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Chavarria V, Rubio-Valera M, Doménech Abella J, Baladón LH, Mateu I, Arias de la Torre J, Alvarós JC, Peña-Salazar C, Dima AL, Serrano-Blanco A. Patient Satisfaction and Willingness to Continue with Telemental Health Care During and After the Early Period of SARS-CoV-2 Pandemic: A User Survey. Telemed J E Health 2024. [PMID: 38597958 DOI: 10.1089/tmj.2023.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Objective: The SARS-CoV-2 pandemic and related lockdown periods generated an increase in the use of virtual care for mental health (MH). This study aimed to assess patient satisfaction with Telemental Health services (TMH) during first lockdown and factors related to their willingness to continue using this service. Methods: We conducted a cross-sectional survey of 364 MH outpatients from 9 centers in the Barcelona region (Spain), who received TMH between April 20 and May 22, 2020. We assessed sociodemographic and clinical characteristics, prior experience, and familiarity with technologies and satisfaction with TMH. Willingness to receive TMH after the lockdown was measured separately for telephone and videoconferencing. We performed descriptive statistics and bivariate and multivariate regression models to predict TMH willingness. Results: From 450 patients contacted, 364 were interviewed. Satisfaction with TMH was high (mean 9.24, standard deviation 0.07); 2.47% preferred only TMH visits after lockdown, 23.08% preferred mostly TMH visits, 50.82% accepted some TMH visits, and 23.63% would prefer in-person consultations. Female patients and those having received TMH during lockdown showed higher odds of willingness to receive TMH in the future, while patients unfamiliar with technologies showed lower odds. Concerning TMH through telephone, willingness was more likely in patients living with more persons. Videoconferencing willingness was more likely for people living with depression. Conclusions: TMH was well accepted during the first lockdown and patients were willing to maintain it after lockdown. Low familiarity with new technologies is an important barrier to TMH willingness, which needs to be addressed for appropriate implementation going forward.
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Affiliation(s)
- Victor Chavarria
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, Madrid, Spain
| | - Maria Rubio-Valera
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Joan Doménech Abella
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Luisa Higuera Baladón
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, Madrid, Spain
| | - Isabel Mateu
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Jorge Arias de la Torre
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Care in Long Term Conditions Research Division, King's College London, London, United Kingdom
- Institute of Biomedicina, University of Leon, Leon, Spain
| | | | - Carlos Peña-Salazar
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Alexandra L Dima
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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Fuente-Moreno M, Dima AL, Rubio-Valera M, Baladon L, Chavarria V, Contaldo SF, Peña-Salazar C, Serra-Sutton V, Hermida-González P, de Loño JP, Rey-Abella ME, Aznar-Lou I, Serrano-Blanco A. Evaluation of adherence to antipsychotics: A real-world data study using four different dosing assumptions. Br J Clin Pharmacol 2024. [PMID: 38499460 DOI: 10.1111/bcp.16042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/28/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024] Open
Abstract
AIMS This study aimed to assess the frequency of dosing inconsistencies in prescription data and the effect of four dosing assumption strategies on adherence estimates for antipsychotic treatment. METHODS A retrospective cohort, which linked prescription and dispensing data of adult patients with ≥1 antipsychotic prescription between 2015-2016 and followed up until 2019, in Catalonia (Spain). Four strategies were proposed for selecting the recommended dosing in overlapping prescription periods for the same patient and antipsychotic drug: (i) the minimum dosing prescribed; (ii) the dose corresponding to the latest prescription issued; (iii) the highest dosing prescribed; and (iv) all doses included in the overlapped period. For each strategy, one treatment episode per patient was selected, and the Continuous Medication Availability measure was used to assess adherence. Descriptive statistics were used to describe results by strategy. RESULTS Of the 277 324 prescriptions included, 76% overlapped with other prescriptions (40% with different recommended dosing instructions). The number and characteristics of patients and treatment episodes (18 292, 18 303, 18 339 and 18 536, respectively per strategy) were similar across strategies. Mean adherence was similar between strategies, ranging from 57 to 60%. However, the proportion of patients with adherence ≥90% was lower when selecting all doses (28%) compared with the other strategies (35%). CONCLUSION Despite the high prevalence of overlapping prescriptions, the strategies proposed did not show a major effect on the adherence estimates for antipsychotic treatment. Taking into consideration the particularities of antipsychotic prescription practices, selecting the highest dose in the overlapped period seemed to provide a more accurate adherence estimate.
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Affiliation(s)
- Marina Fuente-Moreno
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Alexandra L Dima
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Maria Rubio-Valera
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Luisa Baladon
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Victor Chavarria
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - Carlos Peña-Salazar
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS); Health Quality and Assessment Agency of Catalonia, Barcelona, Spain
| | - Vicky Serra-Sutton
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Unitat de Farmàcia. Regió Sanitària Metropolitana Sud CatSalut, Barcelona, Spain
| | | | - Jorge Peláez de Loño
- Unitat de Farmàcia. Regió Sanitària Metropolitana Sud CatSalut, Barcelona, Spain
| | | | - Ignacio Aznar-Lou
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Antoni Serrano-Blanco
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
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Parody-Rua E, Bustamante A, Montaner J, Rubio-Valera M, Serrano D, Pérez-Sánchez S, Sánchez-Viñas A, Guevara-Cuellar C, Serrano-Blanco A. Modeling the potential efficiency of a blood biomarker-based tool to guide pre-hospital thrombolytic therapy in stroke patients. Eur J Health Econ 2023; 24:621-632. [PMID: 35896861 PMCID: PMC10175459 DOI: 10.1007/s10198-022-01495-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 06/21/2022] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Stroke treatment with intravenous tissue-type plasminogen activator (tPA) is effective and efficient, but as its benefits are highly time dependent, it is essential to treat the patient promptly after symptom onset. This study evaluates the cost-effectiveness of a blood biomarker test to differentiate ischemic and hemorrhagic stroke to guide pre-hospital treatment with tPA in patients with suspected stroke, compared with standard hospital management. The standard care for patients suffering stroke consists mainly in diagnosis, treatment, hospitalization and monitoring. METHODS A Markov model was built with four health states according to the modified Rankin scale, in adult patients with suspected moderate to severe stroke (NIHSS 4-22) within 4.5 hours after symptom onset. A Spanish Health System perspective was used. The time horizon was 15 years. Quality-adjusted life-years (QALYs) and life-years gained (LYGs) were used as a measure of effectiveness. Short- and long-term direct health costs were included. Costs were expressed in Euros (2022). A discount rate of 3% was used. Probabilistic sensitivity analysis and several one-way sensitivity analyses were conducted. RESULTS The use of a blood-test biomarker compared with standard care was associated with more QALYs (4.87 vs. 4.77), more LYGs (7.18 vs. 7.07), and greater costs (12,807€ vs. 12,713€). The ICER was 881€/QALY. Probabilistic sensitivity analysis showed that the biomarker test was cost-effective in 82% of iterations using a threshold of 24,000€/QALY. CONCLUSIONS The use of a blood biomarker test to guide pre-hospital thrombolysis is cost-effective compared with standard hospital care in patients with ischemic stroke.
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Affiliation(s)
- Elizabeth Parody-Rua
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Barcelona, Spain
| | | | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville and Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Maria Rubio-Valera
- Head of Quality and Patient Safety, Parc Sanitari Sant Joan de Déu. Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Soledad Pérez-Sánchez
- Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville and Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Alba Sánchez-Viñas
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - Antoni Serrano-Blanco
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- Parc Sanitari Sant Joan de Déu. Institut de Recerca Sant Joan de Déu, Mental Health Directorate, C/Camí Vell de la Colònia, 25, 08830, Sant Boi de Llobregat, Barcelona, Spain.
- Departament de Medicina. Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.
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Vázquez ML, Vargas I, Rubio-Valera M, Aznar-Lou I, Eguiguren P, Mogollón-Pérez AS, Torres AL, Peralta A, Dias S, Jervelund SS. Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study. BMJ Open 2022; 12:e067439. [PMID: 36523219 PMCID: PMC9748968 DOI: 10.1136/bmjopen-2022-067439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Healthcare fragmentation, a main cause for delay in cancer diagnosis and treatment, contributes to high mortality in Latin America (LA), particularly among disadvantaged populations. This research focuses on integrated care interventions, which have been limitedly implemented in the region. The objective is to evaluate the contextual effectiveness of scaling-up an integrated care intervention to improve early diagnosis of frequent cancers in healthcare networks of Chile, Colombia and Ecuador. METHODS AND ANALYSIS This research is two pronged: (A) quasi-experimental design (controlled before and after) with an intervention and a control healthcare network in each LA country, using an implementation-effectiveness hybrid approach to assess the intervention process, effectiveness and costs; and (B) case study design to analyse access to diagnosis of most frequent cancers. Focusing on the most vulnerable socioeconomic population, it develops in four phases: (1) analysis of delays and barriers to early diagnosis (baseline); (2) intervention adaptation and implementation (primary care training, fast-track referral pathway and patient information); (3) intracountry evaluation of intervention and (4) cross-country analysis. Baseline and evaluation studies adopt mixed-methods qualitative (semistructured individual interviews) and quantitative (patient questionnaire survey) methods. For the latter, a sample size of 174 patients with cancer diagnosis per healthcare network and year was calculated to detect a proportions difference of 15%, before and after intervention (α=0.05; β=0.2) in a two-sided test. A participatory approach will be used to tailor the intervention to each context, led by a local steering committee (professionals, managers, policy makers, patients and researchers). ETHICS AND DISSEMINATION This study complies with international and national legal stipulations on ethics. It was approved by each country's ethical committee and informed consent will be obtained from participants. Besides the coproduction of knowledge with key stakeholders, it will be disseminated through strategies such as policy briefs, workshops, e-tools and scientific papers.
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Affiliation(s)
- Maria-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Maria Rubio-Valera
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Ignacio Aznar-Lou
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Research and Development Unit, Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | | | - Ana-Lucía Torres
- Public Health Institute, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Andrés Peralta
- Public Health Institute, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, NOVA University of Lisbon & Comprehensive Health Research Center (CHRC), Lisboa, Portugal
| | - Signe Smith Jervelund
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Corral-Partearroyo C, Sánchez-Viñas A, Gil-Girbau M, Peñarrubia-María MT, Aznar-Lou I, Serrano-Blanco A, Carbonell-Duacastella C, Gallardo-González C, Olmos-Palenzuela MDC, Rubio-Valera M. Improving Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care: Pilot trial of a complex intervention. Front Public Health 2022; 10:1038138. [PMID: 36561857 PMCID: PMC9764337 DOI: 10.3389/fpubh.2022.1038138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The Initial Medication Adherence (IMA) intervention is a multidisciplinary and shared decision-making intervention to improve initial medication adherence addressed to patients in need of new treatments for cardiovascular diseases and diabetes in primary care (PC). This pilot study aims to evaluate the feasibility and acceptability of the IMA intervention and the feasibility of a cluster-RCT to assess the effectiveness and cost-effectiveness of the intervention. Methods A 3-month pilot trial with an embedded process evaluation was conducted in five PC centers in Catalonia (Spain). Electronic health data were descriptively analyzed to test the availability and quality of records of the trial outcomes (initiation, implementation, clinical parameters and use of services). Recruitment and retention rates of professionals were analyzed. Twenty-nine semi-structured interviews with professionals (general practitioners, nurses, and community pharmacists) and patients were conducted to assess the feasibility and acceptability of the intervention. Three discussion groups with a total of fifteen patients were performed to review and redesign the intervention decision aids. Qualitative data were thematically analyzed. Results A total of 901 new treatments were prescribed to 604 patients. The proportion of missing data in the electronic health records was up to 30% for use of services and around 70% for clinical parameters 5 months before and after a new prescription. Primary and secondary outcomes were within plausible ranges and outliers were barely detected. The IMA intervention and its implementation strategy were considered feasible and acceptable by pilot-study participants. Low recruitment and retention rates, understanding of shared decision-making by professionals, and format and content of decision aids were the main barriers to the feasibility of the IMA intervention. Discussion Involving patients in the decision-making process is crucial to achieving better clinical outcomes. The IMA intervention is feasible and showed good acceptability among professionals and patients. However, we identified barriers and facilitators to implementing the intervention and adapting it to a context affected by the COVID-19 pandemic that should be considered before launching a cluster-RCT. This pilot study identified opportunities for refining the intervention and improving the design of the definitive cluster-RCT to evaluate its effectiveness and cost-effectiveness. Clinical trial registration ClinicalTrials.gov, identifier NCT05094986.
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Affiliation(s)
- Carmen Corral-Partearroyo
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Univ Autonoma de Barcelona, Bellaterra, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain
| | - Alba Sánchez-Viñas
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Gil-Girbau
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Spain,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - María Teresa Peñarrubia-María
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Primary Care Centre Bartomeu Fabrés Anglada, Direcció D'Atenció Primària Regió Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain,Unitat de Suport a la Recerca Regió Metropolitana Sud, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ignacio Aznar-Lou
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain
| | - Antoni Serrano-Blanco
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain,Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Spain
| | - Cristina Carbonell-Duacastella
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Carmen Gallardo-González
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain,Primary Care Centre Bartomeu Fabrés Anglada, Direcció D'Atenció Primària Regió Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain,Unitat de Suport a la Recerca Regió Metropolitana Sud, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Maria del Carmen Olmos-Palenzuela
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain,Primary Care Centre Bartomeu Fabrés Anglada, Direcció D'Atenció Primària Regió Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain
| | - Maria Rubio-Valera
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública), Madrid, Spain,Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Spain,*Correspondence: Maria Rubio-Valera
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Sánchez-Viñas A, Corral-Partearroyo C, Gil-Girbau M, Peñarrubia-María MT, Gallardo-González C, Olmos-Palenzuela MDC, Aznar-Lou I, Serrano-Blanco A, Rubio-Valera M. Effectiveness and cost-effectiveness of an intervention to improve Initial Medication Adherence to treatments for cardiovascular diseases and diabetes in primary care: study protocol for a pragmatic cluster randomised controlled trial and economic model (the IMA-cRCT study). BMC Prim Care 2022; 23:170. [PMID: 35790915 PMCID: PMC9255541 DOI: 10.1186/s12875-022-01727-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/04/2022] [Indexed: 02/06/2023]
Abstract
Background Between 2 and 43% of patients who receive a new prescription in PC do not initiate their treatments. Non-initiation is associated with poorer clinical outcomes, more sick leave and higher costs to the healthcare system. Existing evidence suggests that shared decision-making positively impacts medication initiation. The IMA-cRCT assesses the effectiveness of the IMA intervention in improving adherence and clinical parameters compared to usual care in patients with a new treatment for cardiovascular disease and diabetes prescribed in PC, and its cost-effectiveness, through a cRCT and economic modelling. Methods The IMA intervention is a shared decision-making intervention based on the Theoretical Model of Non-initiation. A cRCT will be conducted in 24 PC teams in Catalonia (Spain), randomly assigned to the intervention group (1:1), and community pharmacies in the catchment areas of the intervention PC teams. Healthcare professionals in the intervention group will apply the intervention to all patients who receive a new prescription for cardiovascular disease or diabetes treatment (no other prescription from the same pharmacological group in the previous 6 months). All the study variables will be collected from real-world databases for the 12 months before and after receiving a new prescription. Effectiveness analyses will assess impact on initiation, secondary adherence, cardiovascular risk, clinical parameters and cardiovascular events. Cost-effectiveness analyses will be conducted as part of the cRCT from a healthcare and societal perspective in terms of extra cost per cardiovascular risk reduction and improved adherence; all analyses will be clustered. Economic models will be built to assess the long-term cost-effectiveness of the IMA intervention, in terms of extra cost for gains in QALY and life expectancy, using clinical trial data and data from previous studies. Discussion The IMA-cRCT represents an innovative approach to the design and evaluation of behavioural interventions that use the principles of complex interventions, pragmatic trials and implementation research. This study will provide evidence on the IMA intervention and on a new methodology for developing and evaluating complex interventions. The results of the study will be disseminated among stakeholders to facilitate its transferability to clinical practice. Trial registration ClinicalTrials.gov, NCT05026775. Registered 30th August 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01727-6.
