Clinical validity of a population database definition of remission in patients with major depression.
BACKGROUND
Major depression (MD) is one of the most frequent diagnoses in Primary Care. It is a disabling illness that increases the use of health resources.


OBJECTIVE
To describe the concordance between remission according to clinical assessment and remission obtained from the computerized prescription databases of patients with MD in a Spanish population.


METHODS



METHODS
multicenter cross-sectional. The population under study was comprised of people from six primary care facilities, who had a MD episode between January 2003 and March 2007. A specialist in psychiatry assessed a random sample of patient histories and determined whether a certain patient was in remission according to clinical criteria (ICPC-2). Regarding the databases, patients were considered in remission when they did not need further prescriptions of AD for at least 6 months after completing treatment for a new episode. Validity indicators (sensitivity [S], specificity [Sp]) and clinical utility (positive and negative probability ratio [PPR] and [NPR]) were calculated. The concordance index was established using Cohen's kappa coefficient. Significance level was p < 0.05.


RESULTS
133 patient histories were reviewed. The kappa coefficient was 82.8% (confidence intervals [CI] were 95%: 73.1 - 92.6), PPR 9.8% and NPR 0.1%. Allocation discrepancies between both criteria were found in 11 patients. S was 92.5% (CI was 95%: 88.0 - 96.9%) and Sp was 90.6% (CI was 95%: 85.6 - 95.6%), p < 0.001. Reliability analysis: Cronbach's alpha: 90.6% (CI was 95%: 85.6 - 95.6%).


CONCLUSIONS
Results show an acceptable level of concordance between remission obtained from the computerized databases and clinical criteria. The major discrepancies were found in diagnostic accuracy.
Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain, Gaietà Soler, 6-8 entlo, 08911 Badalona, Barcelona, Spain. asicras@bsa.cat
Antoni
A
Sicras-Mainar
Milagrosa
M
Blanca-Tamayo
Laura
L
Gutiérrez-Nicuesa
Jordi
J
Salvatella-Pasant
Ruth
R
Navarro-Artieda
D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003865:Major Depressive Disorder / Q000145:classification* / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011320:Primary Health Care; D012074:Remission Induction; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D009626:Terminology as Topic