Miglioramento clinico e soddisfazione del paziente come indici di qualità nel ricovero psichiatrico

Aim. During the last decades an increasing interest in the consumer perspective on psychiatric care has developed; evaluation of patients' perspective of psychiatric admission is important to improve treatment quality. The aims of our study were: 1) to analyze the quality of psychiatric hospitalization from an objective viewpoint, investigating improvement of clinical condition at discharge, in a University Psychiatric Clinic in patients affected by depressive disorder, bipolar disorder or psychotic disorder; and 2) to investigate the subjective viewpoint by assessing customer satisfaction in a sample of hospitalized patients. Methods. A sample of 160 consecutive patients voluntarily hospitalized with diagnoses of depressive disorder, bipolar disorder, psychotic disorder, was recruited at the University Psychiatric Clinic, in the period January 2007-December 2008. The diagnosis on Axis I of the DSM-IV-TR was made according to the DSM-IV-TR criteria and was confirmed using the Structured Clinical Interview for DSM-IV disorders (SCID). Psychiatric assessment included the Clinical Global Impression Severity Scale (CGI-S), and the Brief Psychiatric Rating Scale (BPRS). A standardized patient satisfaction questionnaire (General Satisfaction Questionnaire For Use with Psychiatric In-Patients, GSQ), assessing patients' experience of psychiatric admission, has been administered to the sample. We evaluated possible differences comparing BPRS and CGI-S scores at admission and discharge in the different diagnostic subgroups (ANOVA for repeated measures). We used ordered logistic regression to investigate the distribution of satisfaction categories. Results. Demographic variables (age, education, age of onset, hospitalization, length of stay) are summarized in Table I. BPRS scores (total and domains) at admission were significantly different between diagnostic groups (Table II). Upon discharge from hospital our results showed a significant improvement in symptomatology in the whole sample (Table III) with significant differences among diagnoses. The analysis of the distribution of responses to the GSQ showed that a significantly higher number of patients chose as responses "very satisfied" and "satisfied" (Table IV). All patients seemed to be satisfied with hospitalization (Table V). Conclusion. All patients showed an improvement in clinical measures and high satisfaction with psychiatric hospitalization. Different diagnostic groups had an improvement in characteristic symptomatology, but the anxiety-depression BPRS domain showed the highest percentage of change for all diagnostic groups. We suppose that hospitalisation has two effects, a specific one, due to psychopharmacological therapies, and a nonspecific one, due to placebo-like effects. Investigating patients' satisfaction might also be useful to improve mental health services, to focus on patients expectations about hospitalization and to identify factors involved in patients' satisfaction.