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Corral-Partearroyo C, Sánchez-Viñas A, Gil-Girbau M, Peñarrubia-María MT, Aznar-Lou I, Gallardo-González C, Olmos-Palenzuela MDC, Rubio-Valera M. Complex multidisciplinary intervention to improve Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care (the IMA-cRCT study): mixed-methods process evaluation protocol. BMJ Open 2022; 12:e067468. [PMID: 36316078 PMCID: PMC9628671 DOI: 10.1136/bmjopen-2022-067468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Medication non-initiation, or primary non-adherence, is a persistent public health problem that increases the risk of adverse clinical outcomes. The initial medication adherence (IMA) intervention is a complex multidisciplinary intervention to improve adherence to cardiovascular and diabetes treatments in primary care by empowering the patient and promoting informed prescriptions based on shared decision-making. This paper presents the development and implementation strategy of the IMA intervention and the process evaluation protocol embedded in a cluster randomised controlled trial (the IMA-cRCT) to understand and interpret the outcomes of the trial and comprehend the extent of implementation and fidelity, the active mechanisms of the IMA intervention and in what context the intervention is implemented and works. METHODS AND ANALYSIS We present the protocol for a mixed-methods process evaluation including quantitative and qualitative methods to measure implementation and fidelity and to explore the active mechanisms and the interactions between the intervention, participants and its context. The process evaluation will be conducted in primary care centres and community pharmacies from the IMA-cRCT, and participants include healthcare professionals (general practitioners, nurses and community pharmacists) as well as patients. Quantitative data collection methods include data extraction from the intervention operative records, patient clinical records and participant feedback questionnaires, whereas qualitative data collection involves semistructured interviews, focus groups and field diaries. Quantitative and qualitative data will be analysed separately and triangulated to produce deeper insights and robust results. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Research Ethics Comittee (CEIm) at IDIAP Jordi Gol (codeCEIm 21/051 P). Findings will be disseminated through publications and conferences, as well as presentations to healthcare professionals and stakeholders from healthcare organisations. TRIAL REGISTRATION NUMBER NCT05026775.
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Affiliation(s)
- Carmen Corral-Partearroyo
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autonoma de Barcelona, Bellaterra, Catalunya, Spain
| | - Alba Sánchez-Viñas
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Montserrat Gil-Girbau
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Maria Teresa Peñarrubia-María
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Unitat de Suport a la Recerca Regió Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Catalunya, Spain
| | - Ignacio Aznar-Lou
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Comunidad de Madrid, Spain
| | - Carmen Gallardo-González
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Unitat de Suport a la Recerca Regió Metropolitana Sud, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Catalunya, Spain
| | - María Del Carmen Olmos-Palenzuela
- Primary Care Centre Bartomeu Fabrés Anglada, Institut Català de la Salut Gerència Territorial Metropolitana Sud, Barcelona, Catalunya, Spain
| | - Maria Rubio-Valera
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Deu, Institut de Recerca Sant Joan de Deu, St Boi de Llobregat, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Comunidad de Madrid, Spain
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Martin-Iñigo L, Ortiz S, Urbano D, Teba Pérez S, Contaldo SF, Alvarós J, Baladon L, Parody-Rúa E, Rubio-Valera M. Assessment of the efficacy of a Crisis Intervention Team (CIT): experience in the Esplugues Mental Health Center (Barcelona). Soc Psychiatry Psychiatr Epidemiol 2022; 57:2109-2117. [PMID: 35246708 DOI: 10.1007/s00127-022-02250-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Abstract
AIM Crisis Resolution Teams (CRT) have shown positive clinical and service-use results in various countries but evidence in the south of Europe is scarce. The aim is to assess the impact of the Crisis Intervention Team (CIT) in Spain with respect to the course of symptomatology and mental health services use in patients served. METHODS Prospective observational cohort study. Assessment of the psychopathological severity (HoNOS scale) of the clinical course (CGI scale) and use of medical services. RESULTS A positive clinical course was observed following the intervention. The mean difference in HoNOS (Health of the Nation Outcome Scales) scores between baseline and discharge was 7 points (p < 0.05). On discharge, more than 60% of patients had improved their symptomatology according to the CGI scale (Clinical Global Impression) and most were discharged due to improvement or goal achievement. A tendency to reduction in the number of admissions to acute units and day hospital was observed, along with fewer emergency room visits. In contrast, an increase in the number of admissions to subacute units was seen. During the intervention, the median number of visits to the center was 15 and the median duration of care provision by the CIT was 39 days. CONCLUSIONS The CIT intervention promotes patients' clinical improvement and has a positive impact in terms of reducing acute hospitalizations and emergency room visits.
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Affiliation(s)
- Laia Martin-Iñigo
- Parc Sanitari Sant Joan de Déu (Esplugues MHC), Esplugues de Llobregat, Spain
| | - Sonia Ortiz
- Parc Sanitari Sant Joan de Déu (Esplugues MHC), Esplugues de Llobregat, Spain
| | - David Urbano
- Parc Sanitari Sant Joan de Déu (Cerdanyola MHC), Ripollet, Cerdanyola del Vallès, Spain
| | - Silvia Teba Pérez
- Parc Sanitari Sant Joan de Déu (Esplugues MHC), Esplugues de Llobregat, Spain
| | | | - Joan Alvarós
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Luisa Baladon
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - Maria Rubio-Valera
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain. .,Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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9
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Gil-Girbau M, Peñarrubia-Maria MT, Carbonell-Simeón D, Rodríguez-Ferraz B, Contaldo SF, Iglesias-González M, Fernández-Vergel R, Blanco-García E, Baladon-Higuera L, Serrano-Blanco A, Rubio-Valera M. Assessment of a Primary Support Program: family physicians and mental health professionals' perspective. Fam Pract 2022; 39:920-931. [PMID: 35244164 DOI: 10.1093/fampra/cmac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mental health (MH) disorders are increasingly prevalent in primary care (PC) and this has generated, in recent years, the development of strategies based on the collaborative model and the stepped care model. The Primary Support Program (PSP) was implemented in the community of Catalonia (Spain) during 2006 to improve, from the first level of care, treatment of the population with mild-moderate complexity MH problems along with identification and referral of severe cases to specialized care. The aim of the present study was to identify the strengths and limitations of the PSP from the perspective of health professionals involved in the programme. METHODS An explanatory qualitative study based on Grounded Theory. We conducted group semistructured interviews with 37 family physicians and 34 MH professionals. A constant comparative method of analysis was performed. RESULTS Operation of the PSP is influenced by internal factors, such as the programme framework, MH liaison, management of service supply and demand, and the professional team involved. Additionally, external factors which had an impact were related to the patient, the professionals, the Health System, and community resources. CONCLUSIONS The operation of the PSP could benefit from a review of the programme framework and optimization of MH liaison. Improvements are also proposed for MH training in PC, intraprofessional coordination, use of community resources, and creation of efficient continuous assessment systems.
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Affiliation(s)
- Montserrat Gil-Girbau
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain
| | - Maria-Teresa Peñarrubia-Maria
- Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain.,Centre d'Atenció Primària Bartomeu Fabrés Anglada, Gavà, Spain.,Grup 58 del Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | - Salvatore-Fabrizio Contaldo
- Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Psychiatry Department, CSMA d'Esplugues de Llobregat, Esplugues de Llobregat, Spain
| | - Maria Iglesias-González
- Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Grup 58 del Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Psychiatry Service, Hospital Universitari Germans Trias i Pujol, IGTP Campus Can Ruti, Badalona, Spain
| | - Rita Fernández-Vergel
- Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain.,Centre d'Atenció Primària Bartomeu Fabrés Anglada, Gavà, Spain
| | - Elena Blanco-García
- Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain.,Centre d'Atenció Primària Bartomeu Fabrés Anglada, Gavà, Spain
| | - Luisa Baladon-Higuera
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain.,Grup 58 del Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Antoni Serrano-Blanco
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain.,Grup 58 del Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Rubio-Valera
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain.,Grup 58 del Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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10
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Carbonell-Duacastella C, Rubio-Valera M, Marqués-Ercilla S, Peñarrubia-María MT, Gil-Girbau M, Garcia-Cardenas V, Pasarín MI, Parody-Rúa E, Aznar-Lou I. Pediatric Medication Noninitiation in Spain. Pediatrics 2022; 149:184034. [PMID: 34957504 PMCID: PMC9647521 DOI: 10.1542/peds.2020-034371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To estimate medication noninitiation prevalence in the pediatric population and identify the explanatory factors underlying this behavior. METHODS Observational study of patients (<18 years old) receiving at least 1 new prescription (28 pharmaceutical subgroups; July 2017 to June 2018) in Catalonia, Spain. A prescription was considered new when there was no prescription for the same pharmaceutical subgroup in the previous 6 months. Noninitiation occurred when a prescription was not filled within 1 month or 6 months (sensitivity analysis). Prevalence was estimated as the proportion of total prescriptions not initiated. To identify explanatory factors, a multivariable multilevel logistic regression model was used, and adjusted odds ratios were reported. RESULTS Overall, 1 539 003 new prescriptions were issued to 715 895 children. The overall prevalence of 1-month noninitiation was 9.0% (ranging from 2.6% [oral antibiotics] to 21.5% [proton pump inhibitors]), and the prevalence of 6-month noninitiation was 8.5%. Noninitiation was higher in the youngest and oldest population groups, in children from families with a 0% copayment rate (vulnerable populations) and those with conditions from external causes. Out-of-pocket costs of drugs increased the odds of noninitiation. The odds of noninitiation were lower when the prescription was issued by a pediatrician (compared with a primary or secondary care clinician). CONCLUSIONS The prevalence of noninitiation of medical treatments in pediatrics is high and varies according to patients' ages and medical groups. Results suggest that there are inequities in access to pharmacologic treatments in this population that must be taken into account by health care planners and providers.
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Affiliation(s)
- Cristina Carbonell-Duacastella
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain,Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain,School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Maria Rubio-Valera
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain,Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain,Address correspondence to Maria Rubio-Valera, Parc Sanitari Sant Joan de Deu, Carrer Pablo Picasso 12, 08830, Sant Boi de Llobregat, Barcelona, Spain. E-mail:
| | - Sílvia Marqués-Ercilla
- Basic Health Area (ABS) Bartomeu Fabrés Anglada, Direcció d'Atenció Primària Costa Ponent, Institut Català de la Salut, Gavà, Spain,Unitat de Suport a la Recerca Costa Ponent, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAP JGol), Barcelona, Spain
| | - Maria Teresa Peñarrubia-María
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain,Basic Health Area (ABS) Bartomeu Fabrés Anglada, Direcció d'Atenció Primària Costa Ponent, Institut Català de la Salut, Gavà, Spain,Unitat de Suport a la Recerca Costa Ponent, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAP JGol), Barcelona, Spain
| | - Montserrat Gil-Girbau
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain,Primary Care Prevention and Health Promotion Network (redIAPP), Barcelona, Spain
| | - Victoria Garcia-Cardenas
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Maria Isabel Pasarín
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain,Barcelona Public Health Agency (ASPB), Barcelona, Spain,Sant Pau Biomedical Research Institute, Barcelona, Spain,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Elizabeth Parody-Rúa
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain,Primary Care Prevention and Health Promotion Network (redIAPP), Barcelona, Spain
| | - Ignacio Aznar-Lou
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain,Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain,Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
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Peñarrubia-María MT, Gil-Girbau M, Gallardo-González MC, Aznar-Lou I, Serrano-Blanco A, Mendive Arbeloa JM, Garcia-Cardenas V, Sánchez-Viñas A, Rubio-Valera M. Non-initiation of prescribed medication from a Spanish health professionals' perspective: A qualitative exploration based on Grounded Theory. Health Soc Care Community 2022; 30:e213-e221. [PMID: 34080746 DOI: 10.1111/hsc.13431] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/24/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
We explore, from the perspective of primary care health professionals, the motivations that lead patients to not initiate prescribed treatments, by developing a qualitative study in Spanish primary care. Six focus groups (N = 46) were conducted with general practitioners, nurse practitioners, social workers and community pharmacists and carried out in primary care (PC) of Barcelona Province, from April to July of 2018. The 46 participants were identified by three general practitioners and two pharmacists. In the interviews, the reasons for non-initiation of PC patients' medication were explored. Triangulated content analysis was performed. Patients' perspective, analysed in a previous study, and professionals' perspective agree on most of the factors that affect non-initiation. New factors were categorized into existent categories, confirming, and supplementing the model developed with patients. Health professionals identified some new factors which were not present in the patients' discourse, such as stigma related to the drug, hidden reasons for consultation, the role of nurses in prescription and support, the role of the pharmacy technician, illiteracy and lack of social support. The professionals confirm and expand on the Theoretical Model of Medication Non-Initiation. Primary care professionals should consider the factors described when prescribing a new medication. Knowledge contributed by the model should guide the design of interventions to improve initiation.
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Affiliation(s)
- Maria Teresa Peñarrubia-María
- Primary Care Centre Bartomeu Fabrés Anglada, Catalan Institute of Health, Primary Care Research Institute (IDIAP Jordi Gol), Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - Montserrat Gil-Girbau
- Sant Joan de Déu Research Institute, Esplugues de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network (redIAPP), Madrid, Spain
| | - Mari Carmen Gallardo-González
- Primary Care Centre Bartomeu Fabrés Anglada, Catalan Institute of Health, Primary Care Research Institute (IDIAP Jordi Gol), Barcelona, Spain
- Primary Care Prevention and Health Promotion Research Network (redIAPP), Madrid, Spain
| | - Ignacio Aznar-Lou
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
- Sant Joan de Déu Research Institute, Esplugues de Llobregat, Spain
| | - Antoni Serrano-Blanco
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Juan Manuel Mendive Arbeloa
- Primary Care Prevention and Health Promotion Research Network (redIAPP), Madrid, Spain
- Catalan Institute of Health, Barcelona, Spain
| | | | - Alba Sánchez-Viñas
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
- Sant Joan de Déu Research Institute, Esplugues de Llobregat, Spain
| | - Maria Rubio-Valera
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
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12
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Aznar-Lou I, Zabaleta-Del-Olmo E, Casajuana-Closas M, Sánchez-Viñas A, Parody-Rúa E, Bolíbar B, Iracheta-Todó M, Bulilete O, López-Jiménez T, Pombo-Ramos H, Martín Miguel MV, Magallón-Botaya R, Maderuelo-Fernández JÁ, Motrico E, Bellón J, Martí-Lluch R, Rubio-Valera M, Serrano-Blanco A. Cost-effectiveness analysis of a multiple health behaviour change intervention in people aged between 45 and 75 years: a cluster randomized controlled trial in primary care (EIRA study). Int J Behav Nutr Phys Act 2021; 18:88. [PMID: 34215275 PMCID: PMC8254273 DOI: 10.1186/s12966-021-01144-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Multiple health behaviour change (MHBC) interventions that promote healthy lifestyles may be an efficient approach in the prevention or treatment of chronic diseases in primary care. This study aims to evaluate the cost-utility and cost-effectiveness of the health promotion EIRA intervention in terms of MHBC and cardiovascular reduction. METHODS An economic evaluation alongside a 12-month cluster-randomised (1:1) controlled trial conducted between 2017 and 2018 in 25 primary healthcare centres from seven Spanish regions. The study took societal and healthcare provider perspectives. Patients included were between 45 and 75 years old and had any two of these three behaviours: smoking, insufficient physical activity or low adherence to Mediterranean dietary pattern. Intervention duration was 12 months and combined three action levels (individual, group and community). MHBC, defined as a change in at least two health risk behaviours, and cardiovascular risk (expressed in % points) were the outcomes used to calculate incremental cost-effectiveness ratios (ICER). Quality-adjusted life-years (QALYs) were estimated and used to calculate incremental cost-utility ratios (ICUR). Missing data was imputed and bootstrapping with 1000 replications was used to handle uncertainty in the modelling results. RESULTS The study included 3062 participants. Intervention costs were €295 higher than usual care costs. Five per-cent additional patients in the intervention group did a MHBC compared to usual care patients. Differences in QALYS or cardiovascular risk between-group were close to 0 (- 0.01 and 0.04 respectively). The ICER was €5598 per extra health behaviour change in one patient and €6926 per one-point reduction in cardiovascular risk from a societal perspective. The cost-utility analysis showed that the intervention increased costs and has no effect, in terms of QALYs, compared to usual care from a societal perspective. Cost-utility planes showed high uncertainty surrounding the ICUR. Sensitivity analysis showed results in line with the main analysis. CONCLUSION The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects. TRIAL REGISTRATION Clinicaltrials.gov NCT03136211 . Registered 02 May 2017 - Retrospectively registered.
