ISSN 1302-6631
 

Original Research (Original Article) 


The effect of structural and functional changes in a psychiatric state hospital on the quality of psychiatric treatment

Mustafa Bilici, Ergün Sevinç, Cüneyt Ünsal, Aytül Hariri, Hülya Ensari.

Abstract
Objective: The aim of the study is to compare the quality of inpatient psychiatric treatment services offered by the hospital before and after the hospital’s conversion. The main hypothesis of the study is that the quality of the inpatient psychiatric treatment services offered by the hospitals has improved after the conversion. Methods: This study compares the quality of inpatient psychiatric treatment services offered at Erenköy Psychiatric State Hospital before the conversion between the years 2005-2006 (Period A) and after the conversion between the years 2007-2008 (Period B). The study is completely based upon the files of the inpatients who have been treated in both Period A and Period B (n= 185, 100 male, 85 female), which were reviewed retrospectively. Psychopharmacologic Screening Criteria, duration of hospital stay, number of stay, the duration between the last two stays, the range of diagnosis between entrance and discharge, the types of acceptance into the hospital and the details of the electroconvulsive therapy are some of the parameters used for comparison. Results: It was found that the number of hospital stays within Period A is significantly higher than the number of hospital stays in Period B. In addition the duration between the last two hospital stays was found to be significantly longer in Period B. The usage rate of typical antipsychotics was found to be decreased significantly in Period B. In contrast, the usage rate of atypical antipsychotics was found to be increased in Period B. The usage rate of anticholinergics (AC) accompanied by more than one psychotropic medication was found to be significantly higher in Period A. The ratio of off-label use of antipsychotics (AP) and antidepressants (AD) were found to be higher in the Period A. However, the ratio of off-label use of AD was found to be higher in the Period B. Lack of drug documentation was higher than the minimal acceptable level of 10% in Period A. The unacceptable dosage range of AP, AC and mood stabilizer medications was significantly higher in Period A. Discussion: It is suggested that the quality level of the inpatient psychiatric treatment offered in Period B was higher than in Period A. This can be attributed to intensive clinical workload of the doctors. Thus, the transformation of the psychiatric hospitals into training and research hospitals may contribute to the decrease in the intensive clinical workload and in return increase the quality of inpatient psychiatric treatment.
Key words:

Key words: psychiatric state hospital, training and research hospital, quality of psychiatric treatment



Bir psikiyatri devlet hastanesindeki yapısal ve işlevsel dönüşümün psikiyatrik tedavi kalitesine etkisi

Özet
Giriş: Bu çalışmacının amacı bir psikiyatri devlet hastanesinin eğitim ve araştırma hastanesine dönüştürülmeden önceki ve sonraki dönemlerinde sunulan yataklı psikiyatrik tedavi hizmetlerin kalitesini karşılaştırmaktır. Çalışmanın temel varsayımı, dönüşümden sonra yataklı psikiyatrik tedavi hizmetlerin kalitesinin yükseldiğidir. Yöntem: Bu çalışmada, Erenköy Ruh ve Sinir Hastalıkları Hastanesi’nde sunulan yataklı psikiyatrik hizmetlerin, dönüşümden önceki 2005-2006 yılları arası (A dönemi) ve dönüşümden sonraki 2007-2008 yılları arasında (B dönemi) sunulan psikiyatrik hizmetlerinin kalitesi karşılaştırılmıştır. Çalışma hem A, hem de B döneminde yatarak tedavi edilmiş olan tüm hastaların (s=185, 100 erkek, 85 kadın) dosya bilgileri üzerinden geriye dönük olarak gerçekleştirilmiştir. Karşılaştırmada Psikofarmakolojik Tarama Ölçütleri, yatış süresi, yatış sayısı, son iki yatış arasında geçen süre, yatış ve çıkış tanı dağılımları, kliniğe kabul biçimleri ve hastalara uygulanan EKT tedavisinin ayrıntıları gibi parametreler kullanılmıştır. Bulgular: A döneminde hastaların hastaneye yatış sayısı B dönemine göre anlamlı olarak fazla bulunmuştur. Ayrıca hastaların son iki yatışı arasındaki süre B döneminde anlamlı olarak yüksek bulunmuştur. B döneminde A dönemine göre klasik antipsikotik kullanım oranı anlamlı olarak azalmış, buna karşın atipik antipsikotik kullanım oranı artmıştır. Antikolinerjik (AK) kullanımı sırasında birlikte birden fazla psikotrop ilaç kullanım oranı A döneminde anlamlı olarak daha yüksek bulunmuştur. A döneminde antipsikotik (AP) ve antidepresan (AD) ilaçların, B döneminde ise sadece AD grubu ilaçların daha fazla oranda endikasyon dışı kullanıldığı saptanmıştır. A döneminde tüm ilaçların dokümantasyon eksikliği oranları, kabul edilen %10 sınırının üzerindedir. A döneminde AP, AK ve duygudurum düzenleyici ilaçların belirlenen doz aralıkları dışında kullanım oranları B dönemine göre anlamlı olarak yüksek bulunmuştur. Tartışma: Hastalara B döneminde sunulan psikiyatrik hizmet kalitesinin A dönemine göre yükseldiği söylenebilir. Bu durum hekimlerin A dönemindeki klinik yoğunluğuna bağlanabilir. Psikiyatri hastanelerinin eğitim ve araştırma hastanelerine dönüştürülmesinin hekimlerin klinik yoğunluğunu azaltarak kaliteyi artıracağı söylenebilir.

