Quality indicators in the treatment of patients with depression, bipolar disorder or schizophrenia. Consensus study

Basic quality indicators for clinical care of patients with major depression, schizophrenia, and bipolar disorder

OBJECTIVE

To identify a set of indicators to monitor the quality of care for patients with major depression, schizophrenia, or bipolar disorder.

METHODS

A group of 10 experts selected the most automatically applicable indicators from a total of 98 identified in a previous study. Five online sessions and 5 discussion meetings were performed to select the indicators that met theoretical feasibility criteria automatically. Subsequently, feasibility was tested in a pilot study conducted in two hospitals of the Spanish Health Service.

RESULTS

After evaluating its measurement possibilities in the Spanish Health Service, and the fulfillment of all the quality premises defined, 16 indicators were selected. Three were indicators of major depression, 5 of schizophrenia, 3 of bipolar disorder, and 5 indicators common to all three pathologies. They included measures related to patient safety, maintenance and follow-up of treatment, therapeutic adherence, and adequacy of hospital admissions. After the pilot study, 5 indicators demonstrated potential in the automatic generation of results, with 3 of them related to treatments (clozapine in schizophrenia, lithium for bipolar disorder, and valproate in women of childbearing age).

CONCLUSIONS

Indicators support the monitoring of the quality of treatment of patients with major depression, schizophrenia, or bipolar disorder. Based on this proposal, each care setting can draw up a balanced scorecard adjusted to its priorities and care objectives, which will allow for comparison between centers.

Emergency nursing nurse sensitive indicators: An integrative review

BACKGROUND

Nurse sensitive indicators (NSIs) capture the outcomes of each nursing function impacted by nursing care. NSIs are critical in clarifying foci for emergency nurses when providing care in the emergency department (ED).

OBJECTIVE

To establish NSIs key to emergency nursing from existing published literature.

METHODS

Ten databases were searched as well as grey literature and Google Scholar in the development of data for this integrative review. Articles underwent a title and abstract review to establish inclusion/exclusion suitability followed by a full text critical appraisal. Data were extracted, synthesized, and analyzed using a structured process.

RESULTS

Twenty-eight emergency nursing NSIs were identified from three included studies, with little consensus across the literature. The NSIs established in the literature reflected a broad range of non-specific technical skills. Overall, the quality of the included articles was low due to factors including study design and high risk of bias.

CONCLUSIONS

The constrained range of NSIs and the limited literature exploring the outcomes of emergency nursing care perhaps reflects a wide ranging and seemingly evolving scope of emergency nurses. Further research is needed to delineate emergency nursing NSI, perhaps underpinned by a clear definition of an emergency nurse in terms of capability statements, core skills and defining attributes.

Eating and nutritional habits in patients with schizophrenia

BACKGROUND

There are few studies that relate eating and nutritional habits to the severity of the disease and demographic profile in patients with schizophrenia.

OBJECTIVE

To describe eating and nutritional habits and their relationship with the severity of the disease in patients with schizophrenia.

METHOD

Cross-sectional descriptive study.

SAMPLE

31 patients with schizophrenia (ICD-10) under outpatient treatment.

INCLUSION CRITERIA

age 18-65 years, clinically stable and, written informed consent.

ASSESSMENT

Demographic, clinical characteristics (CGI-SCH, length of illness, BMI, abdominal perimeter), ad hoc questionnaire (eating, nutritional, and physical activity).

RESULTS

Mean age 43.13(SD = 7.85) years, males 61.3%. Mean severity of illness was 3.94(SD = 1.06), mean duration of the illness 18.42(SD = 8.27) years. 74.2% used to eatweekly fat meat and 64.5% less than 3-4 servings of fish, 77.4% less than 3 servings of fruit per day, and 51.6% drink less than 1 L of water. 83.9% used to drink coffee daily, 2.81(SD = 2.02) cups per day. Patients showed lower levels of Vitamin A, D, E, K1, C, folic acid, and magnesium. 93.5% did not fulfill the WHO recommendations on physical activity. Only retinol (r = -0.602, P = .039) and vitamin K1 (r = -0.693, P = .012) in women were related to the severity of illness.

CONCLUSIONS

Outpatients with schizophrenia do not follow WHO recommendations on healthy diets, neither physical activity. Both clinical severity of the illness and marital status and cohabitation were associated with poor eating habits and nutrients deficit. These data should be taken into account by the nursing staff when implementing specific care in routine clinical practice.

Structure and Functioning of Acute Inpatient Psychiatric Units in Spain: Qualitative Study

Background

As a consequence of the decentralization of health care provision to the different Regions (called Autonomous Communities) in Spain, different health care models and resources have been developed for psychiatric patients. It would be very useful to obtain comprehensive and comparative data on health care models, resources, and activity of acute inpatient psychiatric units (AIPUs) as a key part of mental health systems.

Objective

The aim of this study was to determine the current state of AIPUs in Spain through a national scorecard that allows the current situation to be visualized in terms of resources, processes, and outputs.

Methods

A 104-item online questionnaire was sent to all the AIPUs of the different Regions in Spain. It was divided into 11 sections, including data on the resources, processes, and outputs of the AIPUs plus general data, an indicator dashboard, and good practices.

