Vázquez-Estupiñán F, Rosel-Palacios JC, Kitazawa-Ohtomo A, Caballero-Castro MA, Salinas-García P, Corlay-Noriega I, Ruiz-Flores LG

Idioma: Español
Referencias bibliográficas: 88
Paginas: 495-502
Archivo PDF: 124.23 Kb.

RESUMEN

Objetivo: evaluar la calidad de la atención del paciente deprimido con comorbilidad médica e identificar áreas de mejora utilizando el expediente electrónico.
Material y métodos: estudio observacional, retrospectivo en el que se revisó la literatura para la identificación de indicadores basados en la evidencia. Con base en las notas electrónicas clínicas se calcularon las proporciones de continuidad en el tratamiento antidepresivo a 12 y 24 semanas, las tasas de respuesta y remisión en fase aguda a ocho semanas, el uso de escalas clinimétricas y de psicoterapia basada en la evidencia, así como la presencia de eventos de seguridad relacionados con los antidepresivos.
Resultados: de 100 enfermos con edad promedio de 48.7 años, 49 y 34 % recibieron tratamiento durante 12 y 24 semanas, respectivamente, con respuesta de 50 % y remisión de 28 % a las ocho semanas. A 33 % se les aplicó escalas clinimétricas y se hicieron intervenciones psicoterapéuticas en 28 % de las visitas. Un paciente presentó crisis convulsivas relacionadas con el uso de antidepresivos.
Conclusiones: la información obtenida del expediente electrónico sugiere como áreas de oportunidad de mejora, incrementar la proporción de pacientes que alcanzan remisión en la fase aguda de la enfermedad y la aplicación de escalas clinimétricas y de psicoterapia basada en la evidencia.

REFERENCIAS (EN ESTE ARTÍCULO)

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46. Pandey M, Sarita GP, Devi N, Thomas BC, Hussain BM, Krishnan R. Distress, anxiety, and depression in cancer patients undergoing chemotherapy. World J Surg Oncol 2006;4:68.

47. Jiang W, Kuchibhatla M, Cuffe MS, Christopher EJ, Alexander JD, Clary GL, et al. Prognostic value of anxiety and depression in patients with chronic heart failure. Circulation 2004;110:3452-3456.

48. Clouse RE, Lustman PJ, Freedland KE, Griffith LS, McGill JB, Carney RM. Depression and coronary heart disease in women with diabetes. Psychosom Med 2003;65:376-383.

49. Rush AJ, Trivedi M, Carmody TJ, Biggs M, Shores-Wilson K, Ibrahim I, et al. One-year clinical outcomes of depressed public sector outpatients: a benchmark for subsequent studies. Biol Psychiatry 2004;56:46-53.

50. Hermann RC. Interpreting measurement data for quality improvement: standards, means, norms, and benchmarks. Psychiatr Serv 2003; 54:655-657.

51. Paolo S, Frank E. Interpersonal psychotherapy as augmentation treatment in depressed elderly responding poorly to antidepressant drugs: a case series. Psychother Psychosom 2002;71:357-361.

52. Beck AT. The current state of cognitive therapy: a 40-year retrospective. Arch Gen Psychiatry 2005; 62:953-959.

53. Brown GK, Ten Have T, Henriques GR, Xie SX, Hollander JE, Beck AT. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA 2005;294:563-570.

54. McBride C, Atkinson L, Quilty LC, Bagby RM. Attachment as moderator of treatment outcome in major depression: a randomized control trial of interpersonal psychotherapy versus cognitive behavior therapy. J Consult Clin Psychol 2006; 74:1041-1054.

55. Wagner EH, Austin BT, Davis C. Improving chronic illness care: translating evidence into action. Health Aff 2001;20:64-78.

56. Stevens DP, Wagner EH. Transform residency training in chronic illness care—now. Acad Med 2006; 81:685-687.

57. Katzelnick DJ, Von Korff M, Chung H, Provost LP, Wagner EH. Applying depression-specific change concepts in a collaborative breakthrough series. Jt Comm J Qual Patient Saf 2005;31:386-397.

58. Sackett DL, Straus SE, Richardson WS, Rosenberg WS, Haynes RB. Evidence-based medicine. How to practice and teach EBM. Second edition. Oxford, UK: Churchill Livingstone; 2000. p. 13.

