[Implementation and evaluation of case management in Catalonia: the ISP-SMD program]. / La implementación y evaluación del modelo de gestión de casos (case management) en Cataluña: el programa PSI-TMS.

INTRODUCTION: The pilot study of the Individualized Service Program for people with Severe Mental Disorders (ISP-SMD) consists of the implementation of case management services in Catalonia. METHODOLOGY: The ISP-SMD has been implemented in two health care sectors and will be expanded to the rest of Catalonia in the next years. The program serves people with persistent mental disorders who have serious social or family problems and/or who have inadequate mental health service use (high use of inpatient services, no use of community services). The ISP-SMD is a community intervention program that focuses its activities on direct care and coordination between services. Thirty patients have been included in the evaluation. RESULTS: The results of the pilot study have shown that, compared to the year before entering the program, the patients show better clinical status, they decrease their unmet need level, they have more appropriate use of health services and have lower treatment costs. Satisfaction of the patients, family members and professionals with the program is very high. CONCLUSION: It is possible to adapt and implement case management services in Catalonia. When implemented, they improve patient quality of life.

[Prevalence and detection of depressive disorders in primary care]. / Prevalencia y detección de los trastornos depresivos en atención primaria.

AIM: To study the prevalence of depression in primary care, the detection of depressive disorders by primary care physicians, and the factors that influence detection. DESIGN: Cross-sectional, descriptive study. SETTING: Gavà II Primary Care Center, in Barcelona, Spain. PARTICIPANTS: A total of 400 people between the ages of 18 and 65 years were chosen randomly from among those who attended appointments with their primary care physician. MAIN MEASURES: A sociodemographic questionnaire and the Beck Depression Inventory (BDI) screening test were administered, and the participant s medical record was reviewed. In a subsample of 40 participants, the Mini-International Neuropsychiatric Interview (MINI) was also administered. The optimum cutoff score for the BDI was estimated with reference to the MINI results. RESULTS: A cutoff score of 20/21 for the BDI had a sensitivity of 86.7% and a specificity of 92%, when the MINI score was used as a reference. The adjusted prevalence of depressive disorder in our primary care setting was 20.2% overall, 8.1% in men, and 26.8% in women (odds ratio 4.15, p < 0.01). The physician detected depressive symptoms in 55.7% of all likely cases of depression. Persons who scored >= 21 on the BDI made more visits to their primary care physician, and had more stressful life events, than those who scored 20. CONCLUSIONS: The prevalence of depression in our primary care setting is high. The disorder was underdiagnosed in as many as 44.3% of the persons likely to have depressive disorder (especially women, widows and widowers, retired persons, persons who had experienced stressful life events, and frequent users of primary care services).