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Anmella G, Primé-Tous M, Segú X, Solanes A, Ruíz V, Martín-Villalba I, Morilla I, Also-Fontanet A, Sant E, Murgui S, Sans-Corrales M, Murru A, Zahn R, Young AH, Vicens V, Viñas-Bardolet C, Martínez-Cerdá JF, Blanch J, Radua J, Fullana MÀ, Cavero M, Vieta E, Hidalgo-Mazzei D. PRimary carE digital Support ToOl in mental health (PRESTO): Design, development and study protocols. Span J Psychiatry Ment Health 2024; 17:114-125. [PMID: 33933665 DOI: 10.1016/j.rpsm.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/02/2021] [Revised: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND About 30-50% of Primary Care (PC) users in Spain suffer mental health problems, mostly mild to moderate anxious and depressive symptoms, which account for 2% of Spain's total Gross domestic product and 50% of the costs associated to all mental disorders. Mobile health tools have demonstrated to cost-effectively reduce anxious and depressive symptoms while machine learning (ML) techniques have shown to accurately detect severe cases. The main aim of this project is to develop a comprehensive ML digital support platform (PRESTO) to cost-effectively screen, assess, triage, and provide personalized treatments for anxious and depressive symptoms in PC. METHODS The project will be carried out in 3 complementary phases: First, a ML predictive severity model will be built based on all the cases referred to the PC mental health support programme during the last 5 years in Catalonia. Simultaneously, a smartphone app to monitor and deliver psychological interventions for anxiety and depressive symptoms will be developed and tested in a clinical trial. Finally, the ML models and the app will be integrated in a comprehensive decision-support platform (PRESTO) which will triage and assign to each patient a specific intervention based on individual personal and clinical characteristics. The effectiveness of PRESTO to reduce waiting times in receiving mental healthcare will be tested in a stepped-wedge cluster randomized controlled trial in 5 PC centres. DISCUSSION PRESTO will offer timely and personalized cost-effective mental health treatment to people with mild to moderate anxious and depressive symptoms. This will result in a reduction of the burden of mental health problems in PC and on society as a whole. TRIAL REGISTRATION The project and their clinical trials were registered in Clinical Trials.gov: NCT04559360 (September 2020).
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Affiliation(s)
- Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Mireia Primé-Tous
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - Xavier Segú
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - Aleix Solanes
- Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Victoria Ruíz
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - Inés Martín-Villalba
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - Ivette Morilla
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain
| | - Antonieta Also-Fontanet
- CAP Casanova, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Catalonia, Spain
| | - Elisenda Sant
- CAP Casanova, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Catalonia, Spain
| | - Sandra Murgui
- CAP Borrell, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Catalonia, Spain
| | - Mireia Sans-Corrales
- CAP Borrell, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Catalonia, Spain
| | - Andrea Murru
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Roland Zahn
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Victor Vicens
- Chief Medical Officer and co-founder of Abi Global Health, Spain
| | - Clara Viñas-Bardolet
- Data Analytics Programme for Health Research and Innovation (PADRIS) from the Catalan Agency for Health Quality and Evaluation (AQuAS), Catalonia, Spain
| | - Juan Francisco Martínez-Cerdá
- Data Analytics Programme for Health Research and Innovation (PADRIS) from the Catalan Agency for Health Quality and Evaluation (AQuAS), Catalonia, Spain
| | - Jordi Blanch
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain; Chief Medical Officer and co-founder of Abi Global Health, Spain; Director of the Mental Health and Addiction Programme, Department of Health, Generalitat de Catalunya, Spain; President of the European Association of Psychosomatic Medicine, Spain
| | - Joaquim Radua
- Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Miquel-Àngel Fullana
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Myriam Cavero
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
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Anmella G, Sanabra M, Primé-Tous M, Segú X, Cavero M, Morilla I, Ruiz V, Grande I, Mas A, Martín-Villalba I, Caballo A, Esteva JP, Rodríguez-Rey A, Piazza F, Valdesoiro FJ, Rodriguez-Torrella C, Espinosa M, Sorroche C, Virgili G, Ruiz A, Solanes A, Radua J, Also MA, Sant E, Murgui S, Sans-Corrales M, H Young A, Vicens V, Blanch J, Caballeria E, López-Pelayo H, López C, Olivé V, Pujol L, Quesada S, Solé B, Martínez-Aran A, Torrent C, Guarch J, Navinés R, Murru A, Fico G, De Prisco M, Oliva V, Pio C, Amoretti S, Fernández-Canseco M, Villegas M, Vieta E, Hidalgo-Mazzei D. Vickybot, a chatbot for anxiety-depressive symptoms and work-related burnout in primary care and healthcare professionals: development, feasibility, and potential effectiveness studies. J Med Internet Res 2023; 25:e43293. [PMID: 36719325 PMCID: PMC10131622 DOI: 10.2196/43293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/19/2022] [Accepted: 01/31/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A significant proportion of people attending Primary Care (PC) have anxiety-depressive symptoms and work-related burnout compounded by a lack of resources to meet their needs. The COVID-19 pandemic has exacerbated this problem and digital tools have been proposed as a solution. OBJECTIVE