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Affiliation(s)
- Ignacio Aznar-Lou
- Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain.
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.
| | - Edurne Zabaleta-Del-Olmo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
- Departament d'Infermeria, Facultat d'Infermeria, Universitat de Girona, Girona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Marc Casajuana-Closas
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain
| | - Alba Sánchez-Viñas
- Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Elizabeth Parody-Rúa
- Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Bonaventura Bolíbar
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain
| | - Montserrat Iracheta-Todó
- Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain
| | - Oana Bulilete
- Primary Care Research Unit, Mallorca, Balearic Public Health Service, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Tomàs López-Jiménez
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Haizea Pombo-Ramos
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Bilbao, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | | | - Rosa Magallón-Botaya
- IIS-Aragón Grupo b21-17R, Universidad de Zaragoza, Zaragoza, Spain
- CS Arrabal.Servicio Aragonés de Salud, Zaragoza, Spain
| | - Jose Ángel Maderuelo-Fernández
- Primary Health Care Research Unit of Salamanca (APISAL), Health Service of Castilla y León (SACyL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Emma Motrico
- Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain
- Universidad Loyola Andalucía, Sevilla, Spain
| | - Juan Bellón
- Primary Care Prevention and Health Promotion Network (redIAPP), Palma de Mallorca, Spain
- Centro de Salud El Palo, Málaga, Spain
- Department of Preventive Medicine, University of Málaga, Málaga, Spain
- Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
| | - Ruth Martí-Lluch
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Girona, Catalonia, Spain
- Biomedical Research Institute, Girona (IdIBGi), ICS, Girona, Catalonia, Spain
| | - Maria Rubio-Valera
- Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Antoni Serrano-Blanco
- Research and development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Dr. Antoni Pujades 42, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
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Rubio-Valera M, Marqués-Ercilla S, Peñarrubia-María MT, Urbanos-Garrido RM, Borrell C, Bosch J, Sánchez-Viñas A, Aznar-Lou I. Who Suffers From Pharmaceutical Poverty and What Are Their Needs? Evidence From a Spanish Region. Front Pharmacol 2021; 12:617687. [PMID: 33959003 PMCID: PMC8093809 DOI: 10.3389/fphar.2021.617687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Pharmaceutical poverty occurs when a patient cannot afford the cost of prescribed medication and/or medical products. Nonprofit organizations are covering the cost of medication to those patients in some contexts. The aim of the study was to describe the population of beneficiaries of the PB, a nongovernmental organization based on the primary healthcare system, which provides free-of-charge access to medicines and their utilization pattern of medicines and healthcare products. Methods: This was an observational study using PB beneficiary data collected between November 2017 and December 2018 in Catalonia. The Catalan Health Service provided information from the general population. A descriptive analysis of the beneficiaries' characteristics was conducted and compared to the general population. Results: The beneficiaries (N = 1,206) were mainly adults with a low level of education, unemployed, with functional disability, and with ≥1 child. Compared with the general population, the beneficiaries were older, had a lower level of education, showed a higher prevalence of functional disability, were less likely to be Spanish, and were more likely to be divorced and unemployed. The beneficiaries were polymedicated, and most were using medication related to the nervous (79%), musculoskeletal (68%), and cardiovascular system (56%) and alimentary tract and metabolism (68%). Almost 19% of beneficiaries used healthcare products. Female beneficiaries were older and more likely to be divorced or widowed, employed, and with children. Compared to men, women were more likely to use medicines for pain and mental disorders. The pediatric group used medications for severe, chronic conditions (heart diseases, autoimmune diseases, conduct disorders, and attention deficit hyperactivity disorder). Conclusion: Patients with severe, chronic, and disabling conditions are affected by pharmaceutical poverty. While the system of copayment remains unchanged, family physicians and pediatricians should explore economic barriers to treatment and direct their patients to resources that help to cover the cost of treatment.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Silvia Marqués-Ercilla
- Centre d’Atenció Primària Bartomeu Fabrés Anglada, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Gavà, Spain
- Unitat de Suport a la Recerca Costa de Ponent, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Cornellà de Llobregat, Spain
| | - M Teresa Peñarrubia-María
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Centre d’Atenció Primària Bartomeu Fabrés Anglada, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Gavà, Spain
- Unitat de Suport a la Recerca Costa de Ponent, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Cornellà de Llobregat, Spain
| | - Rosa M. Urbanos-Garrido
- Department of Applied Economics, Public Economics and Political Economy, The Complutense University of Madrid, Madrid, Spain
| | - Carme Borrell
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | | | - Alba Sánchez-Viñas
- Research and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ignacio Aznar-Lou
- Research and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
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14
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Iglesias-González M, Gil-Girbau M, Peñarrubia-María MT, Blanco-García E, Fernández-Vergel R, Serrano-Blanco A, Carbonell-Duacastella C, Alonso J, Rubio-Valera M. Barriers and opportunities for the treatment of mild-to-moderate depression with a watchful waiting approach. Patient Educ Couns 2021; 104:611-619. [PMID: 32782178 DOI: 10.1016/j.pec.2020.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/17/2020] [Accepted: 07/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim of this study is to explore barriers and opportunities in non-pharmacological treatment of depression in primary care (PC) from the perspective of family physicians (FPs). METHODS Qualitative analysis was used to explore a sample of 36 FPs treating patients with depressive symptoms. Criteria to maximize variability were followed. Participants were identified by key informants. Six group interviews were developed following a semi-structured thematic script. All interviews were transcribed, analyzed and triangulated. Information was saturated. Principals of reflexivity and circularity were implemented. RESULTS The results obtained followed 3 main theoretical axes: the FP, the patient, the healthcare system, and the interaction between them. Barriers included poor alignment with clinical practice guidelines, inadequate FP training, patients' preferences and structural challenges in PC. Among opportunities were good FP clinical interview skills, the beneficial bond of trust between patients and FPs and improved communication with mental healthcare services. CONCLUSION Based on FPs' perceptions, non-pharmacological treatment of depression in PC is particularly limited by lack of structured training; patients' preferences and treatment expectations; structural challenges in PC; and insufficient support from specialized mental health professionals. PRACTICE IMPLICATIONS Resources for education, structural support in PC and modified back up from mental healthcare services are needed.
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Affiliation(s)
- M Iglesias-González
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - M Gil-Girbau
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | - M T Peñarrubia-María
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain; SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut (ICS), Catalonia, Spain
| | - E Blanco-García
- Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain; SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut (ICS), Catalonia, Spain
| | - R Fernández-Vergel
- Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain; Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain; SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut (ICS), Catalonia, Spain
| | - A Serrano-Blanco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - C Carbonell-Duacastella
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - J Alonso
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain
| | - M Rubio-Valera
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.
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15
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González-Suñer L, Carbonell-Duacastella C, Aznar-Lou I, Rubio-Valera M, Iglesias-González M, Peñarrubia-María MT, Gil-Girbau M, Serrano-Blanco A. Use of Mental Health Services for Patients Diagnosed with Major Depressive Disorders in Primary Care. Int J Environ Res Public Health 2021; 18:885. [PMID: 33498567 PMCID: PMC7908155 DOI: 10.3390/ijerph18030885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/12/2021] [Accepted: 01/16/2021] [Indexed: 11/16/2022]
Abstract
Major depressive disorder (MDD) is one of the most disabling diseases worldwide, generating high use of health services. Previous studies have shown that Mental Health Services (MHS) use is associated with patient and Family Physician (FP) factors. The aim of this study was to investigate MHS use in a naturalistic sample of MDD outpatients and the factors influencing use of services in specialized psychiatric care, to know the natural mental healthcare pathway. Non-randomized clinical trial including newly depressed Primary Care (PC) patients (n = 263) with a 12-month follow-up (from 2013 to 2015). Patient sociodemographic variables were assessed along with clinical variables (mental disorder diagnosis, severity of depression or anxiety, quality of life, disability, beliefs about illness and medication). FP (n = 53) variables were also evaluated. A multilevel logistic regression analysis was performed to assess factors associated with public or private MHS use. Subjects were clustered by FP. Having previously used MHS was associated with the use of MHS. The use of public MHS was associated with worse perception of quality of life. No other sociodemographic, clinical, nor FP variables were associated with the use of MHS. Patient self-perception is a factor that influences the use of services, in addition to having used them before. This is in line with Value-Based Healthcare, which propose to put the focus on the patient, who is the one who must define which health outcomes are relevant to him.
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Affiliation(s)
- Laura González-Suñer
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (L.G.-S.); (A.S.-B.)
| | - Cristina Carbonell-Duacastella
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (C.C.-D.); (M.R.-V.); (M.G.-G.)
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Ignacio Aznar-Lou
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (C.C.-D.); (M.R.-V.); (M.G.-G.)
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Maria Rubio-Valera
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (C.C.-D.); (M.R.-V.); (M.G.-G.)
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | | | - Maria Teresa Peñarrubia-María
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Institut Català de la Salut i Institut d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08006 Barcelona, Spain
| | - Montserrat Gil-Girbau
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (C.C.-D.); (M.R.-V.); (M.G.-G.)
| | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (L.G.-S.); (A.S.-B.)
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
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16
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Domènech-Abella J, Mundó J, Haro JM, Rubio-Valera M. Corrigendum to "Anxiety, depression, loneliness and social network in the elderly: Longitudinal associations from The Irish Longitudinal Study on Ageing (TILDA)" [Journal of Affective Disorders 246 (2019) 82-88]. J Affect Disord 2020; 266:811. [PMID: 32217264 DOI: 10.1016/j.jad.2020.01.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Joan Domènech-Abella
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Department of Sociology, Universitat de Barcelona, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Jordi Mundó
- Department of Sociology, Universitat de Barcelona, Barcelona, Spain
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IP), Madrid Spain
| | - Maria Rubio-Valera
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Faculty of Pharmacy and Food Science, Universitat de Barcelona, Barcelona, Spain
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17
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Parody-Rúa E, Rubio-Valera M, Guevara-Cuellar C, Gómez-Lumbreras A, Casajuana-Closas M, Carbonell-Duacastella C, Aznar-Lou I. Economic Evaluations Informed Exclusively by Real World Data: A Systematic Review. Int J Environ Res Public Health 2020; 17:E1171. [PMID: 32059593 PMCID: PMC7068655 DOI: 10.3390/ijerph17041171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 12/28/2022]
Abstract
Economic evaluations using Real World Data (RWD) has been increasing in the very recent years, however, this source of information has several advantages and limitations. The aim of this review was to assess the quality of full economic evaluations (EE) developed using RWD. A systematic review was carried out through articles from the following databases: PubMed, Embase, Web of Science and Centre for Reviews and Dissemination. Included were studies that employed RWD for both costs and effectiveness. Methodological quality of the studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Of the 14,011 studies identified, 93 were included. Roughly half of the studies were carried out in a hospital setting. The most frequently assessed illnesses were neoplasms while the most evaluated interventions were pharmacological. The main source of costs and effects of RWD were information systems. The most frequent clinical outcome was survival. Some 47% of studies met at least 80% of CHEERS criteria. Studies were conducted with samples of 100-1000 patients or more, were randomized, and those that reported bias controls were those that fulfilled most CHEERS criteria. In conclusion, fewer than half the studies met 80% of the CHEERS checklist criteria.
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Affiliation(s)
- Elizabeth Parody-Rúa
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu–Institut de Recerca Sant Joan de Déu, 08830 Barcelona, Spain; (M.R.-V.); (C.C.-D.); (I.A.-L.)
- Primary Care Prevention and Health Promotion Network (redIAPP), 08007 Barcelona, Spain
| | - Maria Rubio-Valera
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu–Institut de Recerca Sant Joan de Déu, 08830 Barcelona, Spain; (M.R.-V.); (C.C.-D.); (I.A.-L.)
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | | | - Ainhoa Gómez-Lumbreras
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), 08007 Barcelona, Spain; (A.G.-L.); (M.C.-C.)
- Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
- Health Science School, Universitat de Girona, 17071 Girona, Spain
| | - Marc Casajuana-Closas
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), 08007 Barcelona, Spain; (A.G.-L.); (M.C.-C.)
- Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
| | - Cristina Carbonell-Duacastella
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu–Institut de Recerca Sant Joan de Déu, 08830 Barcelona, Spain; (M.R.-V.); (C.C.-D.); (I.A.-L.)
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Ignacio Aznar-Lou
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu–Institut de Recerca Sant Joan de Déu, 08830 Barcelona, Spain; (M.R.-V.); (C.C.-D.); (I.A.-L.)
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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18
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Aznar-Lou I, Iglesias-González M, Gil-Girbau M, Serrano-Blanco A, Fernández A, Peñarrubia-María MT, Sabés-Figuera R, Murrugarra-Centurión AG, March-Pujol M, Bolívar-Prados M, Rubio-Valera M. Corrigendum to "Impact of initial medication non-adherence to SSRIs on medical visits and sick leaves" [J Affect Disord. 2018 Jan 15;226:282-286]. J Affect Disord 2020; 261:110. [PMID: 31610310 DOI: 10.1016/j.jad.2019.09.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ignacio Aznar-Lou
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; School of Pharmacy, University of Barcelona, Barcelona, Spain
| | | | - Montserrat Gil-Girbau
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; School of Pharmacy, University of Barcelona, Barcelona, Spain; Primary Care Prevention and Health Promotion Research Network (redIAPP), Spain
| | - Antoni Serrano-Blanco
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Parc Sanitari Sant Joan de Déu, University of Barcelona, Sant Boi de Llobregat, Spain
| | - Ana Fernández
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Community Health Service, Public Health Agency of Barcelona, Barcelona, Spain
| | - María Teresa Peñarrubia-María
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
| | - Ramón Sabés-Figuera
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Faculty of Economic and Business Science, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Marian March-Pujol
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; School of Pharmacy, University of Barcelona, Barcelona, Spain
| | | | - Maria Rubio-Valera
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; School of Pharmacy, University of Barcelona, Barcelona, Spain.
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19
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Gil-Girbau M, Pons-Vigués M, Rubio-Valera M, Murrugarra G, Masluk B, Rodríguez-Martín B, García Pineda A, Vidal Thomás C, Conejo-Cerón S, Recio JI, Martínez C, Pujol-Ribera E, Berenguera A. Modelos teóricos de promoción de la salud en la práctica habitual en atención primaria de salud. Gac Sanit 2019; 35:48-59. [PMID: 31753510 DOI: 10.1016/j.gaceta.2019.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 05/30/2019] [Accepted: 06/09/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Montse Gil-Girbau
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, Barcelona, España; Primary Care Prevention and Health Promotion Research Network, Barcelona, España
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España; Universitat de Girona, Girona, España
| | - Maria Rubio-Valera
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, Barcelona, España; Primary Care Prevention and Health Promotion Research Network, Barcelona, España; CIBER en Epidemiología y Salud Pública (CIBERESP), España; Facultad de Farmacia, Universidad de Barcelona, Barcelona, España
| | - Gabriela Murrugarra
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, Barcelona, España
| | - Barbara Masluk
- Departmento de Psicología y Sociología, Universidad de Zaragoza, Zaragoza, España
| | | | | | - Clara Vidal Thomás
- Gabinete Técnico de la Gerencia de Atención Primaria de Mallorca, Servicio de Salud Illes Balears, Instituto de Investigación Sanitaria de les Illes Balears, España
| | - Sonia Conejo-Cerón
- Instituto de Investigación Biomédica de Málaga, Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, España
| | - José Ignacio Recio
- Institute of Biomedical Research of Salamanca, Primary Health Care Research Unit, La Alamedilla (Salamanca), España
| | - Catalina Martínez
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Bilbao, España
| | - Enriqueta Pujol-Ribera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España; Universitat de Girona, Girona, España
| | - Anna Berenguera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España.
