- Klíčová slova
- Ostrava,
- MeSH
- dětské psychiatrické poradenské kliniky organizace a řízení MeSH
- dítě MeSH
- klinické kompetence normy MeSH
- lidé MeSH
- nemocnice fakultní organizace a řízení MeSH
- psychiatrie - pomocný personál výchova MeSH
- studium lékařství dějiny organizace a řízení MeSH
- studium ošetřovatelství vysokoškolské dějiny organizace a řízení MeSH
- univerzity dějiny organizace a řízení MeSH
- ústavy pro duševně nemocné * ekonomika organizace a řízení MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- MeSH
- lidé MeSH
- psychiatrické oddělení nemocnice organizace a řízení MeSH
- reforma zdravotní péče MeSH
- služby péče o duševní zdraví * dějiny organizace a řízení MeSH
- ústavy pro duševně nemocné ekonomika organizace a řízení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Information about unit costs of psychiatric care is largely unavailable in Central and Eastern Europe, which poses an obstacle to economic evaluations as well as evidence-based development of the care in the region. OBJECTIVE: The objective of this study was to calculate the unit costs of inpatient and community mental health services in Czechia and to assess the current practices of data collection by mental healthcare providers. METHODS: We used bottom-up microcosting to calculate unit costs from detailed longitudinal accounts and records kept by three psychiatric hospitals and three community mental health providers. RESULTS: An inpatient day in a psychiatric hospital costs 1504 Czech koruna (CZK; €59), out of which 75% is consumed by hotel services and the rest by medication and therapies. The costed inpatient therapies include individual therapies provided by a psychiatrist or psychologist, consultations with a social worker, group therapies, organised cultural activities and training activities. As regards the community setting, we costed daycare social facilities, case management services, sheltered housing, supported housing, crisis help, social therapeutic workshops, individual placement and support, and self-help groups. CONCLUSIONS: The unit costs enable assigning financial value to individual items monitored by the Czech version of the Client Service Receipt Inventory, and thus estimation of costs associated with treatment of mental health problems. The employed methodology might serve as a guideline for the providers to improve data collection and to calculate costs of services themselves, with this information likely becoming more crucial for payers in the future.
- MeSH
- lékařská praxe založená na důkazech * MeSH
- lidé MeSH
- reforma zdravotní péče * MeSH
- služby v oblasti duševního zdraví komunity ekonomika MeSH
- ústavy pro duševně nemocné ekonomika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: The absence of economic evidence hinders current reforms of hospital-based mental health systems in central and eastern Europe. We aimed to assess the cost-effectiveness of discharge to community care for people with chronic psychoses compared with care in psychiatric hospitals in the Czech Republic. METHODS: We did a prospective study of people aged 18-64 years with chronic psychotic disorders in the Czech Republic who had been discharged into community services or were receiving inpatient psychiatric care for at least 3 months at baseline. We measured health-related quality of life with the EuroQol five-dimension five-level questionnaire. Adjusting for baseline differences between the two groups, we assessed differences in societal costs in 2016 and quality-adjusted life-years (QALYs) during a 12-month follow-up, which we then used to estimate the incremental cost-effectiveness ratio (ICER). We did multiple sensitivity analyses to assess the robustness of our results. FINDINGS: In our baseline case scenario, we included 115 patients who were either community service users (n=35) or inpatients (n=80) at baseline. The two groups were similar in terms of baseline characteristics. The annual QALY was 0·77 in patients receiving community care at baseline compared with 0·80 in patients in hospital at baseline (difference 0·03, 95% CI -0·04 to 0·10), but the costs of discharge to the community were €8503 compared with €16 425 for no discharge (difference €7922, 95% CI 4497-11 346), such that the ICER reached more than €250 000 per QALY. This ICER is substantially higher than levels that are conventionally considered to be cost-effective and the estimated probability that discharge to the community was cost-effective was very high (≥97%). None of the sensitivity analyses changed these results qualitatively. INTERPRETATION: This study provides economic evidence for deinstitutionalisation by showing that discharge to community care is cost-effective compared with care in psychiatric hospitals in the Czech Republic. These findings add to the human rights and clinical-based arguments for mental health-care reforms in central and eastern Europe. FUNDING: Ministry of Education, Youth and Sports of the Czech Republic; EEA and Norway Grants.
