Management in healthcare
  • 2019 № 7 Improving the system of organizing the psychiatric aid of the megapolis

    Abstract. Currently, a restructuring of the psychiatric service is carried out in Moscow. The changes are implemented accordingto the concept of socially-oriented psychiatry based on a biopsychosocial approach. Reforms include the reductionof inpatient and the development of an outpatient unit of the psychiatric service. Psychiatric hospitals were merged with outpatient units on a territorial basis.
    The aim of the study was a comprehensive analysis of the psychiatric service functioning in Moscow during the period of
    its restructuring.
    A retrospective analysis of the demographic characteristics of the Moscow population and clinical and epidemiological
    indicators characterizing the incidence of mental disorders, as well as an analysis of the functioning of inpatient and
    outpatient units of the Moscow psychiatric service and its staff, was made. The evaluation of the conversion efficiency
    indicators was made. A sociological survey about the reforms (questionnaire) of specialists and relatives of persons with mental disorders being carried out through questionnaires was also conducted.
    During the transformation of the psychiatric service, the incidence of mental disorders, hospital mortality and the number of cases of disability decreased. The provision of the population with places in day hospitals, the number of places in day hospitals and patients who received assistance in day hospitals, the staffing level of outpatient rates, and the number of visits to district psychiatrists increased. The share of persons involuntarily examined and recognized as in need of inpatient treatment increased from 70% to 100%. According to a sociological survey, most of the heads of structural units of the psychiatric service, psychiatrists, and users of the service positively assess the reforms that have been carried out.
    For a large city, the cluster-modular system of psychiatric service, currently organized in Moscow, is a priority.
    Results of this work have found application in the organization of psychiatric care in Moscow, Vladimir, and Tula regions
    and the city of Sevastopol, and can be put into practice in other major cities of the Russian Federation.

    Authors: Zolotareva L. S. [1] Masyakin A. V. [1]

    Tags: community-based  psychiatry2 health care reform1 health care  surveys2 hospitals2 medical staff5 mental  health  services2 psychiatric1 quality of health care3

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