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Monitoring community psychiatric services in Italy: differences between patients who leave care and those who stay in treatment

Department of Psychiatry, Hospital of Legnano, and Laboratory of Epidemiology and Social Psychiatry, ‘Mario Negri’ Institute for Pharmacological Research, Milan

GIANCARLO BELLONI, MD and AGOSTINO CONTINI, MD

Department of Psychiatry, Hospital of Legnano, Milan

CORRADO BARBUI, MD

Laboratory of Epidemiology and Social Psychiatry, ‘Mario Negri’ Institute for Pharmacological Research, Milan

Correspondence: Dr Corrado Barbui, Laboratory of Epidemiology and Social Psychiatry, ‘Mario Negri’ Institute for Pharmacological Research, Via Eritrea 62, 20157 Milan, Italy. Tel: +39 0239014431; fax: +39 02 33200049; e-mail: barbui{at}marionegri.it

Declaration of interest None.

Background Continuity of care has been monitored rarely in Italian community mental health centres.

Aims To estimate the long-term probability of leaving care in first-contact patients attending an out-patient service, and to identify patients most likely to drop out.

Method All patients who had a first contact with the community mental health centre of Magenta during a 1-year recruitment period were followed up for 24 months. Patients who failed to return after the last out-patient visit were regarded as ‘drop-outs’.

Results During the 1-year recruitment period 330 subjects were at their first contact. The 1-year incidence of first-contact patients was nearly 33 per 10 000 inhabitants. At follow-up, 46% of patients had dropped out. In comparison with patients with psychoses, subjects suffering from neurotic (P =0.004) and personality disorders (P=0.029) were more likely to drop out.

Conclusions In the Italian system of community psychiatric care nearly half of the patients are no longer in contact after 2 years. Those who stay in treatment are more likely to suffer from psychosis, suggesting a commitment of Italian out-patient facilities to tackling the needs of patients with more severe disorders.

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