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20
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Aznar-Lou I, Carbonell-Duacastella C, Rodriguez A, Mera I, Rubio-Valera M. Prevalence of Medication-Dietary Supplement Combined Use and Associated Factors. Nutrients 2019; 11:nu11102466. [PMID: 31618867 PMCID: PMC6835757 DOI: 10.3390/nu11102466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/03/2019] [Accepted: 10/05/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction: The use of medication has increased in recent years in the US while the use of dietary supplements has remained stable but high. Interactions between these two kinds of products may have important consequences, especially in the case of widely used medications such as antihypertensives and antibiotics. The aim of this paper is to estimate the prevalence of potentially serious drug–dietary supplement interactions among tetracyclines, thiazides, and angiotensin II receptor blocker users by means of the NHANES 2013–2014 dataset. Methods: Data from 2013–2014 NHANES were obtained. Potential interactions analysed were tetracyclines with calcium, magnesium, and zinc, thiazides with vitamin D, and angiotensin II receptors blockers with potassium. Prevalence was calculated for each potential interaction. Logistic regression was used to assess associated factors. Results: 864 prescriptions issued to 820 patients were analysed. Overall prevalence of potential interaction was 49%. Older age and higher educational level were strongly associated with being at risk of a potential interaction. Factors such as age, race, civil status, citizenship, country of birth, BMI, and physical activity did not show notable associations. Conclusions: Healthcare professionals should be aware of other medical products when they prescribe or dispense a medication or a dietary supplement, especially to the older population and people with a higher educational level.
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Affiliation(s)
- Ignacio Aznar-Lou
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat (Barcelona), Spain.
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, 28029 Madrid, Spain.
| | - Cristina Carbonell-Duacastella
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat (Barcelona), Spain.
| | - Ana Rodriguez
- Spanish Society of Community and Family Pharmacy (SEFAC), 28045 Madrid, Spain.
| | - Inés Mera
- Spanish Society of Community and Family Pharmacy (SEFAC), 28045 Madrid, Spain.
| | - Maria Rubio-Valera
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat (Barcelona), Spain.
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, 28029 Madrid, Spain.
- School of Pharmacy, University of Barcelona, 08028 Barcelona, Spain.
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21
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Rubio-Valera M, Peñarrubia-María MT, Iglesias-González M, Knapp M, McCrone P, Roig M, Sabes-Figuera R, Luciano JV, Mendive JM, Murrugara-Centurión AG, Alonso J, Serrano-Blanco A. Cost-effectiveness of antidepressants versus active monitoring for mild-to-moderate major depressive disorder: a multisite non-randomized-controlled trial in primary care (INFAP study). Eur J Health Econ 2019; 20:703-713. [PMID: 30725226 DOI: 10.1007/s10198-019-01034-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 01/31/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the cost-effectiveness of antidepressants vs active monitoring (AM) for patients with mild-moderate major depressive disorder. METHODS This was a 12-month observational prospective controlled trial. Adult patients with a new episode of major depression were invited to participate and assigned to AM or antidepressants according to General Practitioners' clinical judgment and experience. Patients were evaluated at baseline, and 6 and 12-month follow-up. Quality-adjusted life years (QALYs) gained were estimated and used to calculate incremental cost-utility ratios (ICUR) from the healthcare and government perspective. To minimize the bias resulting from non-randomization, a propensity score-based method was used. RESULTS At 6 and 12-month follow-up, ICUR was 2549 €/QALY and 6,142 €/QALY, respectively, in favor of antidepressants. At 6 months, for a willingness to pay (WTP) of 25,000 €/QALY, antidepressants had a probability of 0.89 (healthcare perspective) and 0.81 (government perspective) of being more cost-effective than AM. At 12 months, this probability was 0.86 (healthcare perspective) and 0.73 (government perspective). CONCLUSIONS Incremental cost-utility ratios favor pharmacological treatment as a first-line approach for patients with mild-moderate major depressive disorder. While our results should be interpreted with caution and further real world research is needed, clinical practice guidelines should consider antidepressant therapy for mild-moderate major depressive patients as an alternative to active monitoring in PC.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain.
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain.
- Department Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona, Spain.
| | - María Teresa Peñarrubia-María
- Primary Care Health Centre Bartomeu Fabrés Anglada, Servei d'Atenció Primària Delta Llobregat, Àmbit Costa de Ponent, Institut Català de la Salut, Gavà, Spain
| | - Maria Iglesias-González
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
| | - Martin Knapp
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, UK
| | - Paul McCrone
- Institute of Psychiatry, King's College London, De Crespigny Park, London, UK
| | - Marta Roig
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Department Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona, Spain
| | - Ramón Sabes-Figuera
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Faculty of Economic and Business Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Juan V Luciano
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain
- Open University of Catalonia (UOC), Barcelona, Spain
| | - Juan M Mendive
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain
- La Mina Primary Care Centre, Institut Català de la Salut, Sant Adrià de Besós, Barcelona, Spain
| | - Ana Gabriela Murrugara-Centurión
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain
| | - Jordi Alonso
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Antoni Serrano-Blanco
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, C/ Pablo Picasso 12, 08830, Sant Boi de Llobregat, Spain
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, Madrid, Spain
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22
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Domènech-Abella J, Mundó J, Haro JM, Rubio-Valera M. Anxiety, depression, loneliness and social network in the elderly: Longitudinal associations from The Irish Longitudinal Study on Ageing (TILDA). J Affect Disord 2019; 246:82-88. [PMID: 30578950 DOI: 10.1016/j.jad.2018.12.043] [Citation(s) in RCA: 193] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/05/2018] [Accepted: 12/16/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Social network, loneliness, generalized anxiety disorder (GAD) and major depression disorder (MDD) are interrelated. However, as the directions of these associations are still unclear, we examined them prospectively using community-based data. METHODS Data on 5066 adults aged ≥50 years from The Irish Longitudinal Study on Ageing (TILDA) were analyzed. Loneliness was assessed through the UCLA loneliness scale. Social integration was measured using the Berkman-Syme Social Network Index. MDD and GAD were assessed with the Composite International Diagnostic Interview (CIDI). Logistic regression models were conducted. RESULTS The longitudinal association between experiencing loneliness and higher likelihood of suffering from MDD or GAD two years later is bidirectional but stronger with loneliness as origin, whereas the association between social isolation and higher likelihood of subsequent MDD or GAD as well as those between loneliness and subsequent deterioration of social integration are unidirectional. CONCLUSION Objective and perceived social isolation independently affect the probability of suffering from MDD or GAD whereas loneliness is a risk factor for the deterioration of social life, which highlights the need to address the subjective factors (such as loneliness) and objective factors (such as social network size) of social isolation in a complementary way in order to improve the mental health of the older adult population.
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Affiliation(s)
- Joan Domènech-Abella
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Department of Sociology, Universitat de Barcelona, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Jordi Mundó
- Department of Sociology, Universitat de Barcelona, Barcelona, Spain
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Maria Rubio-Valera
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Faculty of Pharmacy and Food Science, Universitat de Barcelona, Barcelona, Spain
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23
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Aznar-Lou I, Iglesias-González M, Rubio-Valera M, Peñarrubia-Maria MT, Mendive JM, Murrugarra-Centurión AG, Gil-Girbau M, González-Suñer L, Peuters C, Serrano-Blanco A. Diagnostic accuracy and treatment approach to depression in primary care: predictive factors. Fam Pract 2019; 36:3-11. [PMID: 30423158 DOI: 10.1093/fampra/cmy098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The study assessed the predictive factors of diagnostic accuracy and treatment approach (antidepressants versus active monitoring) for depression in primary care. METHODS This is a cross-sectional study that uses information from a naturalistic prospective controlled trial performed in Barcelona (Spain) enrolling newly diagnosed patients with mild to moderate depression by GPs. Treatment approach was based on clinical judgement. Diagnosis was later assessed according to DSM-IV criteria using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview by an external researcher. Patients (sociodemographic, psychiatric diagnosis, severity of depression and anxiety, health-related quality of life, disability, beliefs about medication and illness and comorbidities) and GP factors associated with diagnostic accuracy and treatment approach were assessed using multilevel logistic regression. Variables with missing data were imputed through multiple imputations. RESULTS Two hundred sixty-three patients were recruited by 53 GPs. Mean age was 51 years (SD = 15). Thirty percent met DSM-IV criteria for major depression. Mean depression symptomatology was moderate-severe. Using multivariate analyses, patients' beliefs about medicines were the only variable associated with the antidepressant approach. Specialization in general medicine and being a resident tutor were associated with a more accurate diagnosis. CONCLUSIONS Clinical depression diagnosis by GPs was not always associated with a formal diagnosis through a SCID-I. GPs' training background was central to an adequate depression diagnosis. Patients' beliefs in medication were the only factor associated with treatment approach. More resources should be allocated to improving the diagnosis of depression.
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Affiliation(s)
- Ignacio Aznar-Lou
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
| | - Maria Iglesias-González
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,School of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria Rubio-Valera
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - M Teresa Peñarrubia-Maria
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut, Catalonia, Spain
| | - Juan M Mendive
- Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,La Mina Primary Care Centre, Institut Català de la Salut, Sant Adrià de Besós, Spain
| | - Ana G Murrugarra-Centurión
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | - Montserrat Gil-Girbau
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | | | - Carmen Peuters
- Department of Movement and Sports Sciences, Ghent University, Belgium
| | - Antoni Serrano-Blanco
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,School of Medicine, University of Barcelona, Barcelona, Spain
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24
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Zabaleta-Del-Olmo E, Pombo H, Pons-Vigués M, Casajuana-Closas M, Pujol-Ribera E, López-Jiménez T, Cabezas-Peña C, Martín-Borràs C, Serrano-Blanco A, Rubio-Valera M, Llobera J, Leiva A, Vicens C, Vidal C, Campiñez M, Martín-Álvarez R, Maderuelo JÁ, Recio JI, García-Ortiz L, Motrico E, Bellón JÁ, Moreno-Peral P, Martín-Cantera C, Clavería A, Aldecoa-Landesa S, Magallón-Botaya R, Bolíbar B. Correction to: Complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in primary health care (EIRA study): study protocol for a hybrid trial. BMC Public Health 2018; 18:1004. [PMID: 30103723 PMCID: PMC6088411 DOI: 10.1186/s12889-018-5905-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Edurne Zabaleta-Del-Olmo
- Institut Universitarid'Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007, Barcelona, Spain. .,Gerència Territorial de Barcelona, Institut Català de la Salut, c/Balmes 22, 08007, Barcelona, Spain. .,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain. .,Faculty of Nursing, Universitat de Girona, Carrer d'Emili Grahit, 77, 17003, Girona, Spain.
| | - Haizea Pombo
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Luis Power Kalea 18, 48014, Bilbao, Spain
| | - Mariona Pons-Vigués
- Institut Universitarid'Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.,Faculty of Nursing, Universitat de Girona, Carrer d'Emili Grahit, 77, 17003, Girona, Spain
| | - Marc Casajuana-Closas
- Institut Universitarid'Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Enriqueta Pujol-Ribera
- Institut Universitarid'Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007, Barcelona, Spain.,Gerència Territorial de Barcelona, Institut Català de la Salut, c/Balmes 22, 08007, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.,Faculty of Nursing, Universitat de Girona, Carrer d'Emili Grahit, 77, 17003, Girona, Spain
| | - Tomás López-Jiménez
- Institut Universitarid'Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Carmen Cabezas-Peña
- Deputy Directorate of Health Promotion, Public Health Agency, Department of Health, Goverment of Catalonia, Roc Boronat, 81-95 (Edifici Salvany), 08005, Barcelona, Spain
| | - Carme Martín-Borràs
- Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, C/Císter 34, 08022, Barcelona, Spain.,Faculty of Health Sciences (FCS) Blanquerna, Ramon Llull Univesity, C/ Padilla 326-332, 08025, Barcelona, Spain
| | - Antoni Serrano-Blanco
- Parc SanitariSant Joan de Déu, Institut de Recerca Sant Joan de Déu, C/Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Rubio-Valera
- Parc SanitariSant Joan de Déu, Institut de Recerca Sant Joan de Déu, C/Santa Rosa 39-57, 08950, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joan Llobera
- Gerènciad'AtencióPrimària de Mallorca, Institut de InvestigacióSanitària de les Illes Balears IdISBa, C/Escola Graduada 3, 07002 Palma, Mallorca, Spain
| | - Alfonso Leiva
- Gerènciad'AtencióPrimària de Mallorca, Institut de InvestigacióSanitària de les Illes Balears IdISBa, C/Escola Graduada 3, 07002 Palma, Mallorca, Spain
| | - Caterina Vicens
- Gerènciad'AtencióPrimària de Mallorca, Institut de InvestigacióSanitària de les Illes Balears IdISBa, C/Escola Graduada 3, 07002 Palma, Mallorca, Spain
| | - Clara Vidal
- Gerènciad'AtencióPrimària de Mallorca, Institut de InvestigacióSanitària de les Illes Balears IdISBa, C/Escola Graduada 3, 07002 Palma, Mallorca, Spain
| | - Manuel Campiñez
- Primary Health Centre Vallcarca, Edificio Pedraforca, Av. Vallcarca 169-205, 08023, Barcelona, Spain
| | - Remedios Martín-Álvarez
- Primary Health Centre Vallcarca, Edificio Pedraforca, Av. Vallcarca 169-205, 08023, Barcelona, Spain
| | - José-Ángel Maderuelo
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACyL), Avda. Comuneros 27-31, 37003, Salamanca, Spain
| | - José-Ignacio Recio
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACyL), Avda. Comuneros 27-31, 37003, Salamanca, Spain.,Department of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
| | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACyL), Avda. Comuneros 27-31, 37003, Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Emma Motrico
- Psychology Department, Universidad Loyola Andalucía, c/Energía Solar 1, Sevilla, Spain
| | - Juan-Ángel Bellón
- Research Unit, Primary Care District of Málaga-Guadalhorce, c/ Sevilla, 23, Málaga, Spain.,Institute of Biomedical Research in Málaga (IBIMA), c/ Sevilla, 23, Málaga, Spain.,El Palo Health Center, Andalusian Health Service (SAS), Av. Salvador Allende 159, 29018, Málaga, Spain.,Department of Public Health and Psychiatry, University of Malaga, Campus de Teatinos s/n, 29071, Málaga, Spain
| | - Patricia Moreno-Peral
- Research Unit, Primary Care District of Málaga-Guadalhorce, c/ Sevilla, 23, Málaga, Spain.,Institute of Biomedical Research in Málaga (IBIMA), c/ Sevilla, 23, Málaga, Spain
| | - Carlos Martín-Cantera
- Institut Universitarid'Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Ana Clavería
- Grupo I-Saúde, Instituto de Investigación Sanitaria Galicia-Sur (IISGS), Xerencia de Xestión Integrada de Vigo, ServizoGalego de Saúde (SERGAS), Universidade de Vigo, Avda Rosalía Castro 21, 36201, Vigo, Spain
| | - Susana Aldecoa-Landesa
- Grupo I-Saúde, Instituto de Investigación Sanitaria Galicia-Sur (IISGS), Xerencia de Xestión Integrada de Vigo, ServizoGalego de Saúde (SERGAS), Universidade de Vigo, Avda Rosalía Castro 21, 36201, Vigo, Spain.,Primary Health Centre Beiramar, Xerencia de Xestión Integrada Vigo, Servizo Galego de Saúde (SERGAS), Avda Rosalía Castro 21, 36201, Vigo, Spain
| | - Rosa Magallón-Botaya
- Instituto de Investigación Sanitaria Aragón, Avda. San Juan Bosco 13, 50009, Zaragoza, Spain
| | - Bonaventura Bolíbar
- Institut Universitarid'Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
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25
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Bai X, Liu C, Baladon L, Rubio-Valera M. Multidimensional determinants of the caregiving burden among Chinese male caregivers of older family members in Hong Kong. Aging Ment Health 2018; 22:980-989. [PMID: 28541777 DOI: 10.1080/13607863.2017.1330872] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The objective of this study was to examine multidimensional determinants of the caregiving burden among Chinese male caregivers of older family members in Hong Kong. Based on a modified stress process model, this study explored how background and contextual factors (demographic characteristics and mental health status of caregivers, caregiving-related factors, and support and services), primary stressors (degree of care dependency and special care needs), and secondary stressors (self-efficacy and gender role conflict) might affect the caregiving burden among male caregivers. METHOD A questionnaire survey was completed by 204 male caregivers who considered themselves as primary caregivers for older family members with care needs aged 60 and over. Descriptive, bivariate, and multivariate analyses were conducted. RESULTS Being the son of the care receiver, the presence of depressive symptoms, a higher degree of gender role conflict, a lower degree of caregiving self-efficacy, and the use of support and services all predicted greater caregiving burden among male caregivers. CONCLUSION This study established a modified stress process model specifically for male caregivers. Gender role conflict and caregiving self-efficacy were introduced into the model as secondary stressors and found to be significantly associated with the degree of caregiving burden. The findings of this study could inform the development of services and interventions to reduce the caregiving burden among male caregivers.
