title: Delivery of electroconvulsive therapy in Canada: a first national survey report on usage, treatment practice, and facilities.
abstract: OBJECTIVE
  The aims of this study were to document electroconvulsive therapy use in Canada with respect to treatment facilities and caseloads based on a survey of practice (Canadian Electroconvulsive Therapy Survey/Enquete Canadienne Sur Les Electrochocs-CANECTS/ECANEC) and to consider these findings in the context of guideline recommendations.
  
  
  METHODS
  All 1273 registered hospitals in Canada were contacted, and 175 sites were identified as providing electroconvulsive therapy; these sites were invited to complete a comprehensive questionnaire. The survey period was calendar year 2006 or fiscal year 2006/2007. National usage rates were estimated from the responses.
  
  
  RESULTS
  Sixty-one percent of the sites completed the questionnaire; a further 10% provided caseload data. Seventy were identified as general; 31, as university teaching; and 21, as provincial psychiatric/other single specialty (psychiatric) hospitals. Caseload volumes ranged from a mean of fewer than 2 to greater than 30 treatments per week. Estimated national usage during the 1-year survey period was 7340 to 8083 patients (2.32-2.56 per 10,000 population) and 66,791 to 67,424 treatments (2.11-2.13 per 1000 population). The diagnostic indications, admission status, and protocols for course end points are described.
  
  
  CONCLUSIONS
  The usage rates are in keeping with earlier Canadian data and with those from other jurisdictions. The difficulty obtaining caseload data from individual hospitals is indicative of the need for standardized data collection to support both clinical research and quality assurance. The wide variation in protocols for number of treatments per course indicates a need for better informed clinical guidelines. The broad range of caseload volumes suggests the need to review the economies of scale in the field.
authors.affiliation: From the *Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; †Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Departments of ‡Psychology and §Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; ∥Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; ¶Department of Anaesthesiology & Perioperative Medicine and Biomedical Molecular Sciences, Queen's University, Kingston, Ontario, Canada; #Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada; **Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; and ††Laval University, Quebec City, Quebec, Canada.
authors.forename: Barry A
authors.initials: BA
authors.lastname: Martin
authors.forename: Nicholas John
authors.initials: NJ
authors.lastname: Delva
authors.forename: Peter
authors.initials: P
authors.lastname: Graf
authors.forename: Caroline
authors.initials: C
authors.lastname: Gosselin
authors.forename: Murray W
authors.initials: MW
authors.lastname: Enns
authors.forename: Ian
authors.initials: I
authors.lastname: Gilron
authors.forename: Mark
authors.initials: M
authors.lastname: Jewell
authors.forename: James Stuart
authors.initials: JS
authors.lastname: Lawson
authors.forename: Roumen
authors.initials: R
authors.lastname: Milev
authors.forename: Simon
authors.initials: S
authors.lastname: Patry
authors.forename: Peter K Y
authors.initials: PK
authors.lastname: Chan
mesh_terms: D002170:Canada; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups; D004565:Electroconvulsive Therapy / Q000379:methods* / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006761:Hospitals / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy; D011795:Surveys and Questionnaires