Objective: In Italy, all mental hospitals have gradually been replaced by general hospital psychiatric units for patients requiring acute care. Yet, after more than 25 years since the reform law was approved, detailed data on public inpatient facilities are still extremely limited. The PROGRES-Acute (PROGetto RESidenze, Residential Care Project for Acute patients) project consists of 2 phases: Phase 1 aims at surveying the main characteristics of all Italian public and private inpatient facilities for acute psychiatric patients. In the second phase, a representative sample of facilities and inpatients will be assessed in detail. Methods: Structured interviews were conducted with the head psychiatrist of each facility. All Italian Regions participated, with the exception of Sicily and six facilities (four public, two private), which refused to take part in the study. All activity data reported refer to 2001 and were obtained through local computerized case records; for the 136 facilities (45.2%) with no information system available, activity data were calculated manually. After data collection, thorough quality control was conducted, first locally in each Region, and then centrally. We also studied three activity indexes: (i) the Occupation Index - i.e., the mean percentage of bed occupation per facility per year; (ii) the Turnover Interval, indicating the mean number of days required to fill a bed after discharge; and (iii) the Rotation Index, which shows the mean number of yearly admissions for each bed available. Results: Overall, it was found that Italy (except Sicily) has a total of 4,108 public inpatient beds in 319 facilities, with 0.78 beds for every 10,000 inhabitants. In the year 2001, these facilities accounted for 103,260 acute admissions, with a total of 70,062 patients admitted and 1,227,676 days of hospitalization. Corresponding rates of psychiatric admissions and admitted patients per 10,000 inhabitants were 19.8 and 13.4, respectively. Furthermore, a total of 4,862 inpatient beds are located in 54 private facilities, with 0.94 beds for every 10,000 inhabitants. These facilities accounted, in the year 2001, for 35,880 acute admissions, with a total of 23,097patients admitted and 1,252,049 days of hospitalization. The mean number of admissions ranged from 363.0 (±154.7) in General Hospital Psychiatric Units (GHPUs) and 342.7 (±197.5) in University Psychiatric Clinics (UPCs), to 111.9 (±49.7) in 24-hour Community Mental Health Centres (CMHCs). Private Psychiatric Clinics (PPCs) are larger facilities, with a mean number of admissions of 676.3 (±409.5). The admission/patient ratio ranged from 1.34 in UPCs, to 1.45 in GHPUs, 1.55 in PPCs and 1.66 in CMHCs. There were 22,893 (32.7%) patients at their first-ever admission to a given facility (but possibly having been admitted to other public or private facilities); 22.3% of admitted patients were at their second admission over the course of the year, and 8.7% were at ≥ 3 admissions to the same facility ("revolving-door" patients). A mean percentage of 15.6% (±12.5) of admitted patients in the 259 units that provided this information came from outside the catchment area; a similar percentage held for UPCs (n = 12,18.5% [±19.1]), but this figure was lower for CMHCs (n = 16, 3.9% [±6.7]). UPCs showed the highest occupation index. On average, fewer than 20 admissions were made per year for each available GHPU bed. The percentage of compulsory admissions was 12.9%, for a total of 114,570 hospital days. Despite the fact that most facilities have been operating for a relatively short time, many suffer from significant logistic and architectural limitations. Staffing showed a great variability among facilities. The regular reporting of sentinel events was not a widespread practice. Conclusions: Despite the importance of acute inpatient care, many quantitative and qualitative features of hospital care remain largely unexplored, and many problems still await appropriate solutions. The marked variation found in many quantitative indicators and activity data of Italian acute inpatient facilities raises serious questions concerning horizontal equity, which refers to the extent to which similar patients can access and use comparable services across different areas of a country.
|Translated title of the contribution||Characteristics and activities of public psychiatric inpatient facilities: A national survey in Italy|
|Number of pages||14|
|Journal||Italian Journal of Psychopathology|
|Publication status||Published - Mar 2007|
ASJC Scopus subject areas
- Psychiatry and Mental health