EPS Barthélémy Durand, Psychiatry Department, Avenue Du 8 Mai 1945, 91150, Etampes, France; Institut de Recherche et Documentation en économie de la santé (IRDES), 117 bis Rue Manin, 75019, Paris, France.
Institut de Recherche et Documentation en économie de la santé (IRDES), 117 bis Rue Manin, 75019, Paris, France.
Brain Stimul. 2022 Jan-Feb;15(1):201-210. doi: 10.1016/j.brs.2021.12.007. Epub 2021 Dec 22.
A comprehensive understanding of variations in the use of electroconvulsive therapy (ECT) among health care providers in charge of ECT referrals is lacking.
Our objectives were to document ECT use and its variations on a nationwide scale in France and to identify the factors that were significantly associated with these variations.
Administrative health claims data on hospitalization were used to perform a descriptive analysis of ECT use for adult patients receiving inpatient psychiatric care in mainland France in 2019 and its variations across hospitals in charge of ECT referrals. Based on a conceptual framework drawn from the literature on medical practice variations, a multilevel logistic regression was then conducted to identify patients, hospitals and contextual characteristics that were significantly associated with ECT treatment using non-ECT-treated patients receiving inpatient psychiatric care as the reference population.
Patients receiving ECT (n = 3288) were older, more frequently female and had more severe diagnoses than other patients seen in inpatient care (n = 295,678). Significant variations were observed in the rate of ECT use across hospitals (n = 468), with a coefficient of variation largely above one. In the multivariable analysis, ECT treatment was associated with patient characteristics (which accounted for 6% of the variations) but also with characteristics of the hospitals and their environments (44% of the variations), including the type of hospital and its distance to the closest facility providing ECT.
Variations in ECT use were strongly linked to health care supply characteristics, which raises questions about access to quality mental health care.
负责电抽搐治疗（ECT）转介的医疗保健提供者在 ECT 使用方面的差异缺乏全面了解。
我们的目的是在法国全国范围内记录 ECT 的使用情况及其差异，并确定与这些差异显著相关的因素。
使用行政健康索赔数据对住院患者进行了描述性分析，以了解 2019 年在法国大陆接受住院精神科护理的成年患者的 ECT 使用情况及其在负责 ECT 转介的医院之间的差异。根据文献中关于医疗实践差异的概念框架，然后进行多水平逻辑回归分析，以确定与 ECT 治疗显著相关的患者、医院和背景特征，将接受住院精神科护理但未接受 ECT 治疗的患者作为参考人群。
接受 ECT（n=3288）的患者比接受住院治疗的其他患者（n=295678）年龄更大，女性更多，诊断更严重。医院之间 ECT 使用率存在显著差异（n=468），变异系数大大超过 1。在多变量分析中，ECT 治疗与患者特征（占差异的 6%）相关，但也与医院及其环境特征（占差异的 44%）相关，包括医院类型及其与提供 ECT 的最近设施的距离。
ECT 使用的差异与医疗保健供应特征密切相关，这引发了对获得高质量精神保健的关注。
