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Introduction: Prior to initiation of the mental health reform in August 2014, people with mental
health problems were provided the bulk of their care in psychiatric hospitals or residential
institutions. While care in institutions was central, a number of people with mental health
problems quality for care in community-based settings, either in: a) primary care services led by
family doctors and nurses; b) community mental health centers staffed by a multidisciplinary
community mental health team, or c) short-term inpatient admission to an acute inpatient ward
in a regional general hospital. To understand how many and which patients qualify for shifting to
services in community settings, this study aims to carry out a psychological and functional
assessment of patients that are residents of the MENSANA project’s 4 pilot rayons (Orhei, Soroca,
Cahul and Cimislia), and after the assessment, applying a referral/indication algorithm for the
more appropriate mental health services that fits their needs. This study carries potential benefits
for people with mental health problems, as they can be re-directed, if necessary, to care that may
be a better fit for their needs and enable them to lead a more fulfilling life in their communities.
Depending on the outcome of the individual assessment, some patients may stay in the service in
which they already receive care (i.e. a psychiatric hospital). This study will have an impact on the
patient flow in the mental health care system in Moldova, particularly for mental health services
in the 4 pilot rayons.
Objective: To conduct a comprehensive diagnostic and functional (psychological and social)
assessment of the patients receiving mental health care that reside in the districts of Orhei, Soroca,
Cimislia or Cahul, in order to determine their further needs for mental health services. A number
of countries have documented the shift in care from psychiatric hospital care to community-based
settings (e.g. England, Canada, Australia). Within these processes, the most frequently assessed
outcomes are social functioning, psychiatric symptoms, and quality of life.
Materials and methods: In order to have a comprehensive assessment to build a patient profile,
the survey developed is a comprehensive assessment consisting of several validated tools and
outcome measures that assess the following dimensions:
• Diagnostic assessment (medical psychiatric assessment);
• Psychological assessment (symptoms and functioning);
• Functional assessment (social functioning, daily life functioning, quality of life).
The first part of the assessment obtains patient-level information which can either be completed
by a ward staff member or CMHC employee and corroborated by the patient. Demographic and
socioeconomic data such as (1) gender, (2) age, (3) partner status, (4) presence or absence of
children under age 18, (5) housing status: independent living (yes/no), (6) occupational status
(paid job yes/no; if yes, how many hours per week). In addition, we like to have some clinical
information: (1) ICD-10 diagnosis, (2) psychiatric and somatic comorbidities, (3) WHO DAS 2
disability level, (5) EQ-5D quality of life.
Conclusions: Often during the course of a mental health problem in Moldova, patients will rotate
in and out of different kinds of services (e.g., hospital-based or community-based) and receive
different kinds of health care interventions (e.g., pharmacological). Given these changes in service
utilization patterns, it is important to capture the types of treatments and services received by
patients to be able to compute the economic costs of offering these treatments and services. |
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