BackgroundThe prevalence of Alzheimer's disease (AD) is increasing, and with it comes the demand for specialized services. Current information on the institutionalization of patients with AD is limited.ObjectiveTo determine the level of institutionalization among AD patients in the facilities of the Czech Republic and the Slovak Republic.MethodsA survey of the rate of institutionalization in facilities in the Czech Republic and Slovak Republic. The survey collects data on the institutionalization of patients suffering from AD in relation to the capacity of the facilities and the prevalence of the disease. Data were collected by representative quantitative survey, during years 2019-2021.ResultsPatients with AD occupy approximately 25% of the total capacities of institutions in the Czech and Slovak Republics. The rate of institutionalization of patients with AD is estimated at 20.5% in the Czech Republic and 24% in the Slovak Republic. This is more than the estimated worldwide rate of institutionalization of people with AD (16%) but less than the estimated rate of institutionalization of these patients in high-income countries (31%).ConclusionsAs the prevalence of AD increases, so do the demands for care. If there is no increase in institutional capacity, this growth will put more pressure on home care. In order to provide specialized care to as many patients as possible, emphasis must be placed on increasing the capacity of institutions.
- MeSH
- Alzheimer Disease * epidemiology therapy MeSH
- Institutionalization * statistics & numerical data trends MeSH
- Humans MeSH
- Prevalence MeSH
- Surveys and Questionnaires MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
- Slovakia MeSH
Článek se zaměřuje na problematiku psychofarmakoterapie u pacientů v dlouhodobé institucionální péči, kde by měl být kladen důraz zejm. na racionální a bezpečnou farmakoterapii. Autorky diskutují specifické výzvy spojené s pokrytím potřeb této populace, zvládáním problematického chování a současně minimalizací rizika nadměrné preskripce. Zdůrazňují, že nevhodné kombinace psychofarmak mohou vést k závažným zdravotním komplikacím. Kriticky hodnotí současnou praxi a snaží se upozornit na potřebu monitorace rizik psychiatrické polyfarmacie. Lékové problémy a konkrétní rizika medikace jsou přiblíženy uvedením příkladů z praxe ve formě třech kazuistik, které jsou opatřeny komentářem klinických farmaceutek. Cílem článku není kritizovat současný stav, ale poskytnout ucelený pohled na problematickou preskripci u této populace a navrhnout strategie, jak se na její rizika zaměřit a následně je zmírnit. Problematika neracionální preskripce u populace dlouhodobě institucionalizovaných pacientů stále nemá v současné době pozornost, jakou by si zasloužila. Je potřeba se tímto tématem více zabývat, a to neznamená jen racionalizovat farmakoterapii, ale nacházet řešení i v oblasti financování, personálního zabezpečení a vůbec dostupnosti zařízení pro tuto cílovou populaci.
The article focuses on the issues of psychopharmacotherapy in patients in long-term institutional care, where emphasis should be placed particularly on rational and safe pharmacotherapy. The authors discuss the specific challenges associated with meeting the needs of this population, managing problematic behaviours, and simultaneously minimizing the risk of over-prescription. They emphasize that inappropriate combinations of psychotropic drugs can lead to serious health complications. They critically evaluate current practices and aim to highlight the need for monitoring the risks of psychiatric polypharmacy. Drug-related problems and specific risks of medication are illustrated by providing examples from practice in the form of three case studies, which are accompanied by commentary from clinical pharmacists. The aim of the article is not to criticize the current state, but to provide a comprehensive view of the problematic prescriptions in this population and propose strategies on how to focus on and subsequently mitigate their risks. The issue of irrational prescription in the population of long-term institutionalized patients still does not receive the attention it deserves. It is necessary to address this topic more thoroughly, which means not only rationalizing pharmacotherapy but also finding solutions in the areas of funding, staffing, and overall availability of facilities for this target population.