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Affiliation(s)
- Xue Bai
- a Department of Applied Social Sciences , The Hong Kong Polytechnic University , Hong Kong.,b Personal Social Services Research Unit , London School of Economics and Political Science , UK
| | - Chang Liu
- a Department of Applied Social Sciences , The Hong Kong Polytechnic University , Hong Kong
| | - Luisa Baladon
- c Adults Mental Health Centre of Garraf , Parc Sanitari Sant Joan De Déu , Barcelona , Spain
| | - Maria Rubio-Valera
- d Research and Teaching Unit , Fundació Sant Joan de Déu , Spain.,e Centre For Biomedical Research in Epidemiology and Public Health, CIBERESP , Madrid , Spain.,f School of Pharmacy , Universitat de Barcelona , Barcelona , Spain
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26
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Resurrección DM, Motrico E, Rubio-Valera M, Mora-Pardo JA, Moreno-Peral P. Reasons for dropout from cardiac rehabilitation programs in women: A qualitative study. PLoS One 2018; 13:e0200636. [PMID: 30011341 PMCID: PMC6047805 DOI: 10.1371/journal.pone.0200636] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 06/29/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Empirical evidence has shown that cardiac rehabilitation programs are effective in reducing morbidity and mortality, improving quality of life in patients with cardiovascular disease. Despite the benefits, women have a high cardiac rehabilitation dropout rate. Our aim was to explore women's perceptions about the reasons they faced for dropout from these programs. METHODS Semi-structured interviews were conducted with women (n = 10) after dropping out from three different cardiac rehabilitation centers in Spain. In addition, a focus group and a semi-structured interview with cardiovascular professionals were conducted. From a grounded theory perspective, thematic analysis was used to derive themes from interview transcripts. RESULTS The women were between 41 and 70 years. We identified five general themes that illustrated reasons for cardiac rehabilitation dropout: intrapersonal reasons (self-reported health, self-reported mental health, health beliefs); interpersonal reasons (family caregiver role, work conflicts); logistical reasons (transport, distance); cardiac rehabilitation program characteristics (perception of the objective of cardiac rehabilitation, exercise component, inconvenient timing, cardiac rehabilitation equipment); and health system reasons (financial assistance for transport, long waiting list). The cardiovascular professionals found barriers to cardiac rehabilitation completion similar to those found by the women. CONCLUSIONS In order to prevent cardiac rehabilitation dropout in women, modular and flexible programs are needed. In addition, the inclusion of primary care centers or community resources could improve cardiac rehabilitation completion in women. Psychological assessment and counseling during cardiac rehabilitation should be included as an essential part of the programs and recommended for those women with depressive symptoms. Finally, improved financial assistance for transport from the health system is essential.
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Affiliation(s)
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucía, Sevilla, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Malaga, Spain
| | - Maria Rubio-Valera
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Patricia Moreno-Peral
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
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Zabaleta-del-Olmo E, Pombo H, Pons-Vigués M, Casajuana-Closas M, Pujol-Ribera E, López-Jiménez T, Cabezas-Peña C, Martín-Borràs C, Serrano-Blanco A, Rubio-Valera M, Llobera J, Leiva A, Vidal C, Campiñez M, Martín-Álvarez R, Maderuelo JÁ, Recio JI, García-Ortiz L, Motrico E, Bellón JÁ, Moreno-Peral P, Martín-Cantera C, Clavería A, Aldecoa-Landesa S, Magallón-Botaya R, Bolíbar B. Complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in primary health care (EIRA study): study protocol for a hybrid trial. BMC Public Health 2018; 18:874. [PMID: 30005705 PMCID: PMC6045838 DOI: 10.1186/s12889-018-5805-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Health promotion is a key process of current health systems. Primary Health Care (PHC) is the ideal setting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority of the adult population engages two or more risk behaviours, that is why a multiple intervention might be more effective and efficient. The primary objectives are to evaluate the effectiveness, the cost-effectiveness and an implementation strategy of a complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in PHC. METHODS This study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing a complex multiple risk behaviour intervention with usual care. It will be carried out in 26 PHC centres in Spain. The study focuses on people between 45 and 75 years who carry out two or more of the following unhealthy behaviours: tobacco use, low adherence to the Mediterranean dietary pattern or insufficient physical activity level. The intervention is based on the Transtheoretical Model and it will be made by physicians and nurses in the routine care of PHC practices according to the conceptual framework of the "5A's". It will have a maximum duration of 12 months and it will be carried out to three different levels (individual, group and community). Incremental cost per quality-adjusted life year gained measured by the tariffs of the EuroQol-5D questionnaire will be estimated. The implementation strategy is based on the "Consolidated Framework for Implementation Research", a set of discrete implementation strategies and an evaluation framework. DISCUSSION EIRA study will determine the effectiveness and cost-effectiveness of a complex multiple risk intervention and will provide a better understanding of implementation processes of health promotion interventions in PHC setting. It may contribute to increase knowledge about the individual and structural barriers that affect implementation of these interventions and to quantify the contextual factors that moderate the effectiveness of implementation. TRIAL REGISTRATION ClinicalTrials.gov , NCT03136211 .Retrospectively registered on May 2, 2017.
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Affiliation(s)
- Edurne Zabaleta-del-Olmo
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Gerència Territorial de Barcelona, Institut Català de la Salut, c/Balmes 22, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Faculty of Nursing, Universitat de Girona, Carrer d’Emili Grahit, 77, 17003 Girona, Spain
| | - Haizea Pombo
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Luis Power Kalea 18, 48014 Bilbao, Spain
| | - Mariona Pons-Vigués
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Faculty of Nursing, Universitat de Girona, Carrer d’Emili Grahit, 77, 17003 Girona, Spain
| | - Marc Casajuana-Closas
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Enriqueta Pujol-Ribera
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Gerència Territorial de Barcelona, Institut Català de la Salut, c/Balmes 22, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Faculty of Nursing, Universitat de Girona, Carrer d’Emili Grahit, 77, 17003 Girona, Spain
| | - Tomás López-Jiménez
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Carmen Cabezas-Peña
- Deputy Directorate of Health Promotion, Public Health Agency, Department of Health, Goverment of Catalonia, Roc Boronat, 81-95 (Edifici Salvany), 08005 Barcelona, Spain
| | - Carme Martín-Borràs
- Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, C/Císter 34, 08022 Barcelona, Spain
- Faculty of Health Sciences (FCS) Blanquerna, Ramon Llull Univesity, C/Padilla 326-332, 08025 Barcelona, Spain
| | - Antoni Serrano-Blanco
- Parc SanitariSant Joan de Déu, Institut de Recerca Sant Joan de Déu, C/Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Rubio-Valera
- Parc SanitariSant Joan de Déu, Institut de Recerca Sant Joan de Déu, C/Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joan Llobera
- Gerènciad’AtencióPrimària de Mallorca, Institut de InvestigacióSanitària de les Illes Balears IdISBa, C/Escola Graduada 3, 07002 Palma, Mallorca Spain
| | - Alfonso Leiva
- Gerènciad’AtencióPrimària de Mallorca, Institut de InvestigacióSanitària de les Illes Balears IdISBa, C/Escola Graduada 3, 07002 Palma, Mallorca Spain
| | - Clara Vidal
- Gerènciad’AtencióPrimària de Mallorca, Institut de InvestigacióSanitària de les Illes Balears IdISBa, C/Escola Graduada 3, 07002 Palma, Mallorca Spain
| | - Manuel Campiñez
- Primary Health Centre Vallcarca, Edificio Pedraforca, Av. Vallcarca 169-205, 08023 Barcelona, Spain
| | - Remedios Martín-Álvarez
- Primary Health Centre Vallcarca, Edificio Pedraforca, Av. Vallcarca 169-205, 08023 Barcelona, Spain
| | - José-Ángel Maderuelo
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACyL), Avda. Comuneros 27-31, 37003 Salamanca, Spain
| | - José-Ignacio Recio
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACyL), Avda. Comuneros 27-31, 37003 Salamanca, Spain
- Department of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
| | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACyL), Avda. Comuneros 27-31, 37003 Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Emma Motrico
- Psychology Department, Universidad Loyola Andalucía, c/Energía Solar 1, Sevilla, Spain
| | - Juan-Ángel Bellón
- Research Unit, Primary Care District of Málaga-Guadalhorce, c/ Sevilla 23, Málaga, Spain
- Institute of Biomedical Research in Málaga (IBIMA), c/ Sevilla 23, Málaga, Spain
- El Palo Health Center, Andalusian Health Service (SAS), Av. Salvador Allende 159, 29018 Málaga, Spain
- Department of Public Health and Psychiatry, University of Malaga, Campus de Teatinos s/n, 29071 Málaga, Spain
| | - Patricia Moreno-Peral
- Research Unit, Primary Care District of Málaga-Guadalhorce, c/ Sevilla 23, Málaga, Spain
- Institute of Biomedical Research in Málaga (IBIMA), c/ Sevilla 23, Málaga, Spain
| | - Carlos Martín-Cantera
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Ana Clavería
- Grupo I-Saúde, Instituto de Investigación Sanitaria Galicia-Sur (IISGS), Xerencia de Xestión Integrada de Vigo, ServizoGalego de Saúde (SERGAS), Universidade de Vigo, Avda Rosalía Castro 21, 36201 Vigo, Spain
| | - Susana Aldecoa-Landesa
- Grupo I-Saúde, Instituto de Investigación Sanitaria Galicia-Sur (IISGS), Xerencia de Xestión Integrada de Vigo, ServizoGalego de Saúde (SERGAS), Universidade de Vigo, Avda Rosalía Castro 21, 36201 Vigo, Spain
- Primary Health Centre Beiramar, Xerencia de Xestión Integrada Vigo, Servizo Galego de Saúde (SERGAS), Avda Rosalía Castro 21, 36201 Vigo, Spain
| | - Rosa Magallón-Botaya
- Instituto de Investigación Sanitaria Aragón, Avda. San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Bonaventura Bolíbar
- Institut Universitarid’Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
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Resurrección DM, Moreno-Peral P, Gómez-Herranz M, Rubio-Valera M, Pastor L, Caldas de Almeida JM, Motrico E. Factors associated with non-participation in and dropout from cardiac rehabilitation programmes: a systematic review of prospective cohort studies. Eur J Cardiovasc Nurs 2018; 18:38-47. [PMID: 29909641 DOI: 10.1177/1474515118783157] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although evidence exists for the efficacy of cardiac rehabilitation programmes to reduce morbidity and mortality among patients with cardiovascular disease, cardiac rehabilitation programmes are underused. We aimed systematically to review the evidence from prospective cohort studies on factors associated with non-participation in and/or dropping out from cardiac rehabilitation programmes. METHODS MedLine, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications from inception to February 2018. Search terms included (a) coronary heart disease and other cardiac conditions; (b) cardiac rehabilitation and secondary prevention; and (c) non-participation in and/or dropout. Databases were searched following the PRISMA statement. Study selection, data extraction and the assessment of study quality were performed in duplicate. RESULTS We selected 43 studies with a total of 63,425 patients from 10 different countries that met the inclusion criteria. Factors associated with non-participation in and dropout from cardiac rehabilitation were grouped into six broad categories: intrapersonal factors, clinical factors, interpersonal factors, logistical factors, cardiac rehabilitation programme factors and health system factors. We found that clinical factors, logistical factors and health system factors were the main factors assessed for non-participation in cardiac rehabilitation. We also found differences between the factors associated with non-participation and dropout. CONCLUSIONS Several factors were determinant for non-participation in and dropout from cardiac rehabilitation. These findings could be useful to clinicians and policymakers for developing interventions aimed at improving participation and completion of cardiac rehabilitation, such as E-health or home-based delivery programmes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) identifier: CRD42016032973.
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Affiliation(s)
| | - Patricia Moreno-Peral
- 2 SAMSERAP Group, Primary Care Prevention and Health Promotion Research Network (RedIAPP), Spain.,3 SAMSERAP Group, Instituto de Investigación Biomédica de Malaga (IBIMA), Spain
| | | | - Maria Rubio-Valera
- 5 Research and Development Unit, Institut de Recerca Sant Joan de Déu, Spain.,6 Grupo PRISMA, Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, Spain
| | - Luis Pastor
- 7 Unidad Clínica de Cardiología, Hospital Nuestra Señora de Valme, Spain
| | | | - Emma Motrico
- 1 Departamento de Psicología, Universidad Loyola Andalucía, Spain.,2 SAMSERAP Group, Primary Care Prevention and Health Promotion Research Network (RedIAPP), Spain
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Aznar-Lou I, Pottegård A, Fernández A, Peñarrubia-María MT, Serrano-Blanco A, Sabés-Figuera R, Gil-Girbau M, Fajó-Pascual M, Moreno-Peral P, Rubio-Valera M. Effect of copayment policies on initial medication non-adherence according to income: a population-based study. BMJ Qual Saf 2018; 27:878-891. [DOI: 10.1136/bmjqs-2017-007416] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/06/2018] [Accepted: 02/11/2018] [Indexed: 01/03/2023]
Abstract
ObjectiveCopayment policies aim to reduce the burden of medication expenditure but may affect adherence and generate inequities in access to healthcare. The objective was to evaluate the impact of two copayment measures on initial medication non-adherence (IMNA) in several medication groups and by income level.DesignA population-based study was conducted using real-world evidence.SettingPrimary care in Catalonia (Spain) where two separate copayment measures (fixed copayment and coinsurance) were introduced between 2011 and 2013.ParticipantEvery patient with a new prescription issued between 2011 and 2014 (3 million patients and 10 million prescriptions).OutcomesIMNA was estimated throughout dispensing and invoicing information. Changes in IMNA prevalence after the introduction of copayment policies (immediate level change and trend changes) were estimated through segmented logistic regression. The regression models were stratified by economic status and medication groups.ResultsBefore changes to copayment policies, IMNA prevalence remained stable. The introduction of a fixed copayment was followed by a statistically significant increase in IMNA in poor population, low/middle-income pensioners and low-income non-pensioners (OR from 1.047 to 1.370). In high-income populations, there was a large statistically non-significant increase. IMNA decreased in the low-income population after suspension of the fixed copayment and the introduction of a coinsurance policy that granted this population free access to medications (OR=0.676). Penicillins were least affected while analgesics were affected to the greatest extent. IMNA to medications for chronic conditions increased in low/middle-income pensioners.ConclusionEven nominal charge fixed copayment may generate inequities in access to health services. An anticipation effect and expenses associated with IMNA may have generated short-term costs. A reduction in copayment can protect from non-adherence and have positive, long-term effects. Copayment scenarios could have considerable long-term consequences for health and costs due to increased IMNA in medication for chronic physical conditions.
