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Psychiatric bed usage under different systems of care. A comparison of South Verona (Italy) and Canberra (Australia)

Published online by Cambridge University Press:  11 October 2011

Stephen Rosenman
Stephen Rosenman*
Affiliation:
NH & MRC Social Psychiatry Research Unit, Australian National University, Canberra, Australia
*
Indirizzo per la corrispondenza: Dr. S. Rosenman, ACT Health, P.O. Box 825, Canberra ACT 2601 (Australia). Fax: (+61) 6-205.1042
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Summary

Objective - To compare psychiatric bed usage for major psychiatric illness in a fully community-centred psychiatric service (South Verona, Italy) with usage in a more conventional hospital-centred service (Canberra, Australia). Design - Registers of hospital admissions for schizophrenia and major affective illness in the three years 1986, 1987, 1988 were examined at each site. The characteristics, socio-demography and rates of admission, the duration of index admission and the rate of readmission in the subsequent twelve months were compared. Results - The community-centred service (South Verona) admitted fewer patients with schizophrenic and major affective illness but they appeared more severely ill, stayed longer and were more likely to be readmitted. The hospital-centred system (Canberra) used hospitals for a wider range of severity of major illness including good prognosis illness. Hospitalisation in Canberra was briefer and readmission less frequent. It appears that the hospital centred service was more willing to use beds for the initiation or stabilisation of treatment. The community based service did not lead to shorter hospital stay or less frequent readmission. Differences in the treated psychiatric morbidity in the populations overshadowed the effect of design of the service on usage. This difference in morbidity, concentrated in the younger age group, remains unexplained.

Riassunto

Scopo - Confrontare l'uso dei servizi ospedalieri per le principali malattie psichiatriche in una struttura che offre un «servizio psichiatrico territoriale» (Verona-Sud, Italia) con l'uso di questi servizi in una struttura più «tradizionale», dove l'ospedale è il centro dell'attività (Canberra, Australia). Disegno - Sono stati esaminati i registri dei ricoveri per i malati da psicosi schizofreniche e distimiche negli anni 1986, 1987 e 1988. Sono state comparate le seguenti caratteristiche: la mappa socio-demografica ed i tassi dei ricoveri per i pazienti, la durata del ricovero iniziale ed i tassi di ri-ricovero per questi pazienti nei dodici mesi seguenti. Risultati - Il servizio psichiatrico territoriale (Verona-Sud) ha ricoverato meno pazienti con psicosi schizofreniche e distimiche ma questi risultavano più gravi, restavano degenti più a lungo ed avevano una probabilità maggiore di essere ricoverati nuovamente. Il servizio psichiatrico «tradizionale» (Canberra) ha usato l'ospedale per una gamma più ampia di malattie, incluse le malattie con buona prognosi. La degenza in Canberra è stata più breve ed il ri-ricovero meno frequente. Sembra che il servizio «tradizionale» sia più orientato ad usare l'ospedale per l'inizio o per la stabilizzazione della terapia. Il servizio psichiatrico territoriale non portava ad una degenza più breve o ad un numero minore di ricoveri successivi al primo. Le differenze nella morbilità psichiatrica incontrata nelle popolazioni ha nascosto l'effetto della struttura del servizio sull'uso. Questa differenza nella distribuzione della morbilitù psichiatrica concentrata nel gruppo di più giovane età, rimane senza spiegazione.

Keywords

valutazione dei serviziospedalizzazionepsichiatrica territorialeservice evaluationbed usagecommunity psychiatry
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 3 , Issue 3 , December 1994 , pp. 163 - 170
Copyright
Copyright © Cambridge University Press 1994

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