- MeSH
- analýza nákladů a výnosů * MeSH
- dospělí MeSH
- kvalitativně upravené roky života MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- prospektivní studie MeSH
- psychotické poruchy terapie MeSH
- služby v oblasti duševního zdraví komunity ekonomika statistika a číselné údaje MeSH
- ústavy pro duševně nemocné ekonomika statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: A continuous tradition of institutional inpatient alcohol treatment in what is now the Czech Republic dates back to 1948. At present this type of treatment generally involves the so-called “Apolinar Addiction Treatment Model”. Prior to the establishment of this treatment facility, there were three institutional inpatient facilities specialising in the treatment of alcohol dependency in what was then, or was later to become, Czechoslovakia. They were located respectively in Velké Kunèice, Tuchlov, and Istebné nad Oravou. The founder of the current model built upon these earlier efforts. AIMS: To explore the development, operation, and dissolution of the specialised inpatient alcohol treatment facility in Velké Kunèice, the earliest establishment of its kind in what is now the Czech Republic, using a case study. The person of Father Bedøich Konaøík, its founder and a pioneer of modern addictology, will also be addressed. METHODS: Qualitative content analysis of available historical documents was used to collect the data. The subject matter of the documents was categorised with respect to their association with the onset and development of the phenomenon of institutional inpatient treatment. RESULTS: F. Bedøich Konaøík was concerned with the issues of alcohol dependency and alcohol abuse from 1901 onwards. His first treatises on alcohol dependency were published in 1908. In these texts, in addition to other observations, he advocated the establishment of a specialised institution dedicated to the treatment of alcohol dependency. The institution he had called for was opened in 1911, with F. Bedøich Konaøík-Beèvan becoming its manager. The treatment facility remained in operation until 1915, when it was closed down because all the patients were called up to fight in World War I. CONCLUSION: Qualitative analysis of historical documents confirmed the existence and efficiency of a fully-fledged institutional treatment facility, which from 1911 to 1915 provided alcohol treatment to male patients in Velké Kunèice. This unique treatment approach was initiated on the territory of this country by F. Bedøich Konaøík, who drew inspiration for this approach especially from Switzerland, Sweden, and Germany. In view of the above, F. Bedøich Konaøík can justly be considered the founder and pioneer of modern residential alcohol dependency treatment in Central Europe.
- MeSH
- alkoholismus * dějiny terapie MeSH
- chorobopisy MeSH
- dějiny 20. století MeSH
- ergoterapie MeSH
- hospitalizace MeSH
- lidé MeSH
- protialkoholické hnutí MeSH
- sociální problémy MeSH
- střídmost MeSH
- ustanovení a nařízení MeSH
- ústavy pro duševně nemocné * dějiny ekonomika organizace a řízení pracovní síly MeSH
- Check Tag
- dějiny 20. století MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- historické články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Rakousko-Uhersko MeSH
- O autorovi
- Konařík-Bečvan, Bedřich, 1878-1944 Autorita
Just over 25 years have passed since the major sociopolitical changes in central and eastern Europe; our aim was to map and analyse the development of mental health-care practice for people with severe mental illnesses in this region since then. A scoping review was complemented by an expert survey in 24 countries. Mental health-care practice in the region differs greatly across as well as within individual countries. National policies often exist but reforms remain mostly in the realm of aspiration. Services are predominantly based in psychiatric hospitals. Decision making on resource allocation is not transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be higher than in other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which happened because of grassroots initiatives supported by international organisations, rather than by systematic implementation of government policies.
- MeSH
- celosvětové zdraví MeSH
- duševní poruchy psychologie terapie MeSH
- duševní zdraví trendy MeSH
- lidé MeSH
- průzkumy a dotazníky MeSH
- služby péče o duševní zdraví organizace a řízení MeSH
- společenské stigma MeSH
- ústavy pro duševně nemocné ekonomika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Geografické názvy
- Evropa MeSH
- Klíčová slova
- protialkoholní léčebna,
- MeSH
- alkoholismus * diagnóza terapie MeSH
- alkoholová abstinence * MeSH
- ergoterapie * MeSH
- hydroterapie MeSH
- lidé MeSH
- masáž MeSH
- poskytování zdravotní péče MeSH
- psychoterapie * MeSH
- sporty * MeSH
- tělesná výchova * MeSH
- ústavy pro duševně nemocné * dějiny ekonomika normy organizace a řízení pracovní síly využití MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Slovenská republika MeSH
- MeSH
- náklady na zdravotní péči MeSH
- platba za výkon MeSH
- poplatky a výdaje MeSH
- psychiatrie * ekonomika MeSH
- úhrada služeb Medicare USA * MeSH
- ústavy pro duševně nemocné * ekonomika MeSH
- zdravotní pojištění ekonomika MeSH
- Publikační typ
- úvodníky MeSH
- Geografické názvy
- Česká republika MeSH
