Objective: Among current early screeners for psychosis-risk states, the Prodromal Questionnaire-16 items (PQ-16) is used. We aimed to assess reliability of the Italian version of the PQ-16 in a young help-seeking sample. Methods: We included 151 individuals, aged 13-35 years, seeking help at the Reggio Emilia outpatient mental health services in a large semirural catchment area (550.000 inhabitants). Participants completed the Italian version of the PQ-16 (iPQ-16) and were subsequently evaluated with the Comprehensive Assessment of At-Risk Mental States (CAARMS). We examined test-retest reliability, internal consistency and diagnostic accuracy (i.e. sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios) between PQ-16 and CAARMS UHR-defined criteria using coefficient of stability (k), Cronbach’s alpha and Cohen’s kappa, respectively. Results: The iPQ-16 showed excellent short term test-retest reliability (k = 0.898), high internal consistency (α = 0.810) and acceptable diagnostic accuracy (sensitivity = 73.5% and specificity = 75.9% at the proposed cut-off of ≥ 6 on symptom total score). Conclusions: Psychometric properties of the iPQ-16 were satisfactory. The iPQ-16 is a suitable screening tool for routine use in mental health care services. Indeed, it is short and therefore easy to implement in routine assessment