The evaluation of health care quality from the patient withdepression perspective: a qualitative study

Ms Analía Abt Sacks1,2, PhD Lina Masana3,4, Ms Martín Romero3, PhD Pedro Serrano-Pérez 3,5, PhD Jorge Barraca6, PhD Lilisbeth, Perestelo-Pérez2,3

BACKGROUNDAlthough depression is one of the most important mental disorders, a large number of patients are under diagnosed or not treated properly. Among the reasons justifying this fact are the difficulties presented by non- psychiatrists professionals to recognize the problem, the shortage of mental health professionals and problems with the operation of the therapeutic itinerary.

DISCUSSIONThe review of patients allows us to identify deficiencies in the public health system that can be improved. Qualitative analysis allows us to conclude that the need for an attention centered in the person and the time available are the two main deficiencies perceived by patients in both specialized and primary care attention.

AIMThe aim of this study is to analyze the perception and evaluation of the care provided during the illness, as experienced by patients with a diagnosis of depressive disorder in Spain.

METHODS AND MATERIAL

RESULTSNeed and deficieny in the Health Service:

• Therapeutic itinenary: the shortage of mental health (MH) professionals, problems with derivation to MH devices (psychologist or psychiatrist), excessive delay to start medical monitoring or between meetings, the high cost of private care and the entry in emergency as option of care, specially in critical situations.

• Humans resources: The need for more specialized training for general practitioners, the absence generally of psychologists in the primary care and the MH services, differences in urban and rural services.

• Quality care: prevalence of pharmacotherapy versus psychotherapy, litle information about the disease, the short time for consultation, the overload working professionals and sudden personnel changes, and care received.

IMPLICATIONSThe multidisciplinary approach to patients with depression, in which the care of the patient is handled by different specialists (psychologists, psychiatrists, general practitioners), the implementation of a shared decision making model, along with the use of patient decision aids (PDAs) could all be efficient and effective strategies to favour patient centered care as well as to improve the relationship between professionals and patients.

REFERENCES•Codony, M, Alonso, J, Almansa, J, Bernert, S et al. Perceived neeed for Mental Health Care and Service Use among adults in Western Europe: Results of the ESEMeD Project. Psychiatric Services. 2009; 60 (8):1051- 58.•Fernández, A, Haro, JM, Codony, M, Gemma Vilagut et al. Treatment adequacy of anxiety and depressive disorders: Primary versus specialised care in Spain. Journal of Affective Disorders. 2006; 96: 9-20.•NICE, 2010). Ref. NICE – National Institute for Clinical Excellence (2010). Depression: Management of Depression in Primary and Secondary Care — NICE Guidance. London, UK: The British Psychology Society & The Royal College of Psychiatrists.•Prins, M; Verhaak; P; Bensing, J; van der Meer, K. Health beliefs and perceived need for mental health care of anxiety and depression—The patients' perspective explored. Clinical Psychology Review. 2008; 28:1038–1058.

A qualitative study based on asemi-structures

interview

Sample:24 patients

with unipolardepression

Patients livedin 8 differentautonomouscommunities

Diagnosedby a health

professional

Age:24-68

years old

1 Canarian Foundation of Health and Research (FUNCIS), Tenerife, Spain | 2 Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain | 3 Evaluation Unit of the Canary Islands Health Service, Tenerife, Spain | 4 Universitat Rovira i Virgili, Tarragona, Spain | 5 University Hospital La Princesa, Madrid, Spain | 6 University Camilo Jose Cela, Madrid, Spain