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Biomedical subjects

Luis Salvador-Carulla

Publications and source records attributed to Luis Salvador-Carulla.

6 recordsLinked to original sources
PubMed2006

Treatment adequacy of anxiety and depressive disorders: primary versus specialised care in Spain.

BACKGROUND: Literature suggests that a high proportion of the population with mental disorders remains either untreated or poorly treated. This study aimed to describe the adequacy of treatment for Anxiety and Depressive disorders in Spain, how this differs between providers (primary versus specialised care) and which factors are associated with appropriate care. METHOD: Data were derived from the Spanish sample (N=5473) of the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross sectional study in a representative sample of adults. The subsample analyzed was composed by the 133 subjects with a mental disorder in the year prior to the interview who received treatment. Treatment adequacy was evaluated in two different ways: (1) considering definitions of minimally adequate treatment evidence based guidelines and criteria used in other epidemiological studies; (2) considering experts rating of treatment appropriateness based on the information contained in the case vignettes created from the CIDI answers. Generalised Estimating Equation (GEE) models and simple logistic regression were conducted to assess the correlates of adequate treatment. RESULTS: Similar proportions of patients in specialty and general medical treatment received a minimally adequate treatment (31.8% and 30.5%, respectively). Associated factors to appropriateness were living in a large city, having a high educational level, and having a good self rated health state. LIMITATIONS: Treatment adequacy was based on simple information and criteria. CONCLUSIONS: Only one third of the mental health treatment in Spain met minimal adequacy criteria. More research is needed in order to find out reasons for these low rates.

Adult↗
PubMed2006

The SOHO (Schizophrenia Outpatient Health Outcome) study: implications for the treatment of schizophrenia.

The European SOHO (Schizophrenia Outpatient Health Outcome) study is an observational, naturalistic study of the outpatient treatment of schizophrenia. The patient recruitment and assessment began in September 2000 and finished in early 2005. A total of 10 972 adult patients from ten European countries who were initiating or changing antipsychotic medication for the treatment of schizophrenia within the normal course of care have been enrolled. The patients have been followed at regular intervals over the 3-year timeframe of the study. Evaluation includes clinical severity, measured with the Clinical Global Impression (CGI) scale; health-related quality of life; social functioning; and medication tolerability. The 6- and 12-month results have been published so far and have demonstrated that the patients in whom treatment was initiated with olanzapine or clozapine or who were started on more than one antipsychotic of any class at baseline tended to have somewhat greater improvement than patients treated with other atypical or typical antipsychotics, both in terms of symptoms measured with the CGI and quality of life. Numbers of social contacts increased with the treatment, but other aspects of social functioning did not show any significant change. Atypical antipsychotics as a class were associated with a lower frequency of extrapyramidal symptoms (EPS) and anticholinergic use than typical antipsychotics. The frequency of EPS was lowest in the clozapine-, quetiapine- and olanzapine-treated patients, at around 10%. The atypical antipsychotics also conferred a lower risk for tardive dyskinesia than the typical antipsychotics. Weight gain occurred in all treatment cohorts over the first 12 months of treatment and was statistically significantly greater in the patients who started treatment with olanzapine and clozapine. Prolactin- and sexually-related adverse events were frequent at baseline assessment: amenorrhoea was present in around one- third of women, impotence in around 40% of men, and loss of libido in 50% of both male and female patients. Patients treated with olanzapine, clozapine and quetiapine were significantly less likely to have sexual/endocrine-related dysfunctions after 6 months of treatment (the 12-month results of this parameter are yet to be published) than those in the other treatment cohorts (typical antipsychotics, risperidone and amisulpride). Concomitant medication use during the study has been high, ranging from 5% to 29% for anticholinergics, 8% to 23% for antidepressants, 22% to 37% for anxiolytics and 7% to 19% for mood stabilisers, depending on the type of antipsychotic prescribed. Fewer olanzapine-, quetiapine- and clozapine-treated patients used concomitant anticholinergics or anxiolytics/hypnotics. The current results from the SOHO study indicate that differences in effectiveness and tolerability do exist between the antipsychotics. Future results from the study will be published during the coming months and years, and will allow patterns of antipsychotic use in routine clinical practice (including how often and why changes are made) to be determined. This important information is likely to impact on the future use of antipsychotics and will assist clinicians in refining the use of these drugs and improving the outcome of patients to whom they are prescribed.

Antipsychotic Agents↗
PubMed2005

Patterns of mental health service utilisation in Italy and Spain--an investigation using the European Service Mapping Schedule.

BACKGROUND: Methods for comparing local mental health service systems are needed to allow identification of different patterns of service provision and of inequities within and between countries. AIM: The aim of this study was to describe and compare mental health service systems in 13 catchment areas in Spain and Italy. Within each country, a range of area characteristics was represented. METHOD: The European Service Mapping Schedule (ESMS) and European Socio-Demographic Schedule (ESDS) were used to describe: (i) socio-demographic and geographical area characteristics; (ii) services provided; and (iii) service utilisation in each area. RESULTS: Great differences emerged in patterns of service provision and use between and within countries. In contrast to Northern Europe, high unemployment rates were not associated with high service utilisation rates, but areas with large numbers of single-person households tended to have high service use. Most service utilisation rates were substantially below those reported from Northern European studies. Spanish centres tended to have low rates of hospital service utilisation despite limited development of community-based services. Trieste, where there has been a strong emphasis on developing innovative community services, showed a distinctive pattern with low hospital bed use and high rates of day service use and of contacts in the community. CONCLUSION: This methodology yielded useful data, which raise significant questions regarding equity and the implementation of mental health policy. The very large variations indicate that underlying local patterns of service provision must be investigated and taken into account in the interpretation of research evaluations of interventions.

