Manejo en atención primaria de un primer episodio depresivo. Uso de antidepresivos y derivaciones / Management of a first depressive episode in the primary care setting. Use of antidepressants and referrals

Introducción. La mayor parte de los pacientes que comienzan con un primer episodio depresivo son tratados por médicos de atención primaria. El objetivo de este trabajo ha sido evaluar la utilización de antidepresivos y derivaciones a salud mental y las modificaciones del tratamiento que realiza el psiquiatra. Material y métodos. Analizamos de forma retrospectiva 64 cupos médicos de atención primaria, distribuidos en cinco provincias españolas. Se estudiaron los datos de la historia clínica en cuanto a utilización de antidepresivos, criterios de derivación y respuesta de atención especializada. Periodo de estudio desde junio 2008 a junio 2011. Resultados. Se incluyeron en el estudio 324 pacientes. El fármaco más prescrito fue escitalopram, siendo los ISRS el 73,5% del total. Un 69,7% de pacientes mantienen el tratamiento durante al menos 6 meses, no existiendo en un 40,4% una causa registrada del abandono. La mayoría de los profesionales espera al menos 3 semanas para modificar la medicación (76,9%), siendo la primera opción cambiar de antidepresivo. Se derivó a psiquiatría un 39,2% de los pacientes, aunque en gran parte de dichas derivaciones (43,9%) no hallamos justificación. Escasa derivación a psicología (23,1%). Gran número de pacientes polimedicados a los que se añade antidepresivo, sin tener en cuenta el riesgo de interacciones en un alto porcentaje. Conclusiones. El médico de atención primaria utiliza de manera adecuada los antidepresivos de primera elección, pero descuida los riesgos en pacientes complejos. Debemos insistir más en que la duración del tratamiento sea la adecuada y mejorar los criterios de derivación a salud mental (AU)

Introduction. The majority of patients who have a first depressive episode are treated by Primary Care physicians. The aim of this study was to evaluate the use of antidepressants and referrals to mental health and the treatment modifications made by psychiatrists. Material and methods. A descriptive, retrospective study was conducted on patients from 64 Primary Care clinics, distributed in five Spanish provinces. The clinical history data, regarding use of antidepressants, criteria for referral, and response of psychiatric services were evaluated from June 2008 to June 2011. Results. The study included 324 patients. The most commonly prescribed medication was escitalopram, with selective serotonin reuptake inhibitors (SSRI) making up 73.5% of the total. More than two-thirds (69.7%) of the patients were on treatment for at least 6 months, with no reason recorded for the 40.4% drop-outs. A large majority of professionals (76.9%) wait at least 3 weeks before modifying the medication, especially changing antidepressant. The Primary Care physicians referred 39.2% of patients to psychiatry, although much of these referrals (43.9%) had no justification. There was a lower referral rate to psychology (23.1%). An antidepressant was given to a large number of patients on multiple medications, without taking into account the risk of interactions in a high percentage. Conclusions. The Primary Care physician appropriately uses the antidepressants of the first choice, but does not pay attention to the risks in complex patients. There must be an appropriate duration of treatment and an improvement of the criteria for referral to mental health services (AU)

[Management of a first depressive episode in the primary care setting. Use of antidepressants and referrals]. / Manejo en atención primaria de un primer episodio depresivo. Uso de antidepresivos y derivaciones.

INTRODUCTION: The majority of patients who have a first depressive episode are treated by Primary Care physicians. The aim of this study was to evaluate the use of antidepressants and referrals to mental health and the treatment modifications made by psychiatrists. MATERIAL AND METHODS: A descriptive, retrospective study was conducted on patients from 64 Primary Care clinics, distributed in five Spanish provinces. The clinical history data, regarding use of antidepressants, criteria for referral, and response of psychiatric services were evaluated from June 2008 to June 2011. RESULTS: The study included 324 patients. The most commonly prescribed medication was escitalopram, with selective serotonin reuptake inhibitors (SSRI) making up 73.5% of the total. More than two-thirds (69.7%) of the patients were on treatment for at least 6 months, with no reason recorded for the 40.4% drop-outs. A large majority of professionals (76.9%) wait at least 3 weeks before modifying the medication, especially changing antidepressant. The Primary Care physicians referred 39.2% of patients to psychiatry, although much of these referrals (43.9%) had no justification. There was a lower referral rate to psychology (23.1%). An antidepressant was given to a large number of patients on multiple medications, without taking into account the risk of interactions in a high percentage. CONCLUSIONS: The Primary Care physician appropriately uses the antidepressants of the first choice, but does not pay attention to the risks in complex patients. There must be an appropriate duration of treatment and an improvement of the criteria for referral to mental health services.

Análisis de las derivaciones hospitalarias desde un servicio de urgencias de Atención Primaria durante un año / Study of hospital referrals from a Primary Health Care emergency service during one year

OBJETIVOS. Analizar a los pacientes atendidos y derivados al hospital de referencia por un servicio de urgencias extrahospitalarias (SUE), a fin de conocer el perfil y las características, así como la calidad de los informes, para intentar optimizar este proceso y producir una mejora de la calidad del servicio. MATERIAL Y MÉTODOS. Estudio observacional descriptivo transversal retrospectivo de todas las asistencias atendidas y derivadas al hospital de referencia por el SUE de Campoo durante el año 2002. Se recogieron variables sociodemográficas, asistenciales y de la calidad del informe. Para la estadística descriptiva se usó la media y la desviación estándar para las variables cuantitativas y porcentajes para las cualitativas; para la comparación de dos medias se ha utilizado la prueba de la t de Student para comparar muestras independientes y la Chi cuadrado para variables cualitativas. RESULTADOS. Se derivaron 707 pacientes, con media de edad de 53,9 años y predominio masculino. La causa más frecuente de derivación fueron las fracturas óseas y por código CIPSAP-2 los traumatismos y envenenamientos (XVII); la mayor derivación se produce por las tardes; no suele requerirse medicación; la calidad del volante fue mayoritariamente buena. CONCLUSIONES. El nivel de resolución del servicio fue del 94%; la principal causa de derivación es traumatológica, por lo que facilitar el acceso a pruebas diagnósticas y terapéuticas a nivel del servicio de urgencias hospitalarias, mejorar la formación y capacitación del personal sanitario y la realización de protocolos de derivación pueden optimizar y reducir las derivaciones hospitalarias. La calidad del volante en general puede considerarse buena

OBJECTIVES. To analyze the patients seen and referred to the reference hospital by an out-patient emergency service in order to know their profile and characteristics as well as the quality of the information, to optimize this process and to produce an improvement in the quality of service. MATERIAL AND METHODS. Retrospective cross-sectional descriptive observational study of all the patients seen and referred to the reference hospital by the emergency service of Campoo during year 2002. Sociodemographic, care and report quality variables were collected. For the descriptive statistics, the mean and standard deviation for the quantitative variables and percentages for the qualitative ones were used. The Student's t test for independent samples was used for the comparison of two means and the chi-square for qualitative variables. RESULTS. A total of 707 patients, average age of 53.9 years and masculine predominance, were referred. The most frequent cause of referral was bone fractures and by code CIPSAP-2, traumatisms and poisoning (XVII). Most of the referrals occurred in the afternoon. Medication is usually not required and the quality of the clinical report was mostly good. CONCLUSIONS. The level of resolution of the service was 94% and the main cause of referral is traumatological. Therefore facilitating access to tests of diagnose and therapeutic at level of the out-patient emergency service, improving the formation and qualification of the sanitary staff and making referral protocols can optimize and reduce hospitable referrals. The quality of the referral report can be considered good