LE PROPOSTE INNOVATIVE NEL CENTRO DI SALUTE MENTALE

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Evelina Catalano
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1 Giovedi 9 ottobre 2014 Terapie integrate in Psichiatria modelli e attività a confronto LE PROPOSTE INNOVATIVE NEL CENTRO DI SALUTE MENTALE Enrico Zanalda Direttore DSM Funzionale ASL TO3 Segretario 2012/15 Società Italiana di Psichiatria ezanalda@aslto3.piemonte.it

MENTALE Enrico Zanalda Direttore DSM Funzionale ASL TO3 Segretario

2 Rilevazione SIP 2013 Tasso copertura DSM E.ZANALDA, 2014

3 Rilevazione SIP 2013 Tasso copertura CSM E.ZANALDA, 2014

4 Rilevazione SIP 2013 Dimensioni Medie DSM E.ZANALDA, 2014

5 Presenza di Servizi e Strutture nei DSM 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% CSM CD Spdc Residenziali DH Centro crisi E.ZANALDA, 2014

6 Numero di CSM ogni abitanti da scheda DSM, per regione Friuli-Venezia-Giulia Calabria Piemonte Trentino Alto-adige Abruzzo Sardegna Liguria Campania Puglia Lombardia Toscana Sicilia Marche Veneto Molise Emilia Romagna 0,00 1,00 2,00 3,00 E.ZANALDA, 2014

7 CRISI DEL CENTRO DI SALUTE MENTALE -Centro operativo presa in carico e percorso di cura paziente nel DSM -Contrazione risorse ed energie umane + incremento richieste e responsabilità -Richiesta percorsi standardizzati ed esiti processi di cura -Fondo Sanitario, intervento psicosociale e crisi economica -Difficoltà integrare interventi ed escludere utenti aree di confine -Età ingresso >18 anni, età uscita..>?

standardizzati ed esiti processi di cura -Fondo Sanitario, intervento psicosociale e crisi economica

8 CENTRO DI SALUTE MENTALE -Innovazioni organizzative: Definizione compiti e confini d intervento del CSM Concentrazione personale e ridefinizione ruoli operativi PDTA definiti in base alle risorse disponibili Informatizzazione e telemedicina

Concentrazione personale e ridefinizione ruoli operativi

9 Telepsychiatry in the 21st Century: Transforming Healthcare with Technology Deslich S, Stec B, Tromblin S, Coustasse A Perspectives in Health Information Management, Summer 2013 This article describes the benefits and constraints of telemedicine, focusing primarily on the field of psychiatry in the United States with the current system of healthcare. Telepsychiatry is believed to provide better access and higher-quality care to patients who need psychiatric care and cost savings to providers of such care. Telemedicine has been successfully integrated into psychiatric facilities reaching rural areas, prisons, and urban facilities. It has increased the volume of patients that physicians can reach and diagnose, as well as allowing them to treat patients with limitations in mobility. While telepsychiatry has been shown to be beneficial, this technology does have some limitations. Concerns about reimbursement, licensure, privacy, security, patient safety, and interoperability have been identified and present current challenges that providers using telepsychiatry must overcome in order to provide the most effective patient care. As more insurance companies start to reimburse for telepsychiatry treatments at the same rate as for faceto-face visits, this evolving medical field has the potential to grow exponentially.

Telepsychiatry is believed to provide better access and higher-quality care to patients who need psychiatric care and cost savings to providers of such care.

10 Hilty DM, Ferrer DC, Burke Parish M, Johnston B, Callahan EJ, Yellowlees PM TELEMEDICINE and e-health JUNE 2013 Today, telemental health services are unquestionably effective in most regards, although more analysis is needed. They are effective for diagnosis and assessment, across many populations (adult, child, geriatric, and ethnic), and in disorders in many settings (emergency, home health), are comparable to in-person care, and complement other services in primary care. Overall, better evaluation with formal measures (i.e., randomized trials, lack of inferiority designs) and analysis of variance to predictors of outcomes are necessary. Studies need to be focused on areas where there is currently a relative paucity of information, such as anxiety, substance use, and psychotic and other disorders.

They are effective for diagnosis and assessment, across many populations (adult, child, geriatric, and ethnic), and in disorders in many settings (emergency, home health), are comparable to in-person

11 Chipps J, Brysiewicz P, Mars M, Afr J Psychiatry 2012;15:

12 When considering smaller studies, some criticisms pertaining to telepsychiatry about technicalities (Nelson et al., 2003; Sorvaniemi et al., 2005; Greenberg et al., 2006), level of encouragement (Urness et al., 2006), and privacy issues (Myers et al., 2006) arise. In addition, when looking at the relevant economic dimension (e.g., costs of the telepsychiatric intervention as compared to the TAU) in smaller studies, telepsychiatry in some cases implied higher costs than TAU (Cluver et al., 2005; Modai et al., 2006). However, in most of the larger studies, telepsychiatry was economically more sustainable than TAU (Edwards et al., 2003; O Really et al., 2007; Smith et al., 2007).

ment (Urness et al., 2006), and privacy issues (Myers et al., 2006) arise. In addition, when looking

13 Improving the Cost-Effectiveness of a Healthcare System for Depressive Disorders by Implementing Telemedicine: A Health Economic Modeling Study Lokkerbol J, Adema D, Cuijpers P, Reynolds CF, Schulz R, Weehiuzen R, Smit F. Am J Geriatr Psychiatry 22:3, March 2014 Conclusions For a healthcare system for depressive disorders to remain economically sustainable, its costbenefi t ratio needs to be improved. Offering preventive telemedicine at a large scale is likely to introduce such an improvement.