59. Vázquez F. Medicina basada en la evidencia. México: Intersistemas; 2005. p. 309.

60. Hermann R, Mattke S; Members of the OECD Mental Health Panel. Selecting indicators for the quality of mental health care at the health system level in OECD countries. France: OECD Health Technical Papers; 2004.

61. Asociación Psiquiátrica Americana. Guía clínica para el tratamiento del trastorno depresivo mayor. Segunda edición. México: Intersistemas; 2002.

62. APA Task Force on Quality Indicators. Quality indicators. Defining and measuring quality in psychiatric care for adults and children. Washington DC: American Psychiatric Association; 2002. p. 20-44.

63. Bronheim HE, Fulop G, Kunkel EJ, Muskin PR, Schindler BA, Yates WR, et al. The Academy of Psychosomatic Medicine practice guidelines for psychiatric consultation in the general medical setting. Pychosomatics 1998;39:S8-S30.

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66. McIntyre RS, Zonarski JZ, Manzini DA, Fulton KA, Parikh SV, Grigoriadis S, et al. Measuring the severity of depression and remission in primary care: validation of the HAMD-7 scale. CMAJ 2005; 173:1-8.

67. Beck AT, Ward CH, Mendelson M. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:53-63.

68. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.

69. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382-389.

70. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983;67: 361-370.

71. Goldman HH, Skodol AE, Lave TR. Revising axis V for DSM-IV: a review of measures of social functioning. Am J Psychiatry 1992;149:1148-1156.

72. Leon AC, Shear MK, Klerman GL. A comparison of symptom determinants of patient and clinical global ratings in patients with panic disorder and depression. J Clin Psychopharmacol 1993;13:327-331.

73. Ruiz LG. Psicoterapia interpersonal. México: Intersistemas; 2000. p. 18-23.

74. Leape L, Brennan T, Laird N, Lawthers A, Russell L, Barnes, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 1991;324:370-376.

75. Ruiz LG, Vázquez F, Corlay I, Báez A. Inhibidores selectivos de la recaptura de la serotonina. Rev Med IMSS 1998;32:267-270.

76. Chiu NM, Strain JJ, Sun TF, Strain JJ, Lee Y, Chong MY, et al. Development of a Taiwanese computerized database for psychiatric consultation in a general hospital. Gen Hosp Psychiatry 2005;27:292-297.

77. Strain JJ, Strain JJ, Mustafa S, Sultana K, Cartagena-Rochas A, Ruiz LG et al. Consultation-Liaison literature database: 2003 update and national lists. Gen Hosp Psychiatry 2003;25:377-478.

78. Brook R. Defining and measuring quality of care: a perspective from US researchers. Int J Qual Health Care 2000; 12:281-295.

79. Campbell SM, Roland MO, Buetow SA. Defining quality of care. Soc Sci Med 2000;51:1611-1625.

80. Schneider F, Harter M, Brand S, Sitta P, Rter H, Menke R, et al. Adherence to guidelines for treatment of depression in in-patients. Br J Psy 2005;187:462-469.

81. Aguirre-Gas HG. Calidad de la atención médica. Bases para su evaluación y mejoramiento continuo. Tercera edición. México: CAMS-Noriega Editores; 2002. p. 79.

82. Garduño J, Cuevas ML. Evaluación de la calidad de la atención médica. En: Moreno L, editor. Epidemiología clínica. Segunda edición. México: Interamericana-McGraw-Hill; 1994. p. 217-234.

83. Anderson RM, Funnell M. The art of empowerment. Stories and strategies for diabetes educators. Washington, DC: American Diabetes Association; 2000. p. 121-140.

84. Ruddy R, House A. Meta-review of high-quality systematic reviews of interventions in key areas of Liaison psychiatry. Br J Psychiatry 2005;187:109-120.

85. Lovejoy NC, Matteis M. Cognitive-behavioural interventions to manage depression in patients with cancer: research and theoretical initiatives. Cancer Nurs 1997;20:155-167.

86. Swick HM. Toward a normative definition of medical professionalism. Acad Med 2000;75:612-616.

87. Plsek P. Quality improvement methods in clinical medicine. Pediatrics 1999;103:203-214.

88. Committee on Quality of Health Care in America, Institute of Medicine. Crossing the quality chasm. US: National Academy Press; 2000.