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Aznar-Lou I, Iglesias-González M, Gil-Girbau M, Serrano-Blanco A, Fernández A, Peñarrubia-María MT, Sabés-Figuera R, Murrugarra-Centurión AG, March-Pujol M, Bolívar-Prados M, Rubio-Valera M. Impact of initial medication non-adherence to SSRIs on medical visits and sick leaves. J Affect Disord 2018; 226:282-286. [PMID: 29024901 DOI: 10.1016/j.jad.2017.09.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/30/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Initial medication non-adherence (IMNA) to antidepressants, which are commonly used to treat depression in primary care (PC), is around 6-12%. Although it is well known that post-initial non-adherence to antidepressants increases the cost of depression, the impact of IMNA on cost is unknown. The aim of this study is to assess the impact of IMNA to Selective Serotonin Reuptake Inhibitors (SSRI) on medical visits and sick leave in patients with depression treated in PC in Catalonia (Spain). METHODS This was a four-year retrospective register-based study (2011-2014). All PC patients of working age who received a new SSRI prescription and had a diagnosis of depression were included (N = 79,642). Treatment initiation, number of visits and days on sick leave were gathered from the database. We assessed the impact of IMNA on costs with ordered logistic regressions. RESULTS The 3-year incidence of IMNA was 15%. Initially non-adherent patients made a lesser number of GP visits (OR = 0.82; 95% CI = 0.79-0.84) but had more days on sick leave (OR = 1.25; 95% CI = 1.20-1.31). There were no differences in the number of specialist visits (OR = 1.04; 95% CI = 0.99-1.08). LIMITATIONS Differences between adherent and non-adherent patients could be explained by non-observed variables. GP recognition and documentation of depression might be inaccurate. Costs of unpaid work and use of hospital services were not considered. CONCLUSIONS Although IMNA decreases the use of medical PC services, it increases the number of days on sick leave. This could also indicate worse health status. These consequences are currently overlooked when considering post-initial medication non-adherence.
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Affiliation(s)
- Ignacio Aznar-Lou
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; School of Pharmacy, University of Barcelona, Barcelona, Spain
| | | | - Montserrat Gil-Girbau
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; School of Pharmacy, University of Barcelona, Barcelona, Spain; Primary Care Prevention and Health Promotion Research Network (redIAPP), Spain
| | - Antoni Serrano-Blanco
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Parc Sanitari Sant Joan de Déu, University of Barcelona, Sant Boi de Llobregat, Spain
| | - Ana Fernández
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Community Health Service, Public Health Agency of Barcelona, Barcelona, Spain
| | - María Teresa Peñarrubia-María
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
| | - Ramón Sabés-Figuera
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Faculty of Economic and Business Science, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Marian March-Pujol
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; School of Pharmacy, University of Barcelona, Barcelona, Spain
| | | | - Maria Rubio-Valera
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; School of Pharmacy, University of Barcelona, Barcelona, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Moreno-Peral P, Conejo-Cerón S, Rubio-Valera M, Fernández A, Navas-Campaña D, Rodríguez-Morejón A, Motrico E, Rigabert A, Luna JDD, Martín-Pérez C, Rodríguez-Bayón A, Ballesta-Rodríguez MI, Luciano JV, Bellón JÁ. Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression. JAMA Psychiatry 2017; 74:1021-1029. [PMID: 28877316 PMCID: PMC5710546 DOI: 10.1001/jamapsychiatry.2017.2509] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/29/2017] [Indexed: 12/31/2022]
Abstract
Importance To our knowledge, no systematic reviews or meta-analyses have been conducted to assess the effectiveness of preventive psychological and/or educational interventions for anxiety in varied populations. Objective To evaluate the effectiveness of preventive psychological and/or educational interventions for anxiety in varied population types. Data Sources A systematic review and meta-analysis was conducted based on literature searches of MEDLINE, PsycINFO, Web of Science, EMBASE, OpenGrey, Cochrane Central Register of Controlled Trials, and other sources from inception to March 7, 2017. Study Selection A search was performed of randomized clinical trials assessing the effectiveness of preventive psychological and/or educational interventions for anxiety in varying populations free of anxiety at baseline as measured using validated instruments. There was no setting or language restriction. Eligibility criteria assessment was conducted by 2 of us. Data Extraction and Synthesis Data extraction and assessment of risk of bias (Cochrane Collaboration's tool) were performed by 2 of us. Pooled standardized mean differences (SMDs) were calculated using random-effect models. Heterogeneity was explored by random-effects meta-regression. Main Outcomes and Measures Incidence of new cases of anxiety disorders or reduction of anxiety symptoms as measured by validated instruments. Results Of the 3273 abstracts reviewed, 131 were selected for full-text review, and 29 met the inclusion criteria, representing 10 430 patients from 11 countries on 4 continents. Meta-analysis calculations were based on 36 comparisons. The pooled SMD was -0.31 (95% CI, -0.40 to -0.21; P < .001) and heterogeneity was substantial (I2 = 61.1%; 95% CI, 44% to 73%). There was evidence of publication bias, but the effect size barely varied after adjustment (SMD, -0.27; 95% CI, -0.37 to -0.17; P < .001). Sensitivity analyses confirmed the robustness of effect size results. A meta-regression including 5 variables explained 99.6% of between-study variability, revealing an association between higher SMD, waiting list (comparator) (β = -0.33 [95% CI, -0.55 to -0.11]; P = .005) and a lower sample size (lg) (β = 0.15 [95% CI, 0.06 to 0.23]; P = .001). No association was observed with risk of bias, family physician providing intervention, and use of standardized interviews as outcomes. Conclusions and Relevance Psychological and/or educational interventions had a small but statistically significant benefit for anxiety prevention in all populations evaluated. Although more studies with larger samples and active comparators are needed, these findings suggest that anxiety prevention programs should be further developed and implemented.
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Affiliation(s)
- Patricia Moreno-Peral
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
| | - Sonia Conejo-Cerón
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
| | - Maria Rubio-Valera
- Sant Joan de Déu Research Foundation, Barcelona, Spain
- Network for Biomedical Research on Epidemiology and Public Health, Biomedical Research Networking Center for Epidemiology and Public Health, Madrid, Spain
- School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Anna Fernández
- Network for Biomedical Research on Epidemiology and Public Health, Biomedical Research Networking Center for Epidemiology and Public Health, Madrid, Spain
- Service of Community Health, Public Health Agency of Barcelona, Barcelona, Spain
| | - Desirée Navas-Campaña
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
| | - Alberto Rodríguez-Morejón
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
- Department of Personality, Evaluation, and Psychological Treatment, Universidad de Málaga, Málaga, Spain
| | - Emma Motrico
- Prevention and Health Promotion Research Network, Málaga, Spain
- Department of Psychology, University Loyola Andalucía, Seville, Spain
| | - Alina Rigabert
- Department of Psychology, University Loyola Andalucía, Seville, Spain
| | - Juan de Dios Luna
- Prevention and Health Promotion Research Network, Málaga, Spain
- Department of Biostatistics, University of Granada, Granada, Spain
| | - Carlos Martín-Pérez
- Prevention and Health Promotion Research Network, Málaga, Spain
- Primary Care Center of Marquesado, Área Nordeste de Granada, Granada, Spain
| | - Antonina Rodríguez-Bayón
- Prevention and Health Promotion Research Network, Málaga, Spain
- Primary Care Center of San José, Linares, Jaén, Spain
| | | | - Juan Vicente Luciano
- Prevention and Health Promotion Research Network, Málaga, Spain
- Sant Joan de Déu Research Foundation, Barcelona, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St Boi de Llobregat, Spain
| | - Juan Ángel Bellón
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
- Primary Care Center of El Palo, Málaga, Spain
- Department of Preventive Medicine, Public Health and Psychiatry, University of Málaga, Málaga, Spain
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Cuevas-Esteban J, Iglesias-González M, Rubio-Valera M, Serra-Mestres J, Serrano-Blanco A, Baladon L. Prevalence and characteristics of catatonia on admission to an acute geriatric psychiatry ward. Prog Neuropsychopharmacol Biol Psychiatry 2017; 78:27-33. [PMID: 28533149 DOI: 10.1016/j.pnpbp.2017.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/08/2017] [Accepted: 05/14/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study aims to describe the prevalence of catatonia in a population of older acute psychiatric inpatients according to different diagnostic criteria. Secondary objectives are: to compare the catatonic symptom profile, prevalence, and severity, in respect to the underlying aetiology, and to evaluate the association between catatonic and somatic comorbidity. METHODS The study included 106 patients admitted to an acute geriatric psychiatry ward. Catatonia was assessed using the Bush Francis Catatonia Rating Scale (BFCRS). RESULTS Catatonia was highly prevalent (n=42; 39.6%), even when using restrictive diagnostic criteria: Fink and Taylor (n=19; 17.9%) and DSM 5 (n=22; 20.8%). Depression was the most frequent psychiatric syndrome among catatonic patients (n=18; 42.8%). Catatonia was more frequent in depression (48.6%) and delirium (66.7%). Affective disorders showed a higher risk than psychotic disorders to develop catatonia (OR=2.68; 95% CI 1.09-6.61). This association was not statistically significant when controlling for dementia and geriatric syndromes. The most prevalent catatonic signs were excitement (64.3%), verbigeration (61.9%), negativism (59.5%), immobility/stupor (57.1%), and staring (52.4%). CONCLUSIONS Catatonia in older psychiatric inpatients was highly prevalent. Depression was the most common psychiatric syndrome among catatonic patients, and catatonia was more frequent in depression and mania, as well as in delirium. Affective disorders were associated with a higher risk of developing catatonia compared to psychotic disorders. Somatic and cognitive comorbidity played a crucial aetiological role in catatonia in this series.
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Affiliation(s)
- Jorge Cuevas-Esteban
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | - Maria Rubio-Valera
- Teaching, Research & Innovation Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain; School of Pharmacy, University of Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Consorcio de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luisa Baladon
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
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Serrano-Blanco A, Rubio-Valera M, Aznar-Lou I, Baladón Higuera L, Gibert K, Gracia Canales A, Kaskens L, Ortiz JM, Salvador-Carulla L. In-patient costs of agitation and containment in a mental health catchment area. BMC Psychiatry 2017; 17:212. [PMID: 28583103 PMCID: PMC5460463 DOI: 10.1186/s12888-017-1373-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area. METHODS A mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatients with mental disorders in an area of 640,572 adult inhabitants in South Barcelona (Spain). To calculate costs, a seven-step methodology with novel definition of agitation was used along with a staff survey, a database of containment events, and data on aggressive incidents. A micro-costing analysis of specific containment interventions was used to estimate both prevalence and direct costs from the healthcare provider perspective, by means of a mixed approach with a probabilistic model evaluated on real data. Due to the complex interaction of the multivariate covariances, a sensitivity analysis was conducted to have empirical bounds of variability. RESULTS During 2013, 918 patients were admitted to the Acute Inpatient Unit. Of these, 52.8% were men, with a mean age of 44.6 years (SD = 15.5), 74.4% were compulsory admissions, 40.1% were diagnosed with schizophrenia or non-affective psychosis, with a mean length of stay of 24.6 days (SD = 16.9). The annual estimate of total agitation events was 508. The cost of containment interventions ranges from 282€ at the lowest level of agitation to 822€ when verbal containment plus seclusion and restraint have to be used. The annual total cost of agitation was 280,535€, representing 6.87% of the total costs of acute hospitalisation in the local area. CONCLUSIONS Agitation events are frequent and costly. Strategies to reduce their number and severity should be implemented to reduce costs to the Health System and alleviate patient suffering.
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Affiliation(s)
- Antoni Serrano-Blanco
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Rubio-Valera
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Ignacio Aznar-Lou
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luisa Baladón Higuera
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain
| | - Karina Gibert
- Statistics and Operations Research Department, Knowledge Engineering and Machine Learning group, Universitat Politècnica de Catalunya-Barcelona Tech, Barcelona, Spain
| | | | | | - José Miguel Ortiz
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Medicine, Biology & Environment, The Australian National University, Canberra, Australia
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Resurrección DM, Motrico E, Rigabert A, Rubio-Valera M, Conejo-Cerón S, Pastor L, Moreno-Peral P. Barriers for Nonparticipation and Dropout of Women in Cardiac Rehabilitation Programs: A Systematic Review. J Womens Health (Larchmt) 2017; 26:849-859. [PMID: 28388314 DOI: 10.1089/jwh.2016.6249] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major health problem worldwide. Cardiac rehabilitation (CR) programs are effective in reducing mortality and improving the quality of life of patients with CVD. Women are under-represented in CR and have a higher dropout rate than men. We aimed to systematically review the literature on barriers perceived by women with CVD affecting their nonparticipation in and/or dropping out from CR programs. METHODS Systematic review was done using MEDLINE, Embase, Scopus, Open Grey, and Cochrane Database from inception to September 2016. Search terms included (1) heart disease and other cardiac conditions, (2) CR and secondary prevention, and (3) nonparticipation in and/or dropout. Databases were searched following the "participants, interventions, comparisons, outcomes, and study design" method. RESULTS A total of 24 studies (17 descriptive, 6 qualitative, and 1 randomized controlled trial) reporting several barriers were grouped into five broad categories: intrapersonal barriers (self-reported health, health beliefs, lack of time, motivation, and religious reasons); interpersonal barriers (lack of family/social support and work conflicts); logistical barriers (transport, distance, and availability of personal/community resources); CR program barriers (services offered, group format, exercise component, and CR sessions); and health system barriers (lack of referral, cost, negative experiences with the health system, and language). We found differences between the barriers related to nonparticipation in and dropout from CR programs. CONCLUSIONS Women reported multilevel barriers for nonparticipation in and dropout from CR programs. Future clinical guidelines should evaluate and eliminate these barriers to improve adherence to CR programs in women. In addition, understanding the barriers for nonparticipation and dropout may be beneficial for future intervention trials.
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Affiliation(s)
| | - Emma Motrico
- 1 Departamento de Psicología, Universidad Loyola Andalucía , Sevilla, Spain .,2 Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Barcelona, Spain
| | - Alina Rigabert
- 1 Departamento de Psicología, Universidad Loyola Andalucía , Sevilla, Spain
| | - Maria Rubio-Valera
- 2 Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Barcelona, Spain .,3 Research and Development Unit , Fundació Sant Joan de Déu, Barcelona, Spain
| | - Sonia Conejo-Cerón
- 4 Instituto de Investigación Biomédica de Málaga (IBIMA) , Málaga, Spain
| | - Luis Pastor
- 5 Hospital Nuestra Señora de Valme , Sevilla, Spain
| | - Patricia Moreno-Peral
- 2 Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Barcelona, Spain .,4 Instituto de Investigación Biomédica de Málaga (IBIMA) , Málaga, Spain
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Domènech-Abella J, Lara E, Rubio-Valera M, Olaya B, Moneta MV, Rico-Uribe LA, Ayuso-Mateos JL, Mundó J, Haro JM. Loneliness and depression in the elderly: the role of social network. Soc Psychiatry Psychiatr Epidemiol 2017; 52:381-390. [PMID: 28154893 DOI: 10.1007/s00127-017-1339-3] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/06/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE Loneliness and depression are associated, in particular in older adults. Less is known about the role of social networks in this relationship. The present study analyzes the influence of social networks in the relationship between loneliness and depression in the older adult population in Spain. METHODS A population-representative sample of 3535 adults aged 50 years and over from Spain was analyzed. Loneliness was assessed by means of the three-item UCLA Loneliness Scale. Social network characteristics were measured using the Berkman-Syme Social Network Index. Major depression in the previous 12 months was assessed with the Composite International Diagnostic Interview (CIDI). Logistic regression models were used to analyze the survey data. RESULTS Feelings of loneliness were more prevalent in women, those who were younger (50-65), single, separated, divorced or widowed, living in a rural setting, with a lower frequency of social interactions and smaller social network, and with major depression. Among people feeling lonely, those with depression were more frequently married and had a small social network. Among those not feeling lonely, depression was associated with being previously married. In depressed people, feelings of loneliness were associated with having a small social network; while among those without depression, feelings of loneliness were associated with being married. CONCLUSION The type and size of social networks have a role in the relationship between loneliness and depression. Increasing social interaction may be more beneficial than strategies based on improving maladaptive social cognition in loneliness to reduce the prevalence of depression among Spanish older adults.
