基于人群的数据库对重性抑郁障碍患者缓解标准的临床有效性。

Clinical validity of a population database definition of remission in patients with major depression.

机构信息

Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain, Gaietà Soler, 6-8 entlo, 08911 Badalona, Barcelona, Spain.

出版信息

BMC Public Health. 2010 Feb 11;10:64. doi: 10.1186/1471-2458-10-64.

DOI:10.1186/1471-2458-10-64

PMID:20149222

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2829005/

Abstract

BACKGROUND

Major depression (MD) is one of the most frequent diagnoses in Primary Care. It is a disabling illness that increases the use of health resources.

AIM

To describe the concordance between remission according to clinical assessment and remission obtained from the computerized prescription databases of patients with MD in a Spanish population.

DESIGN

multicenter cross-sectional. The population under study was comprised of people from six primary care facilities, who had a MD episode between January 2003 and March 2007. A specialist in psychiatry assessed a random sample of patient histories and determined whether a certain patient was in remission according to clinical criteria (ICPC-2). Regarding the databases, patients were considered in remission when they did not need further prescriptions of AD for at least 6 months after completing treatment for a new episode. Validity indicators (sensitivity [S], specificity [Sp]) and clinical utility (positive and negative probability ratio [PPR] and [NPR]) were calculated. The concordance index was established using Cohen's kappa coefficient. Significance level was p < 0.05.

RESULTS

133 patient histories were reviewed. The kappa coefficient was 82.8% (confidence intervals [CI] were 95%: 73.1 - 92.6), PPR 9.8% and NPR 0.1%. Allocation discrepancies between both criteria were found in 11 patients. S was 92.5% (CI was 95%: 88.0 - 96.9%) and Sp was 90.6% (CI was 95%: 85.6 - 95.6%), p < 0.001. Reliability analysis: Cronbach's alpha: 90.6% (CI was 95%: 85.6 - 95.6%).

CONCLUSIONS

Results show an acceptable level of concordance between remission obtained from the computerized databases and clinical criteria. The major discrepancies were found in diagnostic accuracy.

摘要

背景

重度抑郁症（MD）是初级保健中最常见的诊断之一。它是一种使人丧失能力的疾病，会增加对卫生资源的利用。

目的

描述西班牙人群中根据临床评估和计算机化处方数据库得出的 MD 缓解情况之间的一致性。

设计

多中心横断面研究。研究人群由六家初级保健机构的人员组成，他们在 2003 年 1 月至 2007 年 3 月期间发生了 MD 发作。一名精神病专家评估了患者病历的随机样本，并根据临床标准（ICPC-2）确定某个患者是否处于缓解状态。至于数据库，当患者在完成新发作的治疗后至少 6 个月不需要进一步的 AD 处方时，就被认为处于缓解状态。计算了有效性指标（敏感性[S]、特异性[Sp]）和临床实用性（阳性和阴性预测比值[PPR]和[NPR]）。使用 Cohen 的 kappa 系数建立了一致性指数。显著性水平为 p < 0.05。

结果

共审查了 133 份患者病历。kappa 系数为 82.8%（置信区间[CI]为 95%：73.1-92.6），PPR 为 9.8%，NPR 为 0.1%。在两种标准之间发现了 11 例分配差异。S 为 92.5%（CI 为 95%：88.0-96.9%），Sp 为 90.6%（CI 为 95%：85.6-95.6%），p < 0.001。可靠性分析：Cronbach's alpha 为 90.6%（CI 为 95%：85.6-95.6%）。