Which community care for patients with schizophrenic disorders? Packages of care provided by Departments of Mental Health in Lombardy (Italy).
OBJECTIVE
The treatment of schizophrenic disorders is the most important challenge for community care. The analysis focuses on packages of care provided to 23.602 patients with a ICD-10 diagnosis of schizophrenic disorder and treated in 2001 by the Departments of Mental Health in Lombardy, Italy.


METHODS
Packages of care refer to a mix of treatments provided to each patient during the year by different settings. Direct costs of the packages were calculated. Linear Discriminant Analysis has been used to link socio-demographic and diagnostic sub-groups of the patients to packages of care.


RESULTS
People with schizophrenic disorders received relatively few care packages: only four packages involved more than 5%. Two thirds of the patients received only care provided by Community Mental Health Centres. In the other two packages with a percentage over 5%, the activity was provided by CMHCs, jointly with General Hospitals or Day Care Facilities. Complex care packages were rare (only 6%). As well as the intensity, also the variety of care provided by CMHCs increased with the complexity of care packages. In Lombardy more than half of the resources were spent for schizophrenia. The range of the costs per package was very wide. LDA failed to link characteristics of the patients to packages of care.


CONCLUSIONS
Care packages are useful tools to understand better how mental health system works, how resources have been spent and to point out problems in the quality of care.
Lora
Antonio
A
Health Care Directorate, Lombardy Region, Milano, Italy. antoniolora@virgilio.it
Cosentino
Ugo
U
Gandini
Anna
A
Zocchetti
Carlo
C
D002391:Catchment Area, Health; D003156:Community Mental Health Services / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D012559:Schizophrenia / Q000191:economics / Q000453:epidemiology / Q000628:therapy*