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Explaining differences in perceived health-related quality of life: a study within the Spanish population. GACETA SANITARIA 2018; 32:447-453. [DOI: 10.1016/j.gaceta.2017.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 11/22/2022]
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Aragonès E, Palao D, López-Cortacans G, Caballero A, Cardoner N, Casaus P, Cavero M, Monreal JA, Pérez-Sola V, Cirera M, Loren M, Bellerino E, Tomé-Pires C, Palacios L. Development and assessment of an active strategy for the implementation of a collaborative care approach for depression in primary care (the INDI·i project). BMC Health Serv Res 2017; 17:821. [PMID: 29237444 PMCID: PMC5729287 DOI: 10.1186/s12913-017-2774-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/01/2017] [Indexed: 11/05/2022] Open
Abstract
Background Primary care is the principal clinical setting for the management of depression. However, significant shortcomings have been detected in its diagnosis and clinical management, as well as in patient outcomes. We developed the INDI collaborative care model to improve the management of depression in primary care. This intervention has been favorably evaluated in terms of clinical efficacy and cost-effectiveness in a clinical trial. Our aim is to bring this intervention from the scientific context into clinical practice. Methods Objective: To test for the feasibility and impact of a strategy for implementing the INDI model for depression in primary care. Design: A quasi-experiment conducted in primary care. Several areas will be established to implement the new program and other, comparable areas will serve as control group. The study constitutes the preliminary phase preceding generalization of the model in the Catalan public healthcare system. Participants: The target population of the intervention are patients with major depression. The implementation strategy will also involve healthcare professionals, primary care centers, as well as management departments and the healthcare organization itself in the geographical areas where the study will be conducted: Camp de Tarragona and Vallès Occidental (Catalonia). Intervention: The INDI model is a program for improving the management of depression involving clinical, instructional, and organizational interventions including the participation of nurses as care managers, the efficacy and efficiency of which has been proven in a clinical trial. We will design an active implementation strategy for this model based on the PARIHS (Promoting Action on Research Implementation in Health Services) framework. Measures: Qualitative and quantitative measures will be used to evaluate variables related to the successful implementation of the model: acceptability, utility, penetration, sustainability, and clinical impact. Discussion This project tests the transferability of a healthcare intervention supported by scientific research to clinical practice. If implementation is successful in this experimental phase, we will use the information and experience obtained to propose and plan the generalization of the INDI model for depression in the Catalan healthcare system. We expect the program to benefit patients, the healthcare system, and society. Trial registration ClinicalTrials.gov identifier: NCT03285659; Registered 12th September, 2017.
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Affiliation(s)
- Enric Aragonès
- Primary Care Area Camp de Tarragona, Catalan Health Institute, Tarragona, Spain. .,Primary Care Research Institute IDIAP Jordi Gol, Barcelona, Spain. .,Centre d'Atenció Primària de Constantí, Carrer dels Horts, 6, 43120, Constantí (Tarragona), Spain.