- MeSH
- Long-Term Care MeSH
- Mental Disorders drug therapy MeSH
- Institutionalization MeSH
- Drug Interactions MeSH
- Middle Aged MeSH
- Humans MeSH
- Drug-Related Side Effects and Adverse Reactions MeSH
- Polypharmacy * MeSH
- Psychotropic Drugs * administration & dosage pharmacology classification adverse effects MeSH
- Risk MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Review MeSH
BACKGROUND: Secure forensic hospital treatments are resource-intensive, aiming to rehabilitate offenders and enhance public safety. While these treatments consume significant portions of mental health budgets and show efficacy in some countries, their effectiveness in Czechia remains underexplored. Previous research has highlighted various factors influencing the likelihood of discharge from these institutions. Notably, the role of sociodemographic variables and the length of stay (LoS) in the context of forensic treatments has presented inconsistent findings across studies. METHODS: The study, part of the 'Deinstitutionalization project' in Czechia, collected data from all inpatient forensic care hospitals. A total of 793 patients (711 male, 79 female and 3 unknown) were included. Data collection spanned 6 months, with tools like HoNOS, HoNOS-Secure, MOAS, HCR-20V3 and AQoL-8D employed to assess various aspects of patient health, behaviour, risk and quality of life. RESULTS: The study revealed several determinants influencing patient discharge from forensic hospitals. Key assessment tools, such as HoNOS secure scores and the HCR-20 clinical subscale, showed that higher scores equated to lower chances of release. Furthermore, specific diagnoses like substance use disorder increased discharge odds, while a mental retardation diagnosis significantly reduced it. The type of index offense showed no influence on discharge decisions. CONCLUSION: Factors like reduced risk behaviours, absence of mental retardation diagnosis, social support and secure post-release housing plans played significant roles. The results underscored the importance of using standardized assessment tools over clinical judgement. A standout insight was the unique challenges faced by patients diagnosed with mental retardation, emphasizing a need for specialized care units or tailored programmes.
- MeSH
- Deinstitutionalization MeSH
- Length of Stay * MeSH
- Adult MeSH
- Mental Disorders * therapy MeSH
- Quality of Life MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Patient Discharge * MeSH
- Forensic Psychiatry MeSH
- Hospitals, Psychiatric * MeSH
- Criminals psychology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
This study objective to verify the existence of gaps in the dynamics and performance of fulfillment of the deinstitutionalization of psychiatric care in the Czech Republic (CZ) and the Slovak Republic (SR) in the period between 2010 and 2020. The introduction of this the study is a search for expert knowledge in the field of deinstitutionalization of psychiatric care. The study uses the method of multi-criteria comparison of TOPSIS variants and a cluster analysis. The results 22 variants range from (ci 0.6716-0.2571) and confirm that there are large differences between CZ and SR in performance gaps (fulfillment) of deinstitutionalization goals. The SR variants are clearly better than the CZ variants, although during the years studied, the CZ variants are improving, and the size of the gap compared to the SR variants is decreasing. In the first year of the evaluated period (2010), the performance gap was 56% and in the last year (2020), the performance gap was only 31%. The conclusion of the study confirms that the measures associated with the deinstitutionalization of psychiatric care are linked to the time they were introduced and the overall implementation period of the reform.
