Service utilization by schizophrenic patients in Groningen and South-Verona: an event-history analysis.
The question addressed to in this paper is whether severely mentally ill patients are treated differently in a community mental health service without the back-up of a mental hospital (south-Verona, Italy) compared with an institution-based system in which mental hospitals, although highly modernized, are still predominant (Groningen, The Netherlands). Using the psychiatric case-registers in both areas, the patterns of care in 2 years of follow-up of schizophrenic patients were constructed. Survival analysis was used to analyse in-, day- and out-patient episodes of care. Three-quarters of the Groningen and half of the south-Verona patients experienced at least one episode of hospitalization; 20% of the Groningen and 5% of the south-Verona patients were long-stay patients at the end of the observation period. The south-Verona patients had more episodes of in-patient and especially of day-patient and out-patient care. Cox's regression showed that the duration of episodes controlled for the history of events and sociodemographic characteristics, was significantly shorter in south-Verona. One of the main conclusion was that hospitalizations for the severely mental ill are also needed in a community-based system of care, supporting the assumption of a 'bed-rock' of mental illness. However, the south-Verona community mental health service seems to be able to reduce the duration of hospitalizations considerably.
Sytema
S
S
Afdeling Sociale Psychiatrie, Rijksuniversiteit, Groningen, The Netherlands
Micciolo
R
R
Tansella
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003431:Cross-Cultural Comparison; D017050:Episode of Care; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000453:epidemiology* / Q000534:rehabilitation; D012565:Schizophrenic Psychology; D013548:Sweden / Q000453:epidemiology