| | - Diego Palao
- Mental Health Service, University Hospital Parc Taulí, Sabadell, Spain.,Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Germán López-Cortacans
- Primary Care Area Camp de Tarragona, Catalan Health Institute, Tarragona, Spain.,Primary Care Research Institute IDIAP Jordi Gol, Barcelona, Spain
| | - Antonia Caballero
- Primary Care Area Camp de Tarragona, Catalan Health Institute, Tarragona, Spain.,Primary Care Research Institute IDIAP Jordi Gol, Barcelona, Spain
| | - Narcís Cardoner
- Mental Health Service, University Hospital Parc Taulí, Sabadell, Spain.,Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Pilar Casaus
- University Psychiatric Hospital Pere Mata Institute, Reus, Spain
| | - Myriam Cavero
- Mental Health Centre Esquerra Eixample, Hospital Clínic, Barcelona, Spain
| | | | - Víctor Pérez-Sola
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, IMIM, Barcelona, Spain.,CIBERSAM, Madrid, Spain
| | - Miquel Cirera
- Healthcare Corporation Parc Taulí, Primary Care Area, Sabadell, Spain
| | - Maite Loren
- Healthcare Corporation Parc Taulí, Primary Care Area, Sabadell, Spain
| | - Eva Bellerino
- Primary Care Service Vallès Occidental, Catalan Health Institute, Sabadell, Spain
| | - Catarina Tomé-Pires
- Primary Care Research Institute IDIAP Jordi Gol, Barcelona, Spain.,Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Tarragona, Spain.,Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
| | - Laura Palacios
- Primary Care Area Camp de Tarragona, Catalan Health Institute, Tarragona, Spain
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Iglesias-González M, Aznar-Lou I, Gil-Girbau M, Moreno-Peral P, Peñarrubia-María MT, Rubio-Valera M, Serrano-Blanco A. Comparing watchful waiting with antidepressants for the management of subclinical depression symptoms to mild-moderate depression in primary care: a systematic review. Fam Pract 2017; 34:639-648. [PMID: 28985309 DOI: 10.1093/fampra/cmx054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The benefits of watchful waiting (WW) over antidepressants (ADs) for the treatment of depression in primary care (PC) are unclear. Objective We aimed to systematically review the evidence supporting either WW or ADs for the treatment of subclinical depressive symptoms and mild-moderate depression in a PC setting. Methods This systematic review was registered at PROSPERO (42016036345). Four electronic sources (EMBASE, PubMed, PsycINFO, Web of Knowledge) were systematically searched from inception to November 2016 for controlled trials comparing WW and ADs in PC following established guidelines. The studies had to include adult population with new symptoms of subclinical depression or mild-moderate depression. Patients in the intervention group should receive a WW approach, while patients in the control group underwent treatment with ADs. The abstraction form included information on the setting, characteristics of the study population, total sample size, size of the control and intervention groups and date of the study. Outcome measures and variability were extracted. Results The scarcity of studies and the considerable clinical and methodological heterogeneity discouraged us from performing a meta-analysis. Three articles were included and qualitatively synthesized. There was no evidence for the superiority of one treatment option over the other, although two of the studies suggested small differences in favour of ADs when less conservative analyses were conducted (per protocol analysis and analysis not adjusted for missingness predictors). Conclusions Superiority was not demonstrated by either treatment option. More robust evidence is needed to inform recommendations for the management of depressive symptoms in PC.
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Affiliation(s)
- Maria Iglesias-González
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ignacio Aznar-Lou
- Institut de Recerca Sant Joan de Déu, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Madrid, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Montse Gil-Girbau
- Institut de Recerca Sant Joan de Déu, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Madrid, Spain
- School of Pharmacy, University of Barcelona, Barcelona, Spain
- Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | - Patricia Moreno-Peral
- Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
- Unidad de Investigación del Distrito Sanitario de Atención Primaria Málaga-Guadalhorce, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - M Teresa Peñarrubia-María
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
- Idiap Jordi Gol i Gurina, Institut Català de la Salut (ICS), Catalonia, Spain
| | - Maria Rubio-Valera
- Institut de Recerca Sant Joan de Déu, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Madrid, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
- School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
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Impacto económico y carga de los trastornos mentales comunes en España: una revisión sistemática y crítica. ANSIEDAD Y ESTRES-ANXIETY AND STRESS 2017. [DOI: 10.1016/j.anyes.2017.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Villoro R, Merino M, Hidalgo-Vega A. Quality of life and use of health care resources among patients with chronic depression. PATIENT-RELATED OUTCOME MEASURES 2016; 7:145-155. [PMID: 27713651 PMCID: PMC5045235 DOI: 10.2147/prom.s101595] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE This study estimates the health-related quality of life and the health care resource utilization of patients diagnosed with chronic depression (CD) in Spain. PATIENTS AND METHODS We used the Spanish National Health Survey 2011-2012, a cross-sectional survey representative at the national level, that selects people aged between 18 and 64 years (n=14,691). We estimated utility indices through the EuroQol five-dimensional descriptive system questionnaire included in the survey. We calculated percentage use of health care resources (medical visits, hospitalizations, emergency services, and drug consumption) and average number of resources used when available. A systematic comparison was made between people diagnosed with CD and other chronic conditions (OCCs). The chi-square test, Mann-Whitney U-test, and Kruskal-Wallis test were used to determine the statistical significance of differences between comparison groups. Multivariate analyses (Poisson regression, logistic regression, and linear regression) were also carried out to assess the relationship between quality of life and consumption of health care resources. RESULTS Approximately, 6.1% of the subjects aged between 18 and 64 years were diagnosed with CD (average age 48.3±11 years, 71.7% females). After controlling for age, sex, and total number of comorbidities, a diagnosis of CD reduced utility scores by 0.09 (P<0.05) vs OCCs, and increased the average number of hospitalizations by 15%, the average number of days at hospital by 51%, and the average number of visits to emergency services by 15% (P<0.05). CD also increased the average number of visits to secondary care by 14% and visits to general practitioners by 4%. People with CD had a higher probability of consuming drugs than people with OCCs (odds ratio [OR]: 1.24, P<0.05), but only 38.6% took antidepressants. CONCLUSION People with CD had significantly lower health-related quality of life than people with OCCs. CD was associated with increased hospital length of stay and involved a higher consumption of emergency services and drugs than OCCs.
