Does the mental health system provide effective coverage to people with schizophrenic disorder? A self-controlled case series study in Italy
Authors: Corrao Giovanni , Barbato Angelo , D’Avanzo Barbara , Di Fiandra Teresa , Ferrara Lucia , Gaddini Andrea , Monzio Compagnoni Matteo , Saponaro Alessio , Scondotto Salvatore , Tozzi Valeria D. , Carle Flavia , Lora Antonio ,   the “QUADIM project”, “Monitoring, assessing care pathways (M. A. P.)” working groups of the Italian Ministry of Health, Di Fiandra Teresa , Magliocchetti Natalia , Lora Antonio , Barri Miriam , Saponaro Alessio , Gaddini Andrea , Mattia Valentina , Scondotto Salvatore , Pollina Addario Walter , Berardi Marco , Di Giorgi Monica , Corrao Giovanni , Monzio Compagnoni Matteo , Barbato Angelo , D’Avanzo Barbara , Monti Igor , Tozzi Valeria , Ferrara Lucia , Carle Flavia , Bucci Andrea , Casoli Chiara , Dajko Marianxhela , Bellentani Donata , Carbone Simona , Ceccolini Carla , De Feo Angela , Giordani Cristina , Lispi Lucia , Mariniello Rosanna , Medici Federica , Pisanti Paola , Visca Modesta , Zanini Rinaldo , Cantarutti Anna , Corrao Giovanni , Pugni Pietro , Rea Federico , Davoli Marina , Di Martino Mirko , Vittori Patrizia , Vuillermin Giuliana , Bernardo Alfonso , Fusciante Anna , Belotti Laura , De Palma Rossana , Di Felice Enza , Di Lenarda Andrea , Prezza Marisa , Fusco Danilo , Lallo Adele , Marinacci Chiara , Blaco Roberto , Leoni Olivia , Lora Antonio , Spazzafumo Liana , Pizzi Simone , Simiele Maria , Massaro Giuseppe , Attolini Ettore , Lepore Vito , Petrarolo Vito , Scondotto Salvatore , De Luca Giovanni , Francesconi Paolo , Rizzuto Carla , Avossa Francesco , Vigna Silvia , Dondi Letizia , Martini Nello , Pedrini Antonella , Piccinni Carlo , Cosentino Mimma , Marvulli Maria Grazia , Maggioni Aldo 
Published: June 2021

Abstract
Purpose
To measure indicators of timeliness and continuity of treatments on patients with schizophrenic disorder in ‘real-life’ practice, and to validate them through their relationship with relapse occurrences.

Methods
The target population was from four Italian regions overall covering 22 million beneficiaries of the NHS (37% of the entire Italian population). The cohort included 12,054 patients newly taken into care for schizophrenic disorder between January 2015 and June 2016. The self-controlled case series (SCCS) design was used to estimate the incidence rate ratio of relapse occurrences according to mental healthcare coverage.

Results
Poor timeliness (82% and 33% of cohort members had not yet started treatment with psychosocial interventions and antipsychotic drug therapy within the first year after they were taken into care) and continuity (27% and 23% of patients were persistent with psychosocial interventions, and antipsychotic drug therapy within the first 2 years after starting the specific treatment) were observed. According to SCCS design, 4794 relapses occurred during 9430 PY (with incidence rate of 50.8 every 100 PY). Compared with periods not covered by mental healthcare, those covered by psychosocial intervention alone, antipsychotic drugs alone and by psychosocial intervention and antipsychotic drugs together were, respectively, associated with relapse rate reductions of 28% (95% CI 4–46%), 24% (17–30%) and 44% (32–53%).

Conclusion
Healthcare administrative data may contribute to monitor and to assess the effectiveness of a mental health system. Persistent use of both psychosocial intervention and antipsychotic drugs reduces risk of severe relapse.