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Affiliation(s)
- Joan Domènech-Abella
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain.
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
- Department of Sociology, Universitat de Barcelona, Barcelona, Spain.
| | - Elvira Lara
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Maria Rubio-Valera
- Spanish Network of Research on Preventive Activities and Health Promotion in Primary Care, Barcelona, Spain
- Sant Joan de Déu Foundation, Barcelona, Spain
- Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain
| | - Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Sant Joan de Déu Foundation, Barcelona, Spain
| | - Maria Victoria Moneta
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Sant Joan de Déu Foundation, Barcelona, Spain
| | - Laura Alejandra Rico-Uribe
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jose Luis Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Jordi Mundó
- Department of Sociology, Universitat de Barcelona, Barcelona, Spain
| | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IP), Hospital Universitario de La Princesa, Madrid, Spain
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Aznar-Lou I, Fernández A, Gil-Girbau M, Fajó-Pascual M, Moreno-Peral P, Peñarrubia-María MT, Serrano-Blanco A, Sánchez-Niubó A, March-Pujol MA, Jové AM, Rubio-Valera M. Initial medication non-adherence: prevalence and predictive factors in a cohort of 1.6 million primary care patients. Br J Clin Pharmacol 2017; 83:1328-1340. [PMID: 28229476 DOI: 10.1111/bcp.13215] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/30/2016] [Accepted: 12/13/2016] [Indexed: 11/28/2022] Open
Abstract
AIMS Adherence to medicines is vital in treating diseases. Initial medication non-adherence (IMNA) - defined as not obtaining a medication the first time it is prescribed - has been poorly explored. Previous studies show IMNA rates between 6 and 28% in primary care (PC). The aims of this study were to determine prevalence and predictive factors of IMNA in the most prescribed and expensive pharmacotherapeutic groups in the Catalan health system. METHODS This is a retrospective, register-based cohort study which linked the Catalan PC System (Spain) prescription and invoicing databases. Medication was considered non-initiated when it was not collected from the pharmacy by the end of the month following the one in which it was prescribed. IMNA prevalence was calculated using July 2013-June 2014 prescription data. Predictive factors related to patients, general practitioners and PC centres were identified through multilevel logistic regression analyses. Missing data were attributed using simple imputation. RESULTS Some 1.6 million patients with 2.9 million prescriptions were included in the study sample. Total IMNA prevalence was 17.6% of prescriptions. The highest IMNA rate was observed in anilides (22.6%) and the lowest in angiotensin-converting-enzyme (ACE) inhibitors (7.4%). Predictors of IMNA are younger age, American nationality, having a pain-related or mental disorder and being treated by a substitute/resident general practitioner in a resident-training centre. CONCLUSIONS The rate of IMNA is high when all medications are taken into account. Attempts to strengthen trust in resident general practitioners and improve motivation to initiate a needed medication in the general young and older immigrant population should be addressed in Catalan PC.
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Affiliation(s)
- Ignacio Aznar-Lou
- Teaching, Research & Innovation Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Ana Fernández
- Mental Health Policy Unit, The Brain and Mind Research Institute; and Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Montserrat Gil-Girbau
- Teaching, Research & Innovation Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Marta Fajó-Pascual
- Faculty of Health and Sport Sciences, University of Zaragoza, Huesca, 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
| | | | - Antoni Serrano-Blanco
- Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Albert Sánchez-Niubó
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | | | | | - Maria Rubio-Valera
- Teaching, Research & Innovation Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,School of Pharmacy, University of Barcelona, Barcelona, Spain
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Berenguera A, Pons-Vigués M, Moreno-Peral P, March S, Ripoll J, Rubio-Valera M, Pombo-Ramos H, Asensio-Martínez A, Bolaños-Gallardo E, Martínez-Carazo C, Maderuelo-Fernández JÁ, Martínez-Andrés M, Pujol-Ribera E. Beyond the consultation room: Proposals to approach health promotion in primary care according to health-care users, key community informants and primary care centre workers. Health Expect 2017; 20:896-910. [PMID: 28116774 PMCID: PMC5600227 DOI: 10.1111/hex.12530] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 01/24/2023] Open
Abstract
Background Primary health care (PHC) is the ideal setting to provide integrated services centred on the person and to implement health promotion (HP) activities. Objective To identify proposals to approach HP in the context of primary care according to health‐care users aged 45‐75 years, key community informants and primary care centre (PCC) workers. Methods Descriptive‐interpretive qualitative research with 276 participants from 14 PCC of seven Spanish regions. A theoretical sampling was used for selection. A total of 25 discussion groups, two triangular groups and 30 semi‐structured interviews were carried out. A thematic interpretive contents analysis was carried out. Results Participants consider that HP is not solely a matter for the health sector and they emphasize intersectoral collaboration. They believe that it is important to strengthen community initiatives and to create a healthy social environment that encourages greater responsibility and participation of health‐care users in decisions regarding their own health and better management of public services and resources. HP, care in the community and demedicalization should be priorities for PHC. Participants propose organizational changes in the PCC to improve HP. PCC workers are aware that HP falls within the scope of their responsibilities and propose to increase their training, motivation, competences and knowledge of the social environment. Informants emphasize that HP should be person‐centred approach and empathic communication. HP activities should be appealing, ludic and of proven effectiveness. Conclusions According to a socio‐ecological and intersectoral model, PHC services must get actively involved in HP together with community and through outreach interventions.
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Affiliation(s)
- Anna Berenguera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Universitat de Girona, Girona, Spain
| | - Patricia Moreno-Peral
- Instituto de Investigación Biomédica de Málaga (IBIMA), Distrito Sanitario Málaga-Guadalhorce, Málaga, Spain
| | - Sebastià March
- Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Palma, Spain.,Instituto de Investigación Sanitaria de Palma, Palma, Spain
| | - Joana Ripoll
- Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Palma, Spain.,Instituto de Investigación Sanitaria de Palma, Palma, Spain
| | - Maria Rubio-Valera
- Research and Development Unit, Fundació Sant Joan de Déu, Barcelona, Spain.,School of Pharmacy, Universitat de Barcelona, Barcelona, Spain
| | - Haizea Pombo-Ramos
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Palma de Mallorca, Spain
| | - Angela Asensio-Martínez
- Aragon Institute for Health Research (IIS Aragon), Aragón, Spain.,Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | | | - Catalina Martínez-Carazo
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Palma de Mallorca, Spain
| | - José Ángel Maderuelo-Fernández
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, REDIAPP, IBSAL, Salamanca, Spain
| | - Maria Martínez-Andrés
- Social and Health Care Research Center, University of Castilla-La Mancha, Castilla-la-Mancha, Spain
| | - Enriqueta Pujol-Ribera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Universitat de Girona, Girona, Spain
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Fernandez A, Howse E, Rubio-Valera M, Thorncraft K, Noone J, Luu X, Veness B, Leech M, Llewellyn G, Salvador-Carulla L. Setting-based interventions to promote mental health at the university: a systematic review. Int J Public Health 2016; 61:797-807. [DOI: 10.1007/s00038-016-0846-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/12/2015] [Accepted: 06/09/2016] [Indexed: 10/21/2022] Open
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Rubio-Valera M, Pujol MM, Fernández A, Peñarrubia-María MT, Travé P, Del Hoyo YL, Serrano-Blanco A. Corrigendum to: "Evaluation of a pharmacist intervention on patients initiating pharmacological treatment for depression: A randomized controlled superiority trial" [Eur. Neuropsychopharmacol. 23(2013)1057-1066]. Eur Neuropsychopharmacol 2016; 26:1085. [PMID: 27161840 DOI: 10.1016/j.euroneuro.2016.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Fundació Sant Joan de Déu, Dr. Antoni Pujades 42, 08830 Sant Boi de Llobregat, Barcelona, Spain; Red de Investigación en Actividades Preventivas y Promoción de la Saluden Atención Primaria RedIAPP (RD06/0018/0017), Spain.
| | - Marian March Pujol
- Estades en Pràctiques Tutelades Unit, School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Ana Fernández
- Research and Development Unit, Fundació Sant Joan de Déu, Dr. Antoni Pujades 42, 08830 Sant Boi de Llobregat, Barcelona, Spain; Red de Investigación en Actividades Preventivas y Promoción de la Saluden Atención Primaria RedIAPP (RD06/0018/0017), Spain; Clinical and Health Psychology Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Teresa Peñarrubia-María
- Red de Investigación en Actividades Preventivas y Promoción de la Saluden Atención Primaria RedIAPP (RD06/0018/0017), Spain; Primary Care Health Centre Bartomeu Fabrés Anglada, DAP Baix Llobregat Litoral, Àmbit Costa de Ponent, Institut Català de la Salut, Gavà, Spain
| | - Pere Travé
- Estades en Pràctiques Tutelades Unit, School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Yolanda López Del Hoyo
- Red de Investigación en Actividades Preventivas y Promoción de la Saluden Atención Primaria RedIAPP (RD06/0018/0017), Spain; Department of Psychology and Sociology, University of Zaragoza, Spain
| | - Antoni Serrano-Blanco
- Research and Development Unit, Fundació Sant Joan de Déu, Dr. Antoni Pujades 42, 08830 Sant Boi de Llobregat, Barcelona, Spain; Red de Investigación en Actividades Preventivas y Promoción de la Saluden Atención Primaria RedIAPP (RD06/0018/0017), Spain
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de Araújo AA, Ribeiro SB, Dos Santos ACS, Lemos TMAM, Medeiros CAX, Guerra GCB, de Araújo Júnior RF, Serrano-Blanco A, Rubio-Valera M. Quality of Life and Hormonal, Biochemical, and Anthropometric Profile Between Olanzapine and Risperidone Users. Psychiatr Q 2016. [PMID: 26220635 DOI: 10.1007/s11126-015-9385-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This cross-sectional study compared quality of life and side effects in 108 users of olanzapine or risperidone suffering schizophrenia and being attended at psychiatric ambulatory services in Rio Grande do Norte, Brazil. Economic, socio-demographic, anthropometric, biochemical, and hormonal variables were compared. The EuroQoL Five-Dimension Scale (EQ-5D) was used to evaluate quality of life, and side effects were assessed using the Udvalg for Kliniske Undersøgelser (UKU) Side Effect Rating Scale and the Simpson-Angus Scale. Data were analysed using the χ(2) test and Student's t test, with a significance level of 5 %.The household incomes of approximately 80 % of patients were <2.0 minimum wages ($678). Anthropometric variables (waist circumference, hip circumference, weight, waist-to-hip ratio) and systolic and diastolic blood pressure were noted among male olanzapine users (all p < 0.05). EQ-5D scores showed that olanzapine use significantly impacted self-help ability (p < 0.001). Risperidone users had a mean quality-adjusted life year value of 1. Mean total Simpson-Angus Scale scores was 0.38 for olanzapine users and 0.11 for risperidone users (p < 0.02). Significant differences in UKU were observed for the following items: asthenia/lassitude/fatigue (higher among olanzapine users, p = 0.02), dystonia (higher among olanzapine users, p = 0.01), tremors (higher among olanzapine users, p = 0.03), gynecomastia (higher among risperidone users, p < 0.02), and ejaculatory dysfunction (higher among risperidone users, p < 0.02). Olanzapine users had impaired quality of life, which can be explained in part by adverse motor, biochemical, and hormonal effects characteristic of metabolic syndrome.
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Affiliation(s)
- Aurigena Antunes de Araújo
- Postgraduate Programs in Public Health and Pharmaceutical Science, Department of Biophysics and Pharmacology, Federal University of Rio Grande Norte (UFRN), Natal, RN, Brazil.
| | | | | | - Telma Maria Araújo Moura Lemos
- Postgraduate Programs in Health Science and Pharmaceutical Science, Department of Clinical Analyses and Toxicological, Federal University of Rio Grande Norte (UFRN), Natal, RN, Brazil
| | - Caroline Addison Xavier Medeiros
- Postgraduate Program in Health and Society, Department of Biophysics and Pharmacology, State University of Rio Grande Norte (UERN), Natal, RN, Brazil
- Postgraduate Programs in Biological Science, Federal University of Rio Grande Norte (UFRN), Natal, RN, Brazil
| | | | | | - Antoni Serrano-Blanco
- Acute Inpatient Unit of Psychiatry, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Maria Rubio-Valera
- Research and Innovation Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
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Aznar-Lou I, Serrano-Blanco A, Fernández A, Luciano JV, Rubio-Valera M. Attitudes and intended behaviour to mental disorders and associated factors in catalan population, Spain: cross-sectional population-based survey. BMC Public Health 2016; 16:127. [PMID: 26861632 PMCID: PMC4746776 DOI: 10.1186/s12889-016-2815-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/02/2016] [Indexed: 11/27/2022] Open
Abstract
Background Mental disorders have a huge impact on the European population. Two of the main causes of this impact are stigma and discrimination. The aim of this paper is to assess the stigma regarding mental disorder in Catalonia and to explore factors associated with stigma. Methods Cross-sectional population-based survey of a representative sample of non-institutionalized adult population (n = 1872). We evaluated attitudes (CAMI: Authoritarianism, Benevolence and Support to Community Mental Health care) and intended behaviour (RIBS) regarding mental disorder and experience of discrimination. Higher scores showed more favourable attitudes and intended behavior. Mean values and percentiles of the scales were calculated. Multivariable regression models were used to assess factors associated with stigma. Results Mean authoritarianism, benevolence and support to community mental health scores corresponded to the 66th, 90th and 78th percentile, respectively. Mean RIBS score corresponded to the 76th percentile. More favourable attitudes were associated with being male, younger, having a higher education, being Spanish, having suffered a mental disorder and having contact with a person with a mental disorder.Similarly, more favourable intended behaviour was associated with being younger, having secondary education, having Spanish nationality, belonging to a higher social class and having contact with a person with a mental disorder. People with depression or anxiety showed lower discrimination experiences than people with other mental disorders. Conclusions The levels of stigma were generally low among the Catalan population. However, efforts should be made to decrease stigma related to authoritarianism. Interventions addressed to reducing stigma should take into account other mental disorders apart from depression or anxiety. They should be focused on older, immigrant population, people with lower educational attainment and people who have not had contact with someone with a mental disorder.
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Affiliation(s)
- Ignacio Aznar-Lou
- Teaching, Research & Innovation Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.
| | - Antoni Serrano-Blanco
- Teaching, Research & Innovation Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.
| | - Ana Fernández
- Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain. .,Mental Health Policy Unit, The Brain and Mind Research Institute; and Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
| | - Juan V Luciano
- Teaching, Research & Innovation Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.
| | - Maria Rubio-Valera
- Teaching, Research & Innovation Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain. .,School of Pharmacy, University of Barcelona, Barcelona, Spain.
