Quality of care for major depression and its determinants: a multilevel analysis

BMC Psychiatry

Pasquale Roberge¹  Lise Gauvin²  Louise Fournier³  Arnaud Duhoux³ 

[1] Université de Sherbrooke, 3001, 12e Avenue Nord, J1H 5 N4, Sherbrooke, QC, Canada;Université de Montréal, C.P. 6128, succursale Centre-ville, H3C 3 J7, Montreal, QC, Canada;Institut National de Santé Publique du Québec, 190 Crémazie Blvd. East, H2P 1E2, Montreal, QC, Canada

关键词: Multilevel analysis;    Adequacy of treatment;    Major depressive episode;    Quality indicator;    Quality of care;   

Others  :  1124289
DOI  :  10.1186/1471-244X-12-142

 received in 2012-03-23, accepted in 2012-08-09,  发布年份 2012

【 摘 要 】

Background

Numerous studies highlight an important gap in the quality of care for depression in primary care. However, basic indicators were often used. Few of these studies examined factors associated with receiving adequate treatment, particularly with a simultaneous consideration of individual and organizational characteristics. The purpose of this study was to estimate the proportion of primary care patients with a major depressive episode (MDE) who receive adequate treatment and to examine the individual and organizational (i.e., clinic-level) characteristics associated with the receipt of at least one minimally adequate treatment for depression.

Methods

The sample used for this study included 915 adults consulting a general practitioner (GP), regardless of the motive of consultation, meeting DSM-IV criteria for MDE during the 12 months preceding the survey (T1), and nested within 65 primary care clinics. Data reported in this study were obtained from the “Dialogue” project. Adherence rates for 27 quality indicators selected to cover the most important components of depression treatment were estimated. Multilevel analyses were conducted.

Results

Adherence to guidelines was high (>75%) for one third of the quality indicators that were measured but was low (<60%) for nearly half of the measures. Just over half of the sample (52.2%) received at least one minimally adequate treatment for depression. At the individual level, determinants of receipt of minimally adequate care included age, having a family physician, a supplementary insurance coverage, a comorbid anxiety disorder and the severity of depression. At the clinic level, determinants included the availability of psychotherapy on-site, the use of treatment algorithms, and the mode of remuneration.

Conclusions

Our findings suggest that interventions are needed to increase the extent to which primary mental health care conforms to evidence-based recommendations. These interventions should target specific populations (i.e. the younger adults and the elderly), enhance accessibility to psychotherapy and to a regular family physician, and support primary care physicians in their clinical practice with patients suffering from depression in different ways such as developing knowledge to treat depression and adapting mode of remuneration.

【 授权许可】

   
2012 Duhoux et al.; licensee BioMed Central Ltd.

【 图 表 】

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