We present the development, feasibility, and potential effectiveness studies of Vickybot, a chatbot aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout in PC patients and healthcare workers. METHODS User-centered development strategies were adopted. Main functions included self-assessments, psychological modules, and emergency alerts. Healthy controls (HCs) tested Vickybot for reliability. (1) Simulation: HCs used Vickybot for 2 weeks to simulate different clinical situations. (2) Feasibility and effectiveness study: People consulting PC or healthcare workers with mental health problems were offered to use Vickybot for one month. Self-assessments for anxiety (GAD-7) and depression (PHQ-9) symptoms, and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every two weeks. Feasibility was determined from both subjective and objective user-engagement Indicators (UEIs). Potential effectiveness was measured using paired t-tests or the Wilcoxon signed-rank test for the change in self-assessment scores. RESULTS 40 HCs tested Vickybot simultaneously, and data was transmitted and registered reliably. (1) Simulation: 17 HCs (73% female; mean age=36.5±9.7) received 98.8% of the expected modules according to each simulation. Suicidal alerts were correctly received. (2) Feasibility and potential effectiveness study: 34 patients (15 from PC and 19 healthcare workers; 77% female; mean age=35.3±10.1) completed the first self-assessments, with 34 (100%) presenting anxiety symptoms, 32 (94%) depressive symptoms, and 22 (64.7%) work-related burnout. Nine (26.5%) patients completed the second self-assessments after two weeks of use. No significant differences were found between the scores of the first and second self-assessments for anxiety [t(8) = 1.000, P = .34] or depressive [t(8) = .40, P = .70] symptoms. However, work-related burnout scores were moderately reduced (Z = -2.07, P = 0.038, r = .32). There was a non-significant trend towards higher reduction in anxiety-depressive symptoms and work-related burnout with greater use of the chatbot. Three patients (8.8%) activated the suicide alert, and the research team intervened promptly with successful outcomes. Vickybot showed high subjective-UEIs, but low objective-UEIs (completion, adherence, compliance, and engagement). Feasibility was moderate. CONCLUSIONS The chatbot was useful in screening for the presence and severity of anxiety and depressive symptoms, and detecting suicidal risk. Potential effectiveness was shown in reducing work-related burnout, but not anxiety or depressive symptoms. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising but suggest the need to adapt and enhance the smartphone-based solution in order to improve engagement. Consensus on how to report UEIs and validate digital solutions, especially for chatbots, are required. CLINICALTRIAL
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Affiliation(s)
- Gerard Anmella
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Miriam Sanabra
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Mireia Primé-Tous
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Xavier Segú
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Myriam Cavero
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Ivette Morilla
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Victoria Ruiz
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Iria Grande
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Ariadna Mas
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Inés Martín-Villalba
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Alejandro Caballo
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Julia-Parisad Esteva
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Arturo Rodríguez-Rey
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Flavia Piazza
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Francisco José Valdesoiro
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Claudia Rodriguez-Torrella
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Marta Espinosa
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Carlota Sorroche
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Giulia Virgili
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Alicia Ruiz
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Aleix Solanes
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, ES
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, ES
| | - María Antonieta Also
- CAP Casanova, Consorci Atenció primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, ES
| | - Elisenda Sant
- CAP Casanova, Consorci Atenció primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, ES
| | - Sandra Murgui
- CAP Borrell, Consorci d'Atenció primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, ES
| | - Mireia Sans-Corrales
- CAP Borrell, Consorci d'Atenció primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, ES
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, GB
| | - Victor Vicens
- Chief Medical Officer and co-founder of Abi Global Health, Barcelona, ES
| | - Jordi Blanch
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Elsa Caballeria
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Hugo López-Pelayo
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Clara López
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Victoria Olivé
- Hospital Clínic de Barcelona, Occupational Health Department, barcelona, ES
| | - Laura Pujol
- Hospital Clínic de Barcelona, Occupational Health Department, barcelona, ES
| | - Sebastiana Quesada
- Hospital Clínic de Barcelona, Occupational Health Department, barcelona, ES
| | - Brisa Solé
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Anabel Martínez-Aran
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Carla Torrent
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Joana Guarch
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Ricard Navinés
