1 Centre d'Excellence en Électroconvulsivothérapie du Québec, Institut universitaire en santé mentale de Montréal, Montreal, Quebec.
2 Department of Psychiatry, University of Montreal, Montreal. Quebec.
Can J Psychiatry. 2018 Jul;63(7):465-473. doi: 10.1177/0706743717738492. Epub 2017 Oct 25.
As part of a quality improvement process, we propose a model of routinely monitoring electroconvulsive therapy (ECT) in Canadian provinces using linked health administrative databases to generate provincial periodic reports, influence policy, and standardise ECT practices.
ECT practice in Quebec was studied from 1996 to 2013, using longitudinal data from the Quebec Integrated Chronic Disease Surveillance System of the Institut National de Santé Publique du Québec, which links 5 health administrative databases. The population included all persons, aged 18 y and over, eligible for the health insurance registry, who received an ECT treatment at least once during the year.
Among recorded cases, 75% were identified by physician claims and hospitalisation files, 19% exclusively by physician claims, and 6% by hospitalisation files. From 1996 to 2013, 8,149 persons in Quebec received ECT with an annual prevalence rate of 13 per 100,000. A decline was observed, which was more pronounced in women and in older persons. On average, each patient received 9.7 treatments of ECT annually. The proportion of acute ECT decreased whereas maintenance treatment proportions increased. A wide variation in the use of ECT was observed among regions and psychiatrists.
This study demonstrates the profitable use of administrative data to monitor ECT use in Quebec, and provides a reliable method that could be replicated in other Canadian provinces. Although Quebec has one of the lowest utilisation rates reported in industrialized countries, regional disparities highlighted the need for a deeper examination of the quality and monitoring of ECT care and services.
作为质量改进过程的一部分，我们建议使用链接的健康管理数据库来监测加拿大各省的电抽搐治疗（ECT），生成省级定期报告，影响政策，并使 ECT 实践标准化。
使用来自魁北克省国家公共卫生研究所的魁北克综合慢性疾病监测系统的纵向数据，研究了 1996 年至 2013 年期间魁北克的 ECT 实践情况，该系统链接了 5 个健康管理数据库。该人群包括所有符合健康保险登记条件的 18 岁及以上的人，他们在该年内至少接受过一次 ECT 治疗。
在记录的病例中，75%是通过医生索赔和住院档案确定的，19%仅通过医生索赔确定，6%通过住院档案确定。1996 年至 2013 年期间，魁北克有 8149 人接受 ECT 治疗，每年的患病率为 13/10 万。观察到发病率下降，女性和老年人更为明显。平均而言，每位患者每年接受 9.7 次 ECT 治疗。急性 ECT 的比例下降，而维持治疗的比例增加。在地区和精神科医生之间，ECT 的使用存在很大差异。
这项研究表明，使用管理数据监测魁北克 ECT 的使用是有利可图的，并提供了一种可靠的方法，可以在其他加拿大省份复制。尽管魁北克的利用率是工业化国家中报告的最低水平之一，但区域差异突出表明需要更深入地检查 ECT 护理和服务的质量和监测。