Results

The questionnaire was completed by 60.0% (117/195) of the AIPUs invited to participate. The information collected has allowed us to obtain a detailed snapshot of the current situation of AIPUs in Spain at the levels of infrastructure and material resources, staffing, organization and activity of the units, coordination with other units, guidelines, processes and protocols used, participation and communication with patients and their families, teaching activity, and research linked to the units.

Conclusions

This project aimed to help understand the general situation of AIPUs in Spain and its different Regions, contribute to enhancing the benchmarking and harmonization among Spanish Regions, and provide data for future comparisons with other countries.

International Registered Report Identifier (IRRID)

RR1-10.2196/26214

Eating and nutritional habits in patients with schizophrenia

BACKGROUND

There are few studies that relate eating and nutritional habits to the severity of the disease and demographic profile in patients with schizophrenia.

OBJECTIVE

To describe eating and nutritional habits and their relationship with the severity of the disease in patients with schizophrenia.

METHOD

Cross-sectional descriptive study.

SAMPLE

31 patients with schizophrenia (ICD-10) under outpatient treatment.

INCLUSION CRITERIA

age 18-65 years, clinically stable and, written informed consent.

ASSESSMENT

Demographic, clinical characteristics (CGI-SCH, length of illness, BMI, abdominal perimeter), ad hoc questionnaire (eating, nutritional, and physical activity).

RESULTS

Mean age 43.13(SD=7.85) years, males 61.3%. Mean severity of illness was 3.94(SD=1.06), mean duration of the illness 18.42(SD=8.27) years. 74.2% used to eat weekly fat meat and 64.5% less than 3-4 servings of fish, 77.4% less than 3 servings of fruit per day, and 51.6% drink less than 1l of water. 83.9% used to drink coffee daily, 2.81(SD=2.02) cups per day. Patients showed lower levels of Vitamin A, D, E, K1, C, folic acid, and magnesium. 93.5% did not fulfill the WHO recommendations on physical activity. Only retinol (r=-0.602, p=0.039) and vitamin K1 (r=-0.693, p=0.012) in women were related to the severity of illness.

CONCLUSIONS

Outpatients with schizophrenia do not follow WHO recommendations on healthy diets, neither physical activity. Both clinical severity of the illness and marital status and cohabitation were associated with poor eating habits and nutrients deficit. These data should be taken into account by the nursing staff when implementing specific care in routine clinical practice.

Classification of patients with bipolar disorder using k-means clustering

Introduction

Bipolar disorder (BD) is a heterogeneous disorder needing personalized and shared decisions. We aimed to empirically develop a cluster-based classification that allocates patients according to their severity for helping clinicians in these processes.

Methods

Naturalistic, cross-sectional, multicenter study. We included 224 subjects with BD (DSM-IV-TR) under outpatient treatment from 4 sites in Spain. We obtained information on socio-demography, clinical course, psychopathology, cognition, functioning, vital signs, anthropometry and lab analysis. Statistical analysis: k-means clustering, comparisons of between-group variables, and expert criteria.

Results and discussion

We obtained 12 profilers from 5 life domains that classified patients in five clusters. The profilers were: Number of hospitalizations and of suicide attempts, comorbid personality disorder, body mass index, metabolic syndrome, the number of comorbid physical illnesses, cognitive functioning, being permanently disabled due to BD, global and leisure time functioning, and patients’ perception of their functioning and mental health. We obtained preliminary evidence on the construct validity of the classification: (1) all the profilers behaved correctly, significantly increasing in severity as the severity of the clusters increased, and (2) more severe clusters needed more complex pharmacological treatment.

Conclusions

We propose a new, easy-to-use, cluster-based severity classification for BD that may help clinicians in the processes of personalized medicine and shared decision-making.

Barriers to complete recovery of major depression: cross-sectional, multi-centre study on clinical practice. RECORD study

INTRODUCTION

To identify barriers to complete recovery in patients suffering from major depressive disorder.

METHODS

A total of 461 psychiatrists participated in a cross-sectional, non-randomised, qualitative and multi-centre study based on a survey. The study questionnaire included 42 ítems related to management, prevalence, patient profile, impact of residual symptoms, barriers to full recovery, and strategies to increase complete recovery.

RESULTS

Complete recovery was defined by 86% of participants as complete remission of symptoms plus functional recovery. A total of 83.4% of participants considered that sick leave usually lasted more than 4 months. Seventy-five percent stated that residual symptoms were the main reason for prolongation of sick leave, and 62% that between 26%-50% of patients complained of residual symptoms. Poor compliance with treatment was the most important barrier to complete recovery, followed by a lack of patient cooperation, late beginning of treatment, partial response to antidepressants, and low doses of antidepressant medication. In the case of partial response, 71.8% of participants chose to increase the dose of current treatment, and in the case of lack of response, 72.7% would switch to another antidepressant, and 22.8% would use the combination of two antidepressants, in which case 85.2% would choose agents with complementary mechanisms of action. Forty-nine percent of participants would recommend standard cognitive-behavioural psychotherapy for patients without complete response.

CONCLUSIONS

Some 50% of patients did not achieve complete remission, frequently related to persistence of residual symptoms. Achievement of complete recovery should be an essential objective.