Adequacy of Treatment for Patients With Schizophrenia Spectrum Disorders and Affective Disorders in Lombardy, Italy

Abstract

Objective: This study assessed whether patients being treated for schiz- ophrenia spectrum and affective disorders in Lombardy receive ade- quate treatment and sought predictors of adequate treatment. Methods: Patients were aged ≥18, were residents of Italy’s Lombardy region, and were treated in 2007 for schizophrenia spectrum and affective disor- ders (N=44,462). The patients were assessed as part of a retrospective analysis of pharmaceutical and mental health services databases. Ade- quacy of 12-month treatment from the first psychiatric contact in 2007 was assessed at the patient level. A hierarchical log-binomial regression model was fitted to estimate relative risk and 95% confidence intervals for association between patients, characteristics of the departments of mental health (DMH), and receipt of minimally adequate treatment. Re- sults: About half the patients with serious mental disorders did not re- ceive adequate care; 45.5% of patients with depressive disorders, 55.7% of those with bipolar disorders, and 49.3% of those with schizophrenia spectrum disorders received minimally adequate treatment. Diagnosis of a schizophrenia spectrum disorder or bipolar disorder and male gen- der predicted adequate treatment, whereas employment and high co- morbidity predicted inadequate treatment. Patients who received men- tal health services in the past year were significantly more likely to re- ceive adequate treatment compared with those who had received serv- ices in the past five years or new patients. Conclusions: Minimally ade- quate treatment is a useful indicator to monitor quality of care in Italy’s regional mental health system. These data should be used at regional and local levels to implement clinical audits, to create benchmark meas- ures, and to define new quality-improvement projects to meet specific DMH needs.