- MeSH
- Deinstitutionalization * MeSH
- Mental Disorders * MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
CÍLE: Cílem přehledové historizující stati je popsat na příkladu Spojených států amerických proces deinstitucionalizace psychiatrických nemocnic a jeho nezamýšlené důsledky mnohdy vyúsťující v transinstitucionalizaci osob v jiných typech institucí. TEORETICKÁ VÝCHODISKA: Proces deinstitucionalizace v USA je úzce propojený s problémem hromadného věznění, i když ho nelze považovat za jeho přímou příčinu. Na deinstitucionalizaci je nahlíženo v kontextu lidských práv prosazovaných v rámci hnutí abolicionismu. METODY: Pro inspiraci nastavování procesu deinstitucionalizace služeb sociální práce v České republice jsme zvolili přehledovou historizující stať a příklad Spojených států amerických. VÝSLEDKY: Z předložené kulturně historické zkušenosti vyplývá, že proces deinstitucionalizace může vést k transinstitucionalizaci osob v jiných typech pobytových zařízení, čemuž je třeba předcházet. IMPLIKACE PRO SOCIÁLNÍ PRÁCI: Naše zjištění lze využít při plánování a následné realizaci procesů transformace či deinstitucionalizace ve všech typech „ústavních“ zařízení sociální práce. V rámci těchto je nezbytné (1) zajistit dostupnou síť navazujících služeb sociální práce poskytovaných v přirozeném sociálním prostředí; (2) připravit kvalitní individualizovaný transformační plán; (3) mít vytvořenu funkční interdisciplinární spolupráci; (4) sbírat data o počtech uvězněných lidí s duševním onemocněním; (5) usilovat o všeobecnou dostupnost sociálního bydlení a (6) usilovat o stabilní přísun financí, který bude dostatečný pro zajištění potřebných služeb.
OBJECTIVES: This article aims to provide an overview of deinstitutionalisation in psychiatric hospitals and its unintended outcomes that led to trans-institutionalisation of people with severe mental illnesses in other types of institutions. THEORETICAL BASE: The process of deinstitutionalisation in the USA is linked with the rise of mass incarceration, although deinstitutionalisation cannot be considered its cause. This article views deinstitutionalisation from an abolitionist framework that supports human rights. METHODS: We are providing a contextualising, historical overview of deinstitutionalisation in the USA in hopes that it will inform the process of deinstitutionalisation in the Czech Republic. OUTCOMES: Given these experiences it is apparent that deinstitutionalisation can lead to trans-institutionalisation, and that preventative measures are needed. SOCIAL WORK IMPLICATIONS: Our findings can be used for planning and the implementation of transformative processes and deinstitutionalisation of all types of institutions. It is necessary to (1) secure an accessible network of wrap-around services in the community; (2) prepare a thorough individualised plan for people leaving an institution; (3) form functional interdisciplinary collaboration; (4) collect data about the number of incarcerated people with mental illnesses, (5) advocate for access to affordable housing; and (6) advocate for stable sources of funding for creation of necessary services.
- MeSH
- Deinstitutionalization * MeSH
- Humans MeSH
- Social Welfare * MeSH
- Social Work MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Teoretik
Vydání první 164 stran ; 21 cm
Publikace se zaměřuje na aktuální právní úpravu ochranného léčení a zabezpečovací detence v Česku. Určeno odborné veřejnosti.
- Keywords
- ochranné léčení, zabezpečovací detence,
- MeSH
- Persons with Psychiatric Disorders MeSH
- Involuntary Commitment MeSH
- Involuntary Treatment, Psychiatric MeSH
- Criminal Law MeSH
- Residential Treatment MeSH
- Hospitals, Psychiatric MeSH
- Legislation as Topic MeSH
- Criminals MeSH
- Publication type
- Monograph MeSH
- Geographicals
- Czech Republic MeSH
- Europe MeSH
- Conspectus
- Trestní právo
- NML Fields
- právo, zákonodárství
- Keywords
- komunita,
- MeSH
- Deinstitutionalization * organization & administration trends MeSH
- Humans MeSH
- Patient Care Management MeSH
- Personal Narratives as Topic MeSH
- Patient Care trends MeSH
- Persons with Disabilities * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Interview MeSH
- Keywords
- komunita,
- MeSH
- Residence Characteristics MeSH
- Deinstitutionalization * history methods organization & administration statistics & numerical data MeSH
- Humans MeSH
- Patient Care Management history MeSH
- Patient Care history methods statistics & numerical data MeSH
- Persons with Disabilities * MeSH
- Health Policy MeSH
- Check Tag
- Humans MeSH
- Geographicals
- Norway MeSH