Am J Geriatr Psychiatry 22:3, March 2014 Conclusions For a healthcare system for depressive disorders to remain economically

14 Telepsychiatry: new perspectives and open issues Marta Valdagno, Arianna Goracci, Silvia di Volo and Andrea Fagiolini CNS Spectrums / FirstView Article / June 2014, pp 1 3 Telepsychiatry, thanks to the continuous advance of technologies, is an area with excellent prospects to become an effective tool for assistance in psychiatry. Many studies evaluated the effectiveness of telepsychiatry in different psychiatric disorders like anxiety disorders, psychotic disorders and depression. Results showed that telepsychiatry seems to be promising in anxiety and depressive disorders, especially in the maintenance phase, and also for psychotic disorders, especially for these cases with a poor compliance. We reviewed the literature to evaluate the feasibility of telepsychiatry in Italy in terms of satisfaction, costs and cultural acceptability and considering ethical and legal aspects. In Italy the development of telemedicine still presents a high level of fragmentation. A potential integration of these new types of services with the health care system is a very challenging task and poses many legal and ethical challenges. Therefore the creation of legal instruments and formal professional ethical guidelines are needed.

Many studies evaluated the effectiveness of telepsychiatry in different psychiatric disorders like anxiety disorders, psychotic disorders and depression.

15 Clinician satisfaction is less well evaluated; the degree of satisfaction was often related to the quality of the audio and video used. The new generation s familiarity with technology makes this a more feasible possibility; the lack of valid scientific evidence limits the full applicability of this technique Particularly in Italy, there are currently only fragmented and experimental projects of uncertain duration in limited areas and not fully integrated into the health system. MasterMind EU pilot project involves 2 similar public Mental Health Agency of 2 different italian regions: a) USL TV in Veneto b) ASL TO3 in Piedmont More over in this project we will use 2 different telemedicine technologies for the treatment of depressive patients: a) ccbt b) videoconference

Italy, there are currently only fragmented and experimental projects of uncertain duration in limited areas and not fully integrated into the health system.

16 MASTERMIND ( ) MAnagement of mental health disorders Through advanced technology and services telehealth for the MIND Program: ICT Policy Support Programme Call: CIP-ICT-PSP Funding scheme: Pilot Type A - CIP-ICT-PSP-PA Activity: CIP7-Theme 3 -ICT for health, ageing well and inclusion

Policy Support Programme Call: CIP-ICT-PSP-2013-7 Funding scheme: Pilot

17 MasterMind intende: 1) Implementare video-conferenza (VC) per supporto specialistico al MMG trattamento depressione; 2) Implementare su vasta scala (5.000 pazienti) in 11 Paesi Europei servizi di Terapia Cognitivo- Comportamentale computerizzata (ccbt) rivolti ad adulti affetti da depressione.

18 CIP-ICT-PSP MasterMind GA no

19 Obiettivi: 1)Applicazione linee-guida per facilitare trattamento della depressione all interno dei CSM, facilitando rapporti fra Specialisti, MMG e pazienti; 1)Identificare ostacoli e fattori facilitanti l implementazione di strumento ccbt in diversi contestisociali, economicie sanitari.

MMG e pazienti; 1)Identificare ostacoli e fattori facilitanti l

20 Mastermind e contesto europeo di riferimento EIP on AHA «European Innovation Partenship on Active and Healthy Ageing» Working Group B3 «Integrated Care» Mastermind Pilot Type A composto da progetti pilota locali Pilota piemontese: costruzione di una Best practice locale Ponte verso nuove progettualità nell ambito di Horizon Societal Challenge Health, demographic change and wellbeing

progetti pilota locali Pilota piemontese: costruzione di una Best practice locale Ponte verso

21 Riassumendo La telepsichiatria è una promettente modalità di intervento innovativo in ambito psichiatrico per il trattamento di differenti patologie ed è ben accettata da pazienti di tutte le età ed estrazione soaciale; In molte esperienze (DEA, residenze) la telepsichiatria è paragonabile agli interventi di cura diretti e appare un utile complemento per gli interventi degli specialisti con i MMG; La telepsichiatria è sia efficace clinicamente che vantaggiosa economicamente, ma questi vantaggi in letteratura sono evidenti negli studi su larga scala; aumenta le possibilità di trattamento della depressione.

22 Chiunque abbia il controllo della tecnologia ha nelle mani il mondo

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