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Andrea Murru
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Giovanna Fico
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Michele De Prisco
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Vicenzo Oliva
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Casimiro Pio
- Barcelona Supercomputing Center (BSC). Text Mining Technologies in the Health Domain, Barcelona, ES
| | - Silvia Amoretti
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - María Fernández-Canseco
- Barcelona Supercomputing Center (BSC). Text Mining Technologies in the Health Domain, Barcelona, ES
| | - Marta Villegas
- Barcelona Supercomputing Center (BSC). Text Mining Technologies in the Health Domain, Barcelona, ES
| | - Eduard Vieta
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Diego Hidalgo-Mazzei
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
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Anmella G, Sanabra M, Primé-Tous M, Segú X, Solanes A, Ruíz V, Morilla I, Also Fontanet A, Sant E, Murgui S, Sans-Corrales M, Martínez-Aran A, Fico G, De Prisco M, Oliva V, Murru A, Zahn R, Young AH, Vicens V, Viñas-Bardolet C, Aparicio-Nogué V, Martínez-Cerdá JF, Mas A, Carreras B, Blanch J, Radua J, Fullana MA, Cavero M, Vieta E, Hidalgo-Mazzei D. Antidepressants overuse in primary care: Prescription trends between 2010 and 2019 in Catalonia. Rev Psiquiatr Salud Ment 2022:S1888-9891(22)00137-9. [PMID: 37758595 DOI: 10.1016/j.rpsm.2022.12.001] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/17/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION There has been an increase in the prescription of antidepressants (AD) in primary care (PC). However, it is unclear whether this was explained by a rise in diagnoses with an indication for AD. We investigated the changes in frequency and the variables associated with AD prescription in Catalonia, Spain. METHODS We retrieved AD prescription, sociodemographic, and health-related data using individual electronic health records from a population-representative sample (N=947.698) attending PC between 2010 and 2019. Prescription of AD was calculated using DHD (Defined Daily Doses per 1000 inhabitants/day). We compared cumulative changes in DHD with cumulative changes in diagnoses with an indication for AD during the study period. We used Poisson regression to examine sociodemographic and health-related variables associated with AD prescription. RESULTS Both AD prescription and mental health diagnoses with an indication for AD gradually increased. At the end of the study period, DHD of AD prescriptions and mental health diagnoses with an indication for AD reached cumulative increases of 404% and 49% respectively. Female sex (incidence rate ratio (IRR)=2.83), older age (IRR=25.43), and lower socio-economic status (IRR=1.35) were significantly associated with increased risk of being prescribed an AD. CONCLUSIONS Our results from a large and representative cohort of patients confirm a steady increase of AD prescriptions that is not explained by a parallel increase in mental health diagnoses with an indication for AD. A trend on AD off-label and over-prescriptions in the PC system in Catalonia can be inferred from this dissociation.
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Affiliation(s)
- Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Miriam Sanabra
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mireia Primé-Tous
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Xavier Segú
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aleix Solanes
- Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Victoria Ruíz
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ivette Morilla
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antonieta Also Fontanet
- CAP Casanova, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Elisenda Sant
- CAP Casanova, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Sandra Murgui
- CAP Comte Borrell, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Mireia Sans-Corrales
- CAP Comte Borrell, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Anabel Martínez-Aran
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Giovanna Fico
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Michele De Prisco
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Vincenzo Oliva
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Andrea Murru
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Roland Zahn
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | - Clara Viñas-Bardolet
- Data Analytics Programme for Health Research and Innovation (PADRIS), Catalan Agency for Health Quality and Evaluation (AQuAS), Barcelona, Spain
| | - Vicenç Aparicio-Nogué
- Data Analytics Programme for Health Research and Innovation (PADRIS), Catalan Agency for Health Quality and Evaluation (AQuAS), Barcelona, Spain
| | - Juan Francisco Martínez-Cerdá
- Data Analytics Programme for Health Research and Innovation (PADRIS), Catalan Agency for Health Quality and Evaluation (AQuAS), Barcelona, Spain
| | - Ariadna Mas
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Bernat Carreras
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Blanch
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Abi Global Health, Spain; Mental Health and Addiction Programme, Department of Health, Generalitat de Catalunya, Barcelona, Spain; President of the European Association of Psychosomatic Medicine, Spain
| | - Joaquim Radua
- Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Miquel A Fullana
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Myriam Cavero
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
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Sisó-Almirall A, Kostov B, Mas-Heredia M, Vilanova-Rotllan S, Sequeira-Aymar E, Sans-Corrales M, Sant-Arderiu E, Cayuelas-Redondo L, Martínez-Pérez A, García-Plana N, Anguita-Guimet A, Benavent-Àreu J. Prognostic factors in Spanish COVID-19 patients: A case series from Barcelona. PLoS One 2020; 15:e0237960. [PMID: 32822413 PMCID: PMC7444503 DOI: 10.1371/journal.pone.0237960] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023] Open
Abstract
Background In addition to the lack of COVID-19 diagnostic tests for the whole Spanish population, the current strategy is to identify the disease early to limit contagion in the community. Aim To determine clinical factors of a poor prognosis in patients with COVID-19 infection. Design and setting Descriptive, observational, retrospective study in three primary healthcare centres with an assigned population of 100,000. Method Examination of the medical records of patients with COVID-19 infections confirmed by polymerase chain reaction. Logistic multivariate regression models adjusted for age and sex were constructed to analyse independent predictive factors associated with death, ICU admission and hospitalization. Results We included 322 patients (mean age 56.7 years, 50% female, 115 (35.7%) aged ≥ 65 years): 123 (38.2) were health workers (doctors, nurses, auxiliaries). Predictors of ICU admission or death were greater age (OR = 1.05; 95%CI = 1.03 to 1.07), male sex (OR = 2.94; 95%CI = 1.55 to 5.82), autoimmune disease (OR = 2.82; 95%CI = 1.00 to 7.84), bilateral pulmonary infiltrates (OR = 2.86; 95%CI = 1.41 to 6.13), elevated lactate-dehydrogenase (OR = 2.85; 95%CI = 1.28 to 6.90), elevated D-dimer (OR = 2.85; 95%CI = 1.22 to 6.98) and elevated C-reactive protein (OR = 2.38; 95%CI = 1.22 to 4.68). Myalgia or arthralgia (OR = 0.31; 95%CI = 0.12 to 0.70) was protective factor against ICU admission and death. Predictors of hospitalization were chills (OR = 5.66; 95%CI = 1.68 to 23.49), fever (OR = 3.33; 95%CI = 1.89 to 5.96), dyspnoea (OR = 2.92; 95%CI = 1.62 to 5.42), depression (OR = 6.06; 95%CI = 1.54 to 40.42), lymphopenia (OR = 3.48; 95%CI = 1.67 to 7.40) and elevated C-reactive protein (OR = 3.27; 95%CI = 1.59 to 7.18). Anosmia (OR = 0.42; 95%CI = 0.19 to 0.90) was the only significant protective factor for hospitalization after adjusting for age and sex. Conclusion Determining the clinical, biological and radiological characteristics of patients with suspected COVID-19 infection will be key to early treatment and isolation and the tracing of contacts.
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Affiliation(s)
- Antoni Sisó-Almirall
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Primary Care Centre Les Corts, Barcelona, Spain
- * E-mail:
| | - Belchin Kostov
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Minerva Mas-Heredia
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Les Corts, Barcelona, Spain
| | - Sergi Vilanova-Rotllan
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Les Corts, Barcelona, Spain
| | - Ethel Sequeira-Aymar
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Casanova, Barcelona, Spain
| | - Mireia Sans-Corrales
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Primary Care Centre Comte Borrell, Barcelona, Spain
| | - Elisenda Sant-Arderiu
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Casanova, Barcelona, Spain
| | - Laia Cayuelas-Redondo
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Primary Care Centre Casanova, Barcelona, Spain
| | - Angela Martínez-Pérez
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Casanova, Barcelona, Spain
| | - Noemí García-Plana
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Comte Borrell, Barcelona, Spain
| | - August Anguita-Guimet
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Care Centre Les Corts, Barcelona, Spain
| | - Jaume Benavent-Àreu
- Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Gené-Badia J, Ascaso C, Escaramis-Babiano G, Sampietro-Colom L, Catalán-Ramos A, Sans-Corrales M, Pujol-Ribera E. Personalised care, access, quality and team coordination are the main dimensions of family medicine output. Fam Pract 2007; 24:41-7. [PMID: 17079249 DOI: 10.1093/fampra/cml056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Health organisations continually seek good output indicators of family medicine health care provision because they are accountable to society, they need to compare services, and need to evaluate the impact of organisational reforms. OBJECTIVES Using the sources of information routinely available in health-service management, we sought to assess the groups of components of primary health care output that best serve to define the outcome of family medicine services. DESIGN Cross-sectional descriptive study. SITE: Primary health care in Catalunya. PARTICIPANTS 213 primary health care teams. MEASUREMENTS Information was collected on team structure, user satisfaction, quality-of-professional-life of the health care professionals, and physicians' drug prescription. Confirmatory Factor Analysis was used to assess the number of dimensions that best explained the family medicine outcome. RESULTS The model that best fits the structure of the data (AGFI=0.778) is that which consists of three dimensions i.e. (1) the individual accessibility to the services and professional-patient relationship; (2) the coordination within the health care team; (3) the scientific-technical quality of the service. The first two of these dimensions were correlated between themselves, but the third was totally independent of the other two. CONCLUSIONS Using sources of information that are routinely employed in primary health care services management, the model enables the measurement of the output of family medicine by considering the dimensions such as inter-personnel relationships, internal coordination of the team and the scientific-technical quality of the service. Despite its simplicity, this measure of the output incorporates the views not only of the users but of the health care professionals, as well.
