Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 13;17(1):31.
doi: 10.1186/s13033-023-00603-9.

Assessing the quality of the care offer for people with personality disorders in Italy: the QUADIM project. A multicentre research based on the database of use of Mental Health services

Michele Sanza  1 , Matteo Monzio Compagnoni  2   3 , Giulia Caggiu  4   5   6 , Liliana Allevi  6 , Angelo Barbato  7 , Jeannette Campa  8 , Flavia Carle  5   9 , Barbara D'avanzo  7 , Teresa Di Fiandra  10 , Lucia Ferrara  11 , Andrea Gaddini  12 , Alessio Saponaro  13 , Salvatore Scondotto  5   14 , Valeria D Tozzi  11 , Stefano Lorusso  15 , Cristina Giordani  15 , Giovanni Corrao  4   5 , Antonio Lora  5   6
Affiliations

Assessing the quality of the care offer for people with personality disorders in Italy: the QUADIM project. A multicentre research based on the database of use of Mental Health services

Michele Sanza et al. Int J Ment Health Syst. .

Abstract

Background: Italy can be viewed as a laboratory to assess the quality of mental healthcare delivered in a community-oriented system, especially for severe mental disorders, such as personality disorders. Although initiatives based on clinical indicators for assessing the quality of mental healthcare have been developed by transnational-organisations, there is still no widespread practice of measuring the quality of care pathways delivered to patients with severe mental disorders in a community-oriented system, especially using administrative healthcare databases. The aim of the study is to evaluate the quality of care delivered to patients with personality disorders taken-in-care by mental health services of four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily).

Methods: A set of thirty-three clinical indicators, concerning accessibility, appropriateness, continuity, and safety of care, was implemented using regional healthcare utilization databases, containing data on mental health treatments and diagnosis, hospital admissions, outpatient interventions and exams and drug prescriptions.

Results: 31,688 prevalent patients with personality disorders treated in 2015 were identified, of whom 2,331 newly taken-in-care. One-in-10 patients received a standardized assessment, the treatment discontinuity affected half of the cases. 12.7% of prevalent patients received at least one hospitalization, 10.6% in the newly taken-in-care cohort. 6-out-of-10 patients had contact with community-services within 14 days from hospital discharge. Access to psychotherapy and psychoeducational treatments was low and delivered with a low intensity. The median of psychosocial interventions per person-year was 19.1 and 9.4, respectively, in prevalent and newly taken-in-care cases. Nearly 50% of patients received pharmacological treatments.

Conclusions: Healthcare utilization databases were used to systematically evaluate and assess service delivery across regional mental health systems; suggesting that in Italy the public mental health services provide to individuals with personality disorders suboptimal treatment paths.

Keywords: Clinical pathways; Healthcare research; Healthcare services; Healthcare utilization databases; Mental healthcare; Personality disorders; Public health; Quality of mental healthcare; Real-world; Treatment gap.

PubMed Disclaimer

Conflict of interest statement

GC received research support from the European Community (EC), the Italian Agency of Drug (AIFA), and the Italian Ministry for University and Research (MIUR). He took part to a variety of projects that were funded by pharmaceutical companies (i.e., Novartis, GSK, Roche, AMGEN and BMS). He also received honoraria as member of Advisory Board from Roche. Author AL was employed by ASST Lecco. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Flow-chart of inclusion and exclusion criteria for the eligibility of patients newly taken-in-care with personality disorders in three regions (Lombardy, Emilia-Romagna, Lazio) and one province (Palermo), and in the whole Italian sample. QUADIM-MAP Projects, Italy, 2015–2016
See this image and copyright information in PMC

References

    1. Gunderson JG. Borderline personality disorder: ontogeny of a diagnosis. Am J Psychiatry. 2009;166:530–9. doi: 10.1176/appi.ajp.2009.08121825. - DOI - PMC - PubMed
    1. Theodore M. Contemporary directions in psychopathology: scientific foundations of the DSM-V and ICD-11. New York, NY, US: The Guilford Press; 2010. A sociocultural conception of the borderline personality disorder epidemic; pp. 111–23.
    1. Álvarez-Tomás I, Ruiz J, Guilera G, Bados A. Long-term clinical and functional course of borderline personality disorder: a meta-analysis of prospective studies. Eur Psychiatry. 2019;56:75–83. doi: 10.1016/j.eurpsy.2018.10.010. - DOI - PubMed
    1. Goodman M, Roiff T, Oakes AH, Paris J. Suicidal risk and management in borderline personality disorder. Curr Psychiatry Rep. 2012;14:79–85. doi: 10.1007/s11920-011-0249-4. - DOI - PubMed
    1. Pompili M, Girardi P, Ruberto A, Tatarelli R. Suicide in borderline personality disorder: a meta-analysis. Nord J Psychiatry. 2005;59:319–24. doi: 10.1080/08039480500320025. - DOI - PubMed

LinkOut - more resources