Table 2 Battery of indicators for the quantitative evaluation of the impact of INDI model implementation on clinical processes and outcomes
Area of evaluation | Indicator | Description |
|---|---|---|
Diagnosis and evaluation | Diagnostic accuracy | The diagnosis of depression in the target population includes specifying the severity of the depressive episode (mild, moderate, severe, or currently in remission) as well as whether it is a single or recurrent episode. |
Diagnostic reliability | DSM-V criteria were used when making the diagnosis (MINI interview) | |
Baseline evaluation of severity | In the baseline assessment the severity of symptoms was examined with a validated scale (PHQ9) | |
Baseline evaluation of suicide risk | In the baseline assessment the risk of suicide was examined with a validated scale (MINI) | |
Treatment | Adequacy for mild depression | In mild major depression an antidepressant is not prescribed in the first eight weeks |
Adequacy for moderate or severe depression | In moderate or severe major depression treatment with antidepressants is initiated | |
Adequacy for anxiolytic treatment in depression | The prescription of an anxiolytic as the only form of treatment for depression is avoided (i.e., without an antidepressant) | |
Adherence to treatment, acute phase | 12 weeks after initiating treatment the prescription has not been interrupted | |
Adherence to treatment, continuation phase, relapse prevention | 6 months after initiating treatment the prescription has not been interrupted | |
Intensification of antidepressant treatment: switch | Proportion of new treatments in which the antidepressant is changed | |
Intensification of antidepressant treatment: augmentation | Proportion of new treatments in which an antidepressant and an atypical antipsychotic or lithium are concomitantly prescribed | |
Intensification of anti-depressant treatment: combination | Proportion of new treatments in which two antidepressants are prescribed simultaneously | |
Follow-up | Use of a validated scale | Number of times per patient in which a validated scale is used (PHQ9) in clinical follow-up |
Follow-up, after initiating treatment | The patient attends at least one follow-up visit in person in the month following the initiation of antidepressant treatment | |
Follow-up, acute phase | The patient attends at least three follow-up visits in the 12 weeks following the initiation of antidepressant treatment | |
Clinical outcomes | Evolution of the symptoms of depression | PHQ9 descriptive parameters of evolution |
Rate of response to treatment | Proportion of patients who show a reduction ≥50% in their baseline PHQ9 score at 6 and 12 months | |
Rate of remission | Proportion of patients with a PHQ9 score < 5 points at 6 and 12 months | |
Evolution of functional impact | The descriptive parameter of evolution of GAF scale | |
Evolution of suicide risk | Descriptive parameter of the evolution of suicide risk score measured with the MINI suicide risk scale | |
Epidemiological indicators | Prevalence | Proportion of patients diagnosed with major depression in the population served |
Incidence | New diagnoses of major depression in the population served (annually) | |
Rate of antidepressant treatment | Proportion of patients with major depression who receive antidepressant treatment |