title: Structural and organizational determinants of quality of care in patients with schizophrenia in Italy.
abstract: Several reports have described the poor quality of care delivered to psychotic patients. However, the context in which care was delivered, including the structure, organization, and performance of the health care system, as a possible determinant of quality of care has received less attention. In this study we explored the relationship between conformance with guidelines and structural and organizational characteristics in 2 departments of Mental Health in Italy. Dosing of antipsychotic drugs in the maintenance phase was investigated in 125 patients. Higher than recommended doses could be explained by the high patient caseload per psychiatrist, leading to insufficient contacts with patients and their families and to excessive reliance upon drug treatment. The analysis of structural and organizational determinants of care at the local level may help to explain insufficient quality and to plan suitable interventions.
authors.affiliation: Services for Medical Research, forMed, Evolène, Switzerland.
authors.forename: Paola
authors.initials: P
authors.lastname: Bollini
authors.forename: Sandro
authors.initials: S
authors.lastname: Pampallona
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tibaldi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bianco
authors.forename: Salvatore
authors.initials: S
authors.lastname: Nieddu
authors.forename: Carmine
authors.initials: C
authors.lastname: Munizza
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D008605:Mental Health Services / Q000458:organization & administration / Q000592:standards*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012559:Schizophrenia / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents