- What are the indicators that allow monitoring quality in the management of depression?
It is important to know if the expected objectives are reached by complying with the recommendations considered to be the most important. Therefore, it is hereby proposed to assess some of the process variables that take part and the most relevant clinical outcomes.
When assessing the clinical management of depression, it is advisable to measure the three key areas related to quality, for which some indicators are initially proposed, due to their apparent validity, reliability and feasibility of use in primary care consultations and in the scope of the various healthcare areas.
Five of the proposed indicators are listed and described below, which are quantitative measures that can be used as a guide and which, if they are obtained with certain frequency, allow analysing the evolution over time, meaning that they allowing the indicators to be monitored.
| Area | Focus of the assessment | Indicator name |
|---|---|---|
| Diagnosis | Process | Underdiagnosis of major depression |
| Treatment | Process | Follow-up of treatment with antidepressants |
| Treatment | Outcome | Maintenance of treatment with antidepressants |
| Treatment | Process | Efficient use of antidepressant drugs |
| Treatment | Process | Psychotherapeutic treatment in severe major depression |
| Treatment | Process | Psychotherapeutic treatment in mild major depression |
Dimensions of the considered quality:
| Quality dimension | Indicator name |
|---|---|
| Diagnostic effectiveness | Underdiagnosis of major depression |
| Therapeutic effectiveness | Follow-up of treatment with antidepressants |
| Therapeutic effectiveness | Maintenance of treatment with antidepressants |
| Therapeutic effectiveness | Efficient use of antidepressant drugs |
| Therapeutic effectiveness | Psychotherapeutic treatment in severe major depression |
| Therapeutic effectiveness | Psychotherapeutic treatment in mild major depression |
| Indicator name | FOLLOW-UP OF TREATMENT WITH ANTIDEPRESSANTS | |||
|---|---|---|---|---|
| Justification | The continuous treatment of major depression with antidepressants during 6 months or more helps to consolidate the response to treatment and reduces the risk of relapse. To decrease the number of patients who do not suitably complete the treatment period, it is recommended that follow-up contact be made with them. This indicator allows monitoring follow-up on the treatment with antidepressants. | |||
| Formula |
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| Description of terms | Adult patients: patients over 18 years of age. Indication of treatment with antidepressant drugs: written record in the patient’s medical history that, after diagnosis of a major depressive disorder, starting treatment with antidepressant drugs has been indicated. New indications of treatment after new episodes in patients with a prior history of a major depressive disorder will also be counted. Patient’s medical history: it will be considered to be the information coming from the medical history of Primary Care and/or hospital care and on paper support and/or electronic format. Follow-up contact: in addition to personally attended, follow-up medical consultations, it could be considered that a patient has made follow-up contact by another system, as long as it has thus been recommended and previously agreed upon by the attending physician. |
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| Geographic area of reference | The geographic area of reference will be indicated in order to define the resident population in this geographic area during the study period and that, if diagnosed with major depression, would be considered a case. | |||
| Time period of reference | All diagnosed adult patients from the geographic area for whom treatment with antidepressant drugs has been indicated in the period of reference, generally the last 12 months, will be included. | |||
| Exclusion criteria | Patients under 18 years of age and patients not residing in the geographic area of the study are excluded. Other exclusions: patients confined to bed, transfers to other areas, death and diagnosis date within a period of less than one month. | |||
| Type of indicator | Process. | |||
| Data sources | Patient’s medical history. |
| Indicator name | MAINTENANCE OF PHARMACOLOGICAL TREATMENT WITH ANTIDEPRESSANTS | |||
|---|---|---|---|---|
| Justification | The maintenance of treatment of major depression with antidepressants during 6 months or more helps to consolidate the response to treatment and to reduce the risk of early relapse. This indicator allows knowing the maintenance of treatment with antidepressants. | |||
| Formula |
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| Description of terms | Adult patients: patients over 18 years of age. Indication of treatment: recorded indication of pharmacological treatment with antidepressants after diagnosis of an episode of a major depressive disorder. The new episodes of patients with a prior history of a major depressive order will also be counted. The indication must be made during the time period of reference. Recorded in the patient’s medical history: the information coming from the medical history of Primary Care and/or hospital care and on paper support and/or in electronic format will be considered. Time period of reference: all adult patients from the geographic area who are diagnosed in the reference period, generally the last 12 months, will be included. Geographic area: the geographic area of reference will be indicated in order to define the resident population in this geographic area and that, if diagnosed with major depression, would be considered a case. Indication of treatment: all new indications of pharmacological treatment with antidepressants made during the time period of reference will be included. Maintenance of treatment: it will be considered that a patient has maintained treatment for 6 months and that the treatment has been adequate if it is thus recorded in the medical history. |
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| Geographic area of reference | The geographic area of reference will be indicated in order to define the resident population in this geographic area during the study period and that, if diagnosed with major depression, would be considered a case. | |||
| Time period of reference | All adult patients from the geographic area who are diagnosed in the reference period, generally the last 12 months, will be included. | |||
| Exclusion criteria | Patients under 18 years of age and patients not residing in the geographic area of the study are excluded. Other exclusions: transfers to other areas, deaths, withdrawal of medication by medical prescription and diagnosis date within a period of less than 6 months. | |||
| Type of indicator | Outcome. | |||
| Data sources | Patient’s medical history. |
| Indicator name | EFFICIENT USE OF ANTIDEPRESSANT DRUGS | |||
|---|---|---|---|---|
| Justification | SSRI antidepressants are better tolerated and safer than TCAs. New dual drugs or serotonin reuptake inhibitors and noradrenaline are not more effective, although they are more expensive and potentially more dangerous. This indicator allows monitoring efficient use of treatments with antidepressants. | |||
| Formula |
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| Description of terms | Adult patients: all adult patients over 18 years of age, with a recorded diagnosis of major depression and the start of the indication of pharmacological treatment with antidepressants during the time period of reference will be counted. Recorded diagnosis of depression: written record of the diagnosis in the patient’s medical history that a new episode of a major depressive disorder was diagnosed in the reference time period. The new episodes of patients with a prior history of a major depressive order will also be counted. Patient’s medical history: it will be considered to be the information coming from the medical history of Primary Care and/or hospital care and on paper support and/or electronic format. Indication of treatment: all new indications of pharmacological treatment with antidepressants made during the time period of reference will be included. Indication of treatment with SSRI drugs in the first attempt: it will be considered that treatment with SSRI drugs in the first attempt has been indicated for a patient if it thus recorded in the medical history. |
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| Geographic area of reference | The geographic area of reference will be indicated in order to define the resident population in this geographic area and that, if diagnosed with a major depressive disorder, would be considered a case. | |||
| Time period of reference | All adult patients from the geographic area who are diagnosed in the reference period, generally the last 12 months, will be included. | |||
| Exclusion criteria | Patients under 18 years of age and patients not residing in the geographic area of the study are excluded. | |||
| Type of indicator | Process. | |||
| Data sources | Patient’s medical history. |
| Indicator name | PSYCHOTHERAPEUTIC TREATMENT IN SEVERE MAJOR DEPRESSION | |||
|---|---|---|---|---|
| Justification | Some psychotherapeutic treatments have been demonstrated to play a relevant role in the treatment of major depression. In the severe form, the combination of antidepressants and psychotherapy is considered to be the most effective option. This indicator allows monitoring the degree of coverage of psychotherapeutic treatment in combination with pharmacological treatment. | |||
| Formula |
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| Description of terms | Patients with combined antidepressant and psychotherapy treatment: the patient receives both simultaneously and in coordination between the professionals who dispense the treatments. Patients treated with psychotherapy: those who receive any of the duly validated treatments. Adult patients: adult patients over 18 years of age, with a recorded diagnosis of major depression and the start of the indication of psychotherapeutic treatment during the time period of reference will be counted. Recorded diagnosis of depression: written record in the patient’s medical history that a new episode of a severe major depressive disorder was diagnosed in the time period of reference. New episodes in patients with a prior history of major depression will also be counted. Patient’s medical history: it will be considered to be the information coming from the medical history of Primary Care and/or hospital care and on paper support and/or electronic format. Indication of treatment: all new indications of psychotherapeutic treatment with antidepressants made during the time period of reference will be included. |
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| Geographic area of reference | The geographic area of reference will be indicated in order to define the resident population in this geographic area and that, if diagnosed with a major depressive disorder, would be considered a case. | |||
| Time period of reference | All patients who are diagnosed in the reference period, generally the last 12 months, will be included. | |||
| Exclusion criteria | Patients under 18 years of age and patients not residing in the geographic area of the study are excluded. | |||
| Type of indicator | Process. | |||
| Data sources | Patient’s medical history. |
| Indicator name | PSYCHOTHERAPEUTIC TREATMENT IN MILD MAJOR DEPRESSION | |||
|---|---|---|---|---|
| Justification | Some psychotherapeutic treatments have been demonstrated to play a relevant role in the treatment of major depression. This indicator allows monitoring the degree of coverage of psychotherapeutic treatment in mild major depression. | |||
| Formula |
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| Description of terms | Patients treated with psychotherapy: those who receive any of the duly validated treatments. Brief Psychotherapy: psychotherapeutic treatment that does not exceed 6-8 sessions, for 10 to 12 weeks. Adult patients: patients over 18 years of age, with a recorded diagnosis of major depression and the start of the indication of psychotherapeutic treatment during the time period of reference will be counted. Recorded diagnosis of depression: written record in the patient’s medical history that a new episode of a mild major depressive disorder was diagnosed in the time period of reference. New episodes in patients with a prior history of major depression will also be counted. Patient’s medical history: it will be considered to be the information coming from the medical history of Primary Care and/or hospital care and on paper support and/or electronic format. Indication of treatment: all new indications of psychotherapeutic treatment made during the time period of reference will be included. |
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| Geographic area of reference | The geographic area of reference will be indicated in order to define the resident population in this geographic area and that, if diagnosed with a major depressive disorder, would be considered a case. | |||
| Time period of reference | All adult patients from the geographic area who are diagnosed in the reference period, generally the last 12 months, will be included. | |||
| Exclusion criteria | Patients under 18 years of age and patients not residing in the geographic area of the study are excluded. | |||
| Type of indicator | Process. | |||
| Data sources | Patient’s medical history. |
Latest update: May 2009