Cross-Cultural Comparison↗
PubMed2005

Indicators predicting use of mental health services in Piedmont, Italy.

BACKGROUND: Since the 1978 Italian reform, an integrated network of community mental health services has been introduced. With few exceptions, research on determinants of mental health service use at the district level has focused on inpatient activities and social deprivation indicators. The European Psychiatric Care Assessment Team (EPCAT) standardized methodology allows for an evidence-based comparison of mental health systems between geographical areas. AIMS: To compare service provision and utilization between local catchment areas; to explore quantitative relationships between residential and community service use and socio-demographic indicators at the ecological level. METHODS: The European Socio-demographic Schedule (ESDS) was used to describe area characteristics, and the European Service Mapping Schedule (ESMS) to measure service provision and utilization in 18 catchment areas in Piedmont. RESULTS: Substantial variation in service use emerged. Acute hospital bed occupancy rates were lower in areas with more intensive community continuing care service users and with a smaller percentage of the population living alone. The non-acute hospital bed occupancy rate was directly related to the percentage of the population living alone or in overcrowded conditions, and to the level of mobile continuing care service users. Community continuing care service use was highest in areas with a larger percentage of the population living alone. DISCUSSION: Multiple regression models explained between 48 and 55% of the variation in inpatient and community service use between areas. Relationships based on ecological characteristics do not necessarily apply to the individual. This level of assessment, however, is necessary in evaluating mental health policy and service systems, and in allocating resources. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The distribution of mental health care resources should be weighted in terms of indicators of social deprivation shown to be important predictors of both inpatient and community service use, as these are likely to be related. IMPLICATIONS FOR HEALTH POLICIES: To ensure horizontal equity in access to mental health care, particularly for people with severe mental illness, evaluation of mental health policy should be based on a concurrent evidence-based assessment of the organization and use of both residential and community services, in relation to area level indicators of social deprivation. IMPLICATIONS FOR FURTHER RESEARCH: Cross-national research using an internationally standardized methodology should consider the influence of the social network independently of other socio-economic indicators, to verify the relative importance of this in predicting service use in southern and in northern European countries.

Catchment Area, Health↗
PubMed2005

An analysis of the costs of treating schizophrenia in Spain: a hierarchical Bayesian approach.

BACKGROUND: Health care decisions should incorporate cost of illness and treatment data, particularly for disorders such as schizophrenia with a high morbidity rate and a disproportionately low allocation of resources. Previous cost of illness analyses may have disregarded geographical aspects relevant for resource consumption and unit cost calculation. AIMS: To compare the utilisation of resources and the care costs of schizophrenic patients in four mental-health districts in Spain (in Madrid, Catalonia, Navarra and Andalusia), and to analyse factors that determine the costs and the differences between areas. METHODS: A treated prevalence bottom-up three year follow-up design was used for obtaining data concerning socio-demography, clinical evolution and the utilisation of services. 1997 reference prices were updated for years 1998-2000 in euros. We propose two different scenarios, varying in the prices applied. In the first (Scenario 0) the reference prices are those obtained for a single geographic area, and so the cost variations are only due to differences in the use of resources. In the second situation (Scenario 1), we analyse the variations in resource utilisation at different levels, using the prices applicable to each healthcare area. Bayesian hierarchical models are used to discuss the factors that determine such costs and the differences between geographic areas. RESULTS: In scenario 0, the estimated mean cost was 4918.948 euros for the first year. In scenario 1 the highest cost was in Gava (Catalonia) and the lowest in Loja (Andalusia). Mean costs were respectively 4547.24 and 2473.98 euros. With respect to the evolution of costs over time, we observed an increase during the second year and a reduction during the third year. Geographical differences appeared in follow-up costs. The variables related to lower treatment costs were: residence in the family household, higher patient age and being in work. On the contrary, the number of relapses is directly related to higher treatment costs. No differences were observed between health areas concerning resource utilisation. DISCUSSION: Calculating the costs of a given disease involves two principal factors: the resource utilisation and the prices. In most studies, emphasis is placed on the analysis of resource utilisation. Other evaluations, however, have recognized the implications of incorporating different prices into the final results. In this study we show both scenarios. The factors that determine the cost of schizophrenia for the Spanish case are similar to the factors encountered in studies carried out in other countries. IMPLICATIONS FOR HEALTH POLICIES: Treatment costs may be reduced by the prevention of psychotic symptoms and relapse. IMPLICATIONS FOR FUTURE RESEARCH: The use of the same price data in multicentre studies may not be realistic. More effort should be made to obtain price data from all the centres or countries participating in a study. In the present study, only direct healthcare and social costs have been included. Future research should consider informal and indirect costs.

Adult↗