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Affiliation(s)
- Renata Villoro
- Department of Health Economics, Instituto Max Weber, Madrid
| | - María Merino
- Department of Health Economics, Instituto Max Weber, Madrid
| | - Alvaro Hidalgo-Vega
- Department of Economics and Finance, University of Castilla-La Mancha, Toledo, Spain
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A multi-level analysis of the relationship between spatial clusters of outpatient-treated depression, risk factors and mental health service planning in Catalonia (Spain). J Affect Disord 2016; 201:42-9. [PMID: 27174850 DOI: 10.1016/j.jad.2016.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 03/31/2016] [Accepted: 04/16/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Previous research identified high/low clusters of prevalence of outpatient-treated depression at municipal level in Catalonia (Spain). This study aims to analyse potential risk factors, both socioeconomic and related to the mental health service planning, which could influence the occurrence of hot/cold spots of depressed outpatients at two geographical levels: municipalities and service catchment areas. METHOD Hot/cold spots were examined in relation to socioeconomic indicators at municipal level, such as population density, unemployment, university education, personal income, and also those related to service planning at catchment area level, such as adequacy of healthcare, urbanicity, accessibility and the availability of mental health community centres. The analysis has been carried out through multilevel logistic regression models in order to consider the two different scales. RESULTS Hot spots are related to high population density, unemployment, urbanicity, the adequacy of provision of mental health services, and accessibility to mental health community centres at both study levels. On the other hand, the multilevel model weakly explains cold spots, associating them with high personal incomes. LIMITATIONS The dependent variables of the multi-level models are binary. This limits the interpretation of the results, since they cannot provide information about the variance of the dependent variables explained by the models. CONCLUSIONS The results described diverse risk factors at two levels which are related to a high likelihood of hot and cold spots of depression. The findings show the relevance of health planning in the distribution of diseases and the utilisation of healthcare services.
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Gasull M, Pallarès N, Salcedo N, Pumarega J, Alonso J, Porta M. Self-rated health and chronic conditions are associated with blood concentrations of persistent organic pollutants in the general population of Catalonia, Spain. ENVIRONMENTAL RESEARCH 2015; 143:211-220. [PMID: 26505651 DOI: 10.1016/j.envres.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/09/2015] [Accepted: 10/05/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Self-rated health (SRH) is a powerful predictor of mortality, morbidity, and need for health services. SRH generally increases with educational level, and decreases with age, number of chronic conditions, and body mass index (BMI). Because human concentrations of most persistent organic pollutants (POPs) also vary by age, education, and BMI, and because of the physiological and clinical effects of POPs, we hypothesized that body concentrations of POPs are inversely associated with SRH. OBJECTIVES To analyze the relation between serum concentrations of POPs and SRH in the general population of Catalonia, Spain, taking into account sociodemographic factors and BMI, as well as chronic health conditions and mental disorders, measured by the General Health Questionnaire-12 (GHQ-12). METHODS POP serum concentrations were measured by gas chromatography with electron-capture detection in 919 participants of the Catalan Health Interview Survey. RESULTS Individuals with higher concentrations of POPs had significantly poorer SRH; e.g., the median concentration of HCB in subjects with poor SRH was twice as high as in subjects with excellent SRH (366 ng/g vs. 169 ng/g, respectively; p-value<0.001). In crude models and in models adjusted for sex and BMI, the POPs-SRH association was often dose-dependent, and the likelihood of poor or regular SRH was 2 to 4-times higher in subjects with POP concentrations in the top quartile. In models adjusted for age or for chronic conditions virtually all ORs were near unity. No associations were found between POP levels and GHQ-12. CONCLUSIONS Individuals with higher concentrations of POPs had significantly poorer SRH, an association likely due to age and chronic conditions, but not to sex, education, social class, BMI, or mental disorders.