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43
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Rubio-Valera M, Bosmans J, Fernández A, Peñarrubia-María M, March M, Travé P, Bellón JA, Serrano-Blanco A. Correction: Cost-Effectiveness of a Community Pharmacist Intervention in Patients with Depression: A Randomized Controlled Trial (PRODEFAR Study). PLoS One 2016; 11:e0147459. [PMID: 26765519 PMCID: PMC4713208 DOI: 10.1371/journal.pone.0147459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Fernandez A, Moreno-Peral P, Zabaleta-del-Olmo E, Bellon JA, Aranda-Regules JM, Luciano JV, Serrano-Blanco A, Rubio-Valera M. Is there a case for mental health promotion in the primary care setting? A systematic review. Prev Med 2015; 76 Suppl:S5-11. [PMID: 25475684 DOI: 10.1016/j.ypmed.2014.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 11/11/2014] [Accepted: 11/24/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of mental health promotion (MHP) interventions by primary health care professionals in the adult population. METHODS Systematic review of literature in English and Spanish for randomized controlled trials (RCTs) and observational studies evaluating the impact of interventions carried out by primary care professionals explicitly to promote and improve the overall mental health of adult patients. PubMed, PsycINFO, and Web of Science were independently searched by two investigators to identify all MHP articles from inception to October 2013 (no restrictions). RESULTS We retrieved 4262 records and excluded 4230 by a review of title and abstract. Of 32 full-text articles assessed, 3 RCTs were selected (2 in USA, 1 in UK); two focused on the mental health of parents whose children have behavioral problems, the other on older people with disabilities. One study reported a MHP intervention that improved participants' mental health at 6-month follow-up. All studies had low-moderate quality (2 of 5 points) on the Jadad Scale. CONCLUSION There is a lack of implementation and/or evaluation of mental health promotion activities conducted by primary care professionals. More research is needed to clearly understand the benefits of promoting mental health in this setting.
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Affiliation(s)
- Ana Fernandez
- Centre for Disability Research and Policy/Brain and Mind Research Institute, Faculty of Health Sciences, University of Sydney, Australia; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Department of Pharmacology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Spain.
| | - Patricia Moreno-Peral
- Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Investigación del Distrito de Atención Primaria de Málaga, Spain
| | - Edurne Zabaleta-del-Olmo
- Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Juan Angel Bellon
- Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Investigación del Distrito de Atención Primaria de Málaga, Spain; Centro de Salud El Palo, Distrito de Atención Primaria Málaga-Guadalohorce, Departamento de Medicina Preventiva, Universidad de Málaga, Spain
| | - Jose Manuel Aranda-Regules
- Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Investigación del Distrito de Atención Primaria de Málaga, Spain; Centro de Salud San Andrés Torcal, Distrito Sanitario Málaga-Guadalhorce, Servicio Andaluz de Salud, Málaga, Spain
| | - Juan Vicente Luciano
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Open University of Catalonia, Barcelona, Spain
| | - Antoni Serrano-Blanco
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain
| | - Maria Rubio-Valera
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Open University of Catalonia, Barcelona, Spain
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Rubio-Valera M, Beneitez I, Peñarrubia-María MT, Luciano JV, Mendive JM, McCrone P, Knapp M, Sabés-Figuera R, Kocyan K, García-Campayo J, Serrano-Blanco A. Cost-effectiveness of active monitoring versus antidepressants for major depression in primary health care: a 12-month non-randomized controlled trial (INFAP study). BMC Psychiatry 2015; 15:63. [PMID: 25885818 PMCID: PMC4394418 DOI: 10.1186/s12888-015-0448-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/18/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Clinical practice guidelines for the treatment of major depressive disorder (MDD) recommend antidepressants for patients with moderate-severe depression and active monitoring for patients with mild-moderate symptoms. The feasibility and efficiency of active monitoring has not been proven conclusively. The aim of this study is to evaluate the cost-effectiveness of active monitoring in comparison to antidepressants for primary care patients with mild-moderate MDD. METHODS/DESIGN This is a 12-month follow-up multicenter observational prospective controlled trial. Patients are enrolled in 12 primary care centers in Barcelona (Spain). Eligible patients are adults (≥18 years-old) with a new episode of MDD that sign a written consent to participate. This is a naturalistic study in which general practitioners (GPs) use their professional judgment to allocate patients into active monitoring or antidepressants groups. GPs treat the patients following their clinical criteria. At baseline, GPs complete a questionnaire (sociodemographic/job characteristics, training, attitude towards depression, interest on mental health and participation in communication groups). Patients' measurements take place at baseline and after six and 12 months. Main outcome measures include severity of depression (PHQ-9), health-related quality of life (EuroQol-5D) and use of healthcare and social care services (Client Service Receipt Inventory). Secondary outcomes include diagnosis of MDD according to DSM-IV diagnostic criteria (SCID-I), disability (WHO-DAS), anxiety (BAI), comorbidities, medication side-effects and beliefs about medicines (BMQ). The analysis will be done according to the intention to treat analysis. Missing data will be imputed using multiple imputation by chained equations. To minimize the bias resulting from the lack of randomization, a propensity score will be used. Incremental effects and costs between groups will be modelled in each of the imputed databases using multivariate generalized linear models and then combined as per Rubin's rules. Propensity scores will be used to adjust the models. Incremental cost-effectiveness ratios will be calculated by dividing the difference in costs between groups by the difference in effects. To deal with the uncertainty, resampling techniques with bootstrapping will be used and cost-effectiveness planes and cost-effectiveness acceptability curves will be constructed. A series of sensitivity analyses will be performed. DISCUSSION Given the high burden and costs generated by depressive disorder, it is important that general practitioners treat major depression efficiently. Recent evidence has suggested that antidepressants have low benefits for patients with mild to moderate major depression. For such cases of depression, active monitoring exists as a treatment option, but it is not without difficulties for implementation and its effectiveness and efficiency have not been demonstrated conclusively. The results of the study will provide information on which is the most efficient approach to treat patients with mild to moderate major depression in primary care. TRIAL REGISTRATION ClinicalTrials.gov: NCT02245373.
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Affiliation(s)
- Maria Rubio-Valera
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,School of Pharmacy, Universitat de Barcelona, Barcelona, Spain.
| | - Imma Beneitez
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Open University of Catalonia (UOC), Barcelona, Spain.
| | - María Teresa Peñarrubia-María
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Primary Care Health Centre Bartomeu Fabrés Anglada, Servei d'Atenció Primària Delta Llobregat, Àmbit Costa de Ponent, Institut Català de la Salut, Gavà, Spain.
| | - Juan V Luciano
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Open University of Catalonia (UOC), Barcelona, Spain.
| | - Juan M Mendive
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,La Mina Primary Care Centre, Institut Català de la Salut, Sant Adrià de Besós, Barcelona, Spain.
| | - Paul McCrone
- Institute of Psychiatry, King's College London, De Crespigny Park, London, UK.
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, UK.
| | - Ramon Sabés-Figuera
- Institute for Prospective Technological Studies/Joint Research Centre, European Commission, Sevilla, Spain.
| | | | - Javier García-Campayo
- Miguel Servet Hospital, University of Zaragoza, Instituto Aragones de Ciencias de la Salud, Zaragoza, Spain.
| | - Antoni Serrano-Blanco
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.
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Rubio-Valera M, Luciano JV, Ortiz JM, Salvador-Carulla L, Gracia A, Serrano-Blanco A. Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care: a systematic review of the evidence. BMC Psychiatry 2015; 15:35. [PMID: 25881240 PMCID: PMC4356166 DOI: 10.1186/s12888-015-0417-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Agitation and containment are frequent in psychiatric care but little is known about their costs. The aim was to evaluate the use of services and costs related to agitation and containment of adult patients admitted to a psychiatric hospital or emergency service. METHODS Systematic searches of four electronic databases covering the period January 1998-January 2014 were conducted. Manual searches were also performed. Paper selection and data extraction were performed in duplicate. Cost data were converted to euros in 2014. RESULTS Ten studies met inclusion criteria and were included in the analysis (retrospective cohorts, prospective cohorts and cost-of-illness studies). Evaluated in these studies were length of stay, readmission rates and medication. Eight studies assessed the impact of agitation on the length of stay and six showed that it was associated with longer stays. Four studies examined the impact of agitation on readmission and a statistically significant increase in the probability of readmission of agitated patients was observed. Two studies evaluated medication. One study showed that the mean medication dose was higher in agitated patients and the other found higher costs of treatment compared with non-agitated patients in the unadjusted analysis. One study estimated the costs of conflict and containment incurred in acute inpatient psychiatric care in the UK. The estimation for the year 2014 of total annual cost per ward for all conflict was €182,616 and €267,069 for containment based on updated costs from 2005. CONCLUSIONS Agitation has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher drug use. Evidence is scarce and further research is needed to estimate the burden of agitation and containment from the perspective of hospitals and the healthcare system.
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Affiliation(s)
- Maria Rubio-Valera
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,School of Pharmacy, Universitat de Barcelona, Barcelona, Spain. .,Research & Development Unit, Parc Sanitari Sant Joan de, 22 Déu. C/ Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
| | - Juan V Luciano
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Open University of Catalonia (UOC), Barcelona, Spain.
| | | | - Luis Salvador-Carulla
- Centre for Disability Research and Policy, Faculty of Health Sciences, and Mental Health Policy Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
| | | | - Antoni Serrano-Blanco
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.
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47
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Rubio-Valera M, Luciano-Devís JV, Ortiz JM, Salvador-Carulla L, Haro JM, Gracia A, Serrano-Blanco A. Use of Services and Cost of Agitation and Containment in Psychiatric Hospitals: a Systematic Review. Value Health 2014; 17:A460. [PMID: 27201291 DOI: 10.1016/j.jval.2014.08.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- M Rubio-Valera
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - J M Ortiz
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - J M Haro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - A Gracia
- Ferrer Internacional, Barcelona, Spain
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Rubio-Valera M, Ortiz JM, Baladón L, Luciano-Devís JV, Salvador-Carulla L, Haro JM, Gracia A, Serrano-Blanco A. Description of Agitation and Crisis Interventions in a Psychiatric Hospital in Spain: a Qualitative Study. Value Health 2014; 17:A463. [PMID: 27201308 DOI: 10.1016/j.jval.2014.08.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- M Rubio-Valera
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - J M Ortiz
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - L Baladón
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | | | - J M Haro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
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Rubio-Valera M, Chen TF, O'Reilly CL. New roles for pharmacists in community mental health care: a narrative review. Int J Environ Res Public Health 2014; 11:10967-90. [PMID: 25337943 PMCID: PMC4211017 DOI: 10.3390/ijerph111010967] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/30/2014] [Accepted: 10/07/2014] [Indexed: 02/05/2023]
Abstract
Medicines are a major treatment modality for many mental illnesses, and with the growing burden of mental disorders worldwide pharmacists are ideally positioned to play a greater role in supporting people with a mental illness. This narrative review aims to describe the evidence for pharmacist-delivered services in mental health care and address the barriers and facilitators to increasing the uptake of pharmacist services as part of the broader mental health care team. This narrative review is divided into three main sections: (1) the role of the pharmacist in mental health care in multidisciplinary teams and in supporting early detection of mental illness; (2) the pharmacists' role in supporting quality use of medicines in medication review, strategies to improve medication adherence and antipsychotic polypharmacy, and shared decision making; and (3) barriers and facilitators to the implementation of mental health pharmacy services with a focus on organizational culture and mental health stigma. In the first section, the review presents new roles for pharmacists within multidisciplinary teams, such as in case conferencing or collaborative drug therapy management; and new roles that would benefit from increased pharmacist involvement, such as the early detection of mental health conditions, development of care plans and follow up of people with mental health problems. The second section describes the impact of medication review services and other pharmacist-led interventions designed to reduce inappropriate use of psychotropic medicines and improve medication adherence. Other new potential roles discussed include the management of antipsychotic polypharmacy and involvement in patient-centered care. Finally, barriers related to pharmacists' attitudes, stigma and skills in the care of patients with mental health problems and barriers affecting pharmacist-physician collaboration are described, along with strategies to reduce mental health stigma.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Fundació Sant Joan de Déu, Department of Pharmacology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona 08830, Spain.
| | - Timothy F Chen
- Faculty of Pharmacy, The University of Sydney, Sydney 2006, Australia.
| | - Claire L O'Reilly
- Faculty of Pharmacy, The University of Sydney, Sydney 2006, Australia.
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Moreno-Peral P, Conejo-Cerón S, Motrico E, Rodríguez-Morejón A, Fernández A, García-Campayo J, Roca M, Serrano-Blanco A, Rubio-Valera M, Bellón JÁ. Risk factors for the onset of panic and generalised anxiety disorders in the general adult population: a systematic review of cohort studies. J Affect Disord 2014; 168:337-48. [PMID: 25089514 DOI: 10.1016/j.jad.2014.06.021] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND We aimed to assess available evidence on risk factors associated with the onset of panic disorder (PD) and/or generalised anxiety disorder (GAD) in cohort studies in the general adult population. METHODS Systematic review using MEDLINE, PsycINFO and Embase. Search terms included panic disorder, generalised anxiety disorder, cohort studies and risk factors. RESULTS We finally selected 21 studies, involving 163,366 persons with a median follow-up of 5 years. 1) Sociodemographic factors: PD was associated with age, female gender, and few economic resources. GAD was associated with age, non-Hispanics and Blacks, being divorced or widowed, and few economic resources. 2) Psychosocial factors: PD was associated with smoking and alcohol problems. GAD was associated with stressful life events in childhood and adulthood, and personality. 3) Physical and mental health factors: PD was associated with the number of physical diseases suffered and the joint hypermobility syndrome. PD was also associated with a parental history of mental disorders, as well as with other anxiety disorders and other mental health problems in the person affected. GAD was associated with a parental history of mental disorders, as well as with other anxiety disorders and other mental health problems in the person affected, plus already having received psychiatric care. LIMITATIONS Few studies examined the same risk factors. CONCLUSIONS Sociodemographic, psychosocial and mental-physical health risk factors were determinant for the onset of PD and GAD in the general adult population. These findings could be useful for developing preventive interventions in PD and GAD.
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Affiliation(s)
- Patricia Moreno-Peral
- Unidad de Investigación, del Distrito Sanitario de Atención Primaria Málaga-Guadalhorce, Spain; Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Sonia Conejo-Cerón
- Unidad de Investigación, del Distrito Sanitario de Atención Primaria Málaga-Guadalhorce, Spain; Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Emma Motrico
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Departamento de Psicología Evolutiva y de la Educación, Universidad de Sevilla, Spain; Departamento de Psicología, Sociología y Trabajo Social. Universidad Loyola Andalucía, Sevilla, Spain
| | - Alberto Rodríguez-Morejón
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; Departamento de Personalidad, Evaluación y Tratamiento Psicológico. Universidad de Málaga, Spain
| | - Anna Fernández
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Faculty of Health Sciences, Centre for Disability Research and Policy, Brain and Mind Research Institute University of Sydney, Australia; Fundacio Sant Joan de Deu per a la Recerca i la Docencia, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Javier García-Campayo
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Servicio de Psiquiatría, Hospital Miguel Servet, Instituto Aragonés Ciencias de la Salud, Zaragoza, Spain
| | - Miquel Roca
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), Universidad de las Islas Baleares, Palma de Mallorca, Spain
| | - Antoni Serrano-Blanco
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Fundacio Sant Joan de Deu per a la Recerca i la Docencia, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Maria Rubio-Valera
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Fundacio Sant Joan de Deu per a la Recerca i la Docencia, Parc Sanitari Sant Joan de Deu, Barcelona, Spain; School of Pharmacy, Universitat de Barcelona, Spain
| | - Juan Ángel Bellón
- Unidad de Investigación, del Distrito Sanitario de Atención Primaria Málaga-Guadalhorce, Spain; Red de Investigación en Actividades Preventivas y Promoción de la Salud, ISCIII (redIAPP), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; Centro de Salud El Palo, Servicio Andaluz de Salud, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Campus de Teatinos, 29071 Málaga, Spain.
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