Anahtar Kelimeler: Psikiyatri devlet hastanesi, eğitim ve araştırma hastanesi, psikiyatrik tedavi kalitesi


 
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How to Cite this Article
Pubmed Style

Bilici M, Sevinc E, Unsal C, Hariri A, Ensari H. [The effect of structural and functional changes in a psychiatric state hospital on the quality of psychiatric treatment]. Anadolu Psikiyatri Derg. 2013; 14(2): 100-107. Turkish. doi:10.5455/apd.34485


Web Style

Bilici M, Sevinc E, Unsal C, Hariri A, Ensari H. [The effect of structural and functional changes in a psychiatric state hospital on the quality of psychiatric treatment]. http://www.anadolupsikiyatri.net/?mno=34485 [Access: April 26, 2018]. Turkish. doi:10.5455/apd.34485


AMA (American Medical Association) Style

Bilici M, Sevinc E, Unsal C, Hariri A, Ensari H. [The effect of structural and functional changes in a psychiatric state hospital on the quality of psychiatric treatment]. Anadolu Psikiyatri Derg. 2013; 14(2): 100-107. Turkish. doi:10.5455/apd.34485



Vancouver/ICMJE Style

Bilici M, Sevinc E, Unsal C, Hariri A, Ensari H. [The effect of structural and functional changes in a psychiatric state hospital on the quality of psychiatric treatment]. Anadolu Psikiyatri Derg. (2013), [cited April 26, 2018]; 14(2): 100-107. Turkish. doi:10.5455/apd.34485



Harvard Style

Bilici, M., Sevinc, E., Unsal, C., Hariri, A. & Ensari, H. (2013) [The effect of structural and functional changes in a psychiatric state hospital on the quality of psychiatric treatment]. Anadolu Psikiyatri Derg, 14 (2), 100-107. Turkish. doi:10.5455/apd.34485



Turabian Style

Bilici, Mustafa, Ergun Sevinc, Cuneyt Unsal, Aytul Hariri, and Hulya Ensari. 2013. [The effect of structural and functional changes in a psychiatric state hospital on the quality of psychiatric treatment]. Anatolian Journal of Psychiatry, 14 (2), 100-107. Turkish. doi:10.5455/apd.34485



Chicago Style

Bilici, Mustafa, Ergun Sevinc, Cuneyt Unsal, Aytul Hariri, and Hulya Ensari. "[The effect of structural and functional changes in a psychiatric state hospital on the quality of psychiatric treatment]." Anatolian Journal of Psychiatry 14 (2013), 100-107. Turkish. doi:10.5455/apd.34485



MLA (The Modern Language Association) Style

Bilici, Mustafa, Ergun Sevinc, Cuneyt Unsal, Aytul Hariri, and Hulya Ensari. "[The effect of structural and functional changes in a psychiatric state hospital on the quality of psychiatric treatment]." Anatolian Journal of Psychiatry 14.2 (2013), 100-107. Print.Turkish. doi:10.5455/apd.34485



APA (American Psychological Association) Style

Bilici, M., Sevinc, E., Unsal, C., Hariri, A. & Ensari, H. (2013) [The effect of structural and functional changes in a psychiatric state hospital on the quality of psychiatric treatment]. Anatolian Journal of Psychiatry, 14 (2), 100-107. Turkish. doi:10.5455/apd.34485





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