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Gené-Badia J, Escaramis-Babiano G, Sans-Corrales M, Sampietro-Colom L, Aguado-Menguy F, Cabezas-Peña C, de Puelles PG. Impact of economic incentives on quality of professional life and on end-user satisfaction in primary care. Health Policy 2007; 80:2-10. [PMID: 16546287 DOI: 10.1016/j.healthpol.2006.02.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 02/09/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND A new economic incentive scheme based on (i) quality of care objectives for physicians, and (ii) professional development for both physicians and nurses, was introduced in primary care teams. OBJECTIVE To assess weather the implementation of these economic incentive schemes has had an impact on the quality of professional life (QPL) of both physicians and nurses and on end-user satisfaction. METHODS Before-after study. Participants are 257 primary care teams in Catalonia, Spain, in the period 2002-2003. QPL and end-user satisfaction were used as outcome measures. RESULTS QPL was improved in terms of the dimension "perception of support from the management structure" among physicians (4.897 versus 5.220; p<0.001) as well as nurses (5.272 versus 5.638; p<0.001). Further, physicians perceived an increase in the dimension "demands made upon them" (6.124 versus 6.364; p<0.001), differently from the nurses group (5.8191 versus 5.929; p=0.063). Overall, user satisfaction did not vary significantly, although a positive relationship was found between "perception of support from the management structure" and user satisfaction among nurses (beta=0.078, p=0.007), and a negative relationship between "demands made upon them" and user satisfaction in the case of physicians (beta=-0.057, p=0.011). CONCLUSIONS Incentives related to quality of care annual targets may increase physicians' perception of burden and it may have a negative impact on consumer satisfaction. Incentives on long-term professional development seem to be related to an increase in professionals' perception of support from the management structure. Among nurses, this increase is related to an improvement of user satisfaction.
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Affiliation(s)
- Joan Gené-Badia
- Consorci d'Atenció Primària de Salut de l'Eixample (CAPSE), Barcelona, Spain.
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Sans-Corrales M, Pujol-Ribera E, Gené-Badia J, Pasarín-Rua MI, Iglesias-Pérez B, Casajuana-Brunet J. Family medicine attributes related to satisfaction, health and costs. Fam Pract 2006; 23:308-16. [PMID: 16461452 DOI: 10.1093/fampra/cmi112] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [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] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To identify, from a systematic review of the literature, the attributes of Family Medicine (FM) that influence the primary health care outcome as measured by users' satisfaction, improvement in patient health and in costs. DATA SOURCES Literature search of Medline and the Cochrane library using MeSH terms 'Primary Health' or 'Family Practice' or 'Family Physicians' and 'Outcome Assessment' or 'Process Assessment'. Papers were excluded if they lacked a based on primary data, if no single component of FM was assessed; if indicators of evaluation were not related to health, satisfaction or costs. RESULTS A total of 356 articles were initially identified and 19 finally met the inclusion criteria. Study methods were a systematic review of randomized control trials, a double-blind randomized trial, 4 systematic reviews of observational studies, 2 cohort studies and 12 descriptive cross-sectional studies. CONCLUSIONS There was evidence of relationships between the attributes of FM and the service outcomes measured by indicators of satisfaction, health and cost. User satisfaction was associated with accessibility, continuity of care, consultation time and the doctor-patient relationship. Improvement in patient's health was related to continuity, consultation time, doctor-patient relationship and the implementation of preventive activities. Coordination of care showed mixed results with health outcomes. Continuity, consultation time, doctor-patient communication and prevention were cost-effective in the primary care setting.
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