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Affiliation(s)
- Magda Gasull
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Natàlia Pallarès
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Natalia Salcedo
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - José Pumarega
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Jordi Alonso
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra, Catalonia, Spain
| | - Miquel Porta
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain.
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Cuéllar-Flores I, Sánchez-López MP, Limiñana-Gras RM, Colodro-Conde L. The GHQ-12 for the assessment of psychological distress of family caregivers. Behav Med 2014; 40:65-70. [PMID: 24754441 DOI: 10.1080/08964289.2013.847815] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the utility of the 12-item General Health Questionnaire (GHQ-12) to assess the psychological distress of family caregivers. To accomplish this goal, a sample of 172 caregivers, 25 men and 147 women, aged 56.6 (SD = 13.7) completed self-report questionnaires and provided data on demographic factors. Univariate and bivariate models adjust adequately, although the two-factor model (anxiety/depression and social dysfunction) presented a better fit. Relative caregivers scored higher in psychological distress (anxiety and depression levels) on the GHQ-12 than did the normal population. In conclusion, the GHQ-12 is a sensitive instrument to detect the presence of anxiety and depression in relative caregivers, and the external validity of the instrument is generally adequate. The GHQ-12 seems particularly appropriate for research and clinical and health intervention in caregivers. Implications and limitations of these results are discussed, along with suggestions for future research.
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Affiliation(s)
- Isabel Cuéllar-Flores
- a Hospital Universitario de Getafe and Red Hygeia Health & Gender International Alliance
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Salvador-Carulla L, Fernandez A, Madden R, Lukersmith S, Colagiuri R, Torkfar G, Sturmberg J. Framing of scientific knowledge as a new category of health care research. J Eval Clin Pract 2014; 20:1045-55. [PMID: 25421111 DOI: 10.1111/jep.12286] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 12/25/2022]
Abstract
RATIONALE The new area of health system research requires a revision of the taxonomy of scientific knowledge that may facilitate a better understanding and representation of complex health phenomena in research discovery, corroboration and implementation. METHOD A position paper by an expert group following and iterative approach. RESULTS 'Scientific evidence' should be differentiated from 'elicited knowledge' of experts and users, and this latter typology should be described beyond the traditional qualitative framework. Within this context 'framing of scientific knowledge' (FSK) is defined as a group of studies of prior expert knowledge specifically aimed at generating formal scientific frames. To be distinguished from other unstructured frames, FSK must be explicit, standardized, based on the available evidence, agreed by a group of experts and subdued to the principles of commensurability, transparency for corroboration and transferability that characterize scientific research. A preliminary typology of scientific framing studies is presented. This typology includes, among others, health declarations, position papers, expert-based clinical guides, conceptual maps, classifications, expert-driven health atlases and expert-driven studies of costs and burden of illness. CONCLUSIONS This grouping of expert-based studies constitutes a different kind of scientific knowledge and should be clearly differentiated from 'evidence' gathered from experimental and observational studies in health system research.
