[Variability of managerial and clinical decisions in mental health services of the Lombardy Region: the vignette method]

This paper concerns one of the four research projects developed during a training course in clinical epidemiology managed by the Lombardy training centers IREF.To compare the recommendations for treatment concerning 9 vignettes derived from the Australian Quality Assurance Project.Six Mental Health Services of Regione Lombardia.For each vignette, all psychiatrists working in the 6 Mental Health Services were asked to fill in a questionnaire about treatment location, psychopharmacology, psychotherapy, priority between psychotherapy and psychopharmacology and degree of difficulty in answering.44 out of 52 target psychiatrists took part to the study. Remarkable variability for treatment location and psychotherapies; moderate variation for psychodrugs prescriptions and a good agreement for diagnoses were observed. In drugs prescription an access of association was observed. The most prevalent model of psychotherapy was the psychodynamic, followed by the cognitive-behavioural and the family-systemic. There was a tendency toward a flexible approach, as suggested by recommendations of different psychotherapeutic models according to the nature of the disorder. No case were judged very difficult; only in 3 cases a judgement of "somewhat difficult" was expressed by more than 20% (but less than 30%) of the psychiatrists.Studies of this type are very easy to carry out and give useful information for continuous training programs and Continuous Quality Improvement projects.