[Variability of managerial and clinical decisions in mental health services of the Lombardy Region: the vignette method]

Abstract

This paper concerns one of the four research projects developed during a training course in clinical epidemiology managed by the Lombardy training centers IREF.

Objectives: To compare the recommendations for treatment concerning 9 vignettes derived from the Australian Quality Assurance Project.

Setting: Six Mental Health Services of Regione Lombardia.

Design and participants: For each vignette, all psychiatrists working in the 6 Mental Health Services were asked to fill in a questionnaire about treatment location, psychopharmacology, psychotherapy, priority between psychotherapy and psychopharmacology and degree of difficulty in answering.

Results: 44 out of 52 target psychiatrists took part to the study. Remarkable variability for treatment location and psychotherapies; moderate variation for psychodrugs prescriptions and a good agreement for diagnoses were observed. In drugs prescription an access of association was observed. The most prevalent model of psychotherapy was the psychodynamic, followed by the cognitive-behavioural and the family-systemic. There was a tendency toward a flexible approach, as suggested by recommendations of different psychotherapeutic models according to the nature of the disorder. No case were judged very difficult; only in 3 cases a judgement of "somewhat difficult" was expressed by more than 20% (but less than 30%) of the psychiatrists.

Conclusions: Studies of this type are very easy to carry out and give useful information for continuous training programs and Continuous Quality Improvement projects.