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

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 Erenkoy 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: