Quality assessment of psychopharmacologicaltreatment in mental health hospitals in Turkey

Objective: In recent years, the health insurance companies and government agencies focused on the assesment of health care owing to steady increase in the cost of mental health care due to overuse of certain diagnostic and therapeutic techniques. Thus ?Quality Assurance Programs? were developed in order to observe and compare the adequate use of medication in accordance with desired standarts and correct the possible problems. The aim of this study was to evaluate the practice in three mental hospitals in Turkey according to ?Quality Assurance Program?. Method: With the ?Quality Assurance Program?, the quality of care can be assessed by evaluating aspects of ?structure?, ?process? and ?outcome?. ?Psychopharmacological Screening Criteria? have been developed by American Psychiatric Association in order to evaluate the quality of the process of drug treatments. In this study, by using the Psychopharmacological Screening Criteria in three Mental Health Hospitals in Turkey, 612 inpatient documentations were reviewed retrospectively and inspected for antipsychotic, antiparkinsonian, anxiolytic, antidepressive drug and lithium treatments. Results: The most important problems regarding quality assurance in these mental hospitals were deficiency in required minimal documentation, unacceptable dosage range, unusual duration of therapy, unusual concomitant prescribing, critical adverse effects, critical adjunctive services and relative contraindicative drug usage. Minimal documentation deficiency which is the most valuable resource of information in implementation of quality assurance was found to be inadequate in about 30-77.7% of all cases. Critical adjunctive services were also insufficient in all psychotropic medications with a ratio between 26.2-65.1%. Conclusion: We determined that deficiency in minimal documentation requirement and polypharmacy are the main problem areas that should be focused on. This might be a resulf of a much lower number of psychiatric beds in Turkey than in other countries. There are only 6000 beds in Turkey instead of an optimal number of 60 000. Premature discharge due to lack of available psychiatric beds and revolving door syndrome are other important problem areas in assuring quality in providing mental health service.