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Affiliation(s)
- Luis Salvador-Carulla
- Mental Health Policy Unit, Brain and Mind Research Institute, Centre for Disability Research Policy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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Bendeck M, Serrano-Blanco A, García-Alonso C, Bonet P, Jordà E, Sabes-Figuera R, Salvador-Carulla L. An integrative cross-design synthesis approach to estimate the cost of illness: an applied case to the cost of depression in Catalonia. J Ment Health 2013; 22:135-54. [PMID: 23323630 DOI: 10.3109/09638237.2012.745185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cost of illness (COI) studies are carried out under conditions of uncertainty and with incomplete information. There are concerns regarding their generalisability, accuracy and usability in evidence-informed care. AIMS A hybrid methodology is used to estimate the regional costs of depression in Catalonia (Spain) following an integrative approach. METHODS The cross-design synthesis included nominal groups and quantitative analysis of both top-down and bottom-up studies, and incorporated primary and secondary data from different sources of information in Catalonia. Sensitivity analysis used probabilistic Monte Carlo simulation modelling. A dissemination strategy was planned, including a standard form adapted from cost-effectiveness studies to summarise methods and results. RESULTS The method used allows for a comprehensive estimate of the cost of depression in Catalonia. Health officers and decision-makers concluded that this methodology provided useful information and knowledge for evidence-informed planning in mental health. CONCLUSIONS The mix of methods, combined with a simulation model, contributed to a reduction in data gaps and, in conditions of uncertainty, supplied more complete information on the costs of depression in Catalonia. This approach to COI should be differentiated from other COI designs to allow like-with-like comparisons. A consensus on COI typology, procedures and dissemination is needed.
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Salinas-Pérez JA, García-Alonso CR, Molina-Parrilla C, Jordà-Sampietro E, Salvador-Carulla L. Identification and location of hot and cold spots of treated prevalence of depression in Catalonia (Spain). Int J Health Geogr 2012; 11:36. [PMID: 22917223 PMCID: PMC3460765 DOI: 10.1186/1476-072x-11-36] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 08/10/2012] [Indexed: 12/04/2022] Open
Abstract
Background Spatial analysis is a relevant set of tools for studying the geographical distribution of diseases, although its methods and techniques for analysis may yield very different results. A new hybrid approach has been applied to the spatial analysis of treated prevalence of depression in Catalonia (Spain) according to the following descriptive hypotheses: 1) spatial clusters of treated prevalence of depression (hot and cold spots) exist and, 2) these clusters are related to the administrative divisions of mental health care (catchment areas) in this region. Methods In this ecological study, morbidity data per municipality have been extracted from the regional outpatient mental health database (CMBD-SMA) for the year 2009. The second level of analysis mapped small mental health catchment areas or groups of municipalities covered by a single mental health community centre. Spatial analysis has been performed using a Multi-Objective Evolutionary Algorithm (MOEA) which identified geographical clusters (hot spots and cold spots) of depression through the optimization of its treated prevalence. Catchment areas, where hot and cold spots are located, have been described by four domains: urbanicity, availability, accessibility and adequacy of provision of mental health care. Results MOEA has identified 6 hot spots and 4 cold spots of depression in Catalonia. Our results show a clear spatial pattern where one cold spot contributed to define the exact location, shape and borders of three hot spots. Analysing the corresponding domain values for the identified hot and cold spots no common pattern has been detected. Conclusions MOEA has effectively identified hot/cold spots of depression in Catalonia. However these hot/cold spots comprised municipalities from different catchment areas and we could not relate them to the administrative distribution of mental care in the region. By combining the analysis of hot/cold spots, a better statistical and operational-based visual representation of the geographical distribution is obtained. This technology may be incorporated into Decision Support Systems to enhance local evidence-informed policy in health system research.
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Affiliation(s)
- José A Salinas-Pérez
- Universidad Loyola Andalucía, Business Administration Faculty, Sevilla, Córdoba, Spain.
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Rocha KB, Rodríguez-Sanz M, Pérez K, Obiols JE, Borrell C. Inequalities in the Utilization of Psychiatric and Psychological Services in Catalonia: A Multilevel Approach. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2012; 40:355-63. [DOI: 10.1007/s10488-012-0426-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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