Beatriz González de León

Background: Multimorbidity is associated with higher mortality rates, reduced functional capacity, and lower health‐related quality of life (HRQoL). Multidisciplinary transitional care interventions (TCIs) provided after hospital discharge have the potential to improve HRQoL and patient satisfaction. Methods: A systematic review was conducted, inception to October 2023, focusing on randomized clinical trials retrieved from MEDLINE, Embase, CENTRAL, CINAHL, and PsycINFO. The primary outcome measures were HRQoL and patient satisfaction. Secondary outcomes included mortality, adverse events, activities of daily living, adherence, hospitalizations, length of stay, emergency department visits, specialist and primary care visits, social support, mood, and caregiver burden. Risk of bias was assessed using the Cochrane RoB‐2 tool, and the overall quality of evidence was evaluated with GRADE. When possible, a meta‐analysis was conducted using Stata 17. Results: A total of 21 studies ( N = 5790) were included. The data suggest that TCIs may lead to small improvements in short‐term HRQoL (1 month: MD = 0.22; 95% CI: 0.19–0.42), although this effect diminishes by 3 months. No evidence was found for patient satisfaction. TCIs likely do not reduce mortality or hospitalization rates but may result in a slight reduction in depression (SMD = −0.27; 95% CI: −0.47 to −0.06). Evidence on other outcomes is limited, with no significant differences observed in adverse events or adherence. Conclusion: Overall, TCIs have a limited impact on mortality or hospitalization rates and may offer short‐term improvements in HRQoL and depression, while evidence for patient satisfaction and other outcomes remains limited and their long‐term effects remain uncertain.

Introduction: Psychotropic polypharmacy typically refers to the prescription of more than one psychotropic medication to a patient. While polypharmacy can sometimes be clinically justified, it is widely recognized that multiple drug use and exposure can be problematic. The aim of this article is to analyze polypharmacy experienced by patients with depressive disorders, estimating its incidence during the first year after diagnosis and exploring the sociodemographic, clinical, and health‐related lifestyle factors related to psychotropic polypharmacy. Methods: A retrospective population‐based cohort study was conducted among adults (aged 18 and over) within the Canary Islands Health Service. The study analyzed routine health record data from patients diagnosed with depressive disorders who received antidepressant treatment between 2013 and 2022. Psychotropic polypharmacy refers to the concurrent use of two or more psychotropic medications by the same patient. To explore the relationship with sociodemographic, clinical, and lifestyle characteristics, multivariate logistic regression analyses were conducted. Results: The study included a total of 39,800 participants, with a polypharmacy incidence of 86.28%. Most patients (48.10%) received three or more medications ( N = 19,145). Factors associated with polypharmacy included the 45–64 age group (OR: 1.21), previous depressive episodes (OR: 1.15), number of comorbidities (OR: 1.11), and male gender (OR: 0.83). Conclusion: The results highlight the complexity of psychotropic polypharmacy, especially in patients with previous episodes and comorbidities. While the use of multiple medications may be necessary, it is critical to periodically review treatments to ensure their safety, especially in vulnerable populations. New prescription trends suggest a shift toward more rational approaches, although further research is required to support clinical guidelines.

This study examines the experiences and expectations of patients with depressive disorders regarding the disease and different antidepressants, as well as examining the barriers and facilitating factors that could affect their adherence to medications. An exploratory qualitative study was carried out. The study involved two focus groups made up of patients and caregivers and six semi-structured interviews with psychiatrists. In both cases, the participants were selected by intentional theoretical sampling, seeking maximum significance variation of social types. Prejudice about the side effects of medication was relevant. The importance of patients being well informed about the disease/treatments was noteworthy. The stigmatization of antidepressants by patients was identified as a barrier to medication adherence. The involvement of family members and the motivation of patients to be actively involved in the process to recover from the disease were identified as facilitating factors. The work carried out suggests the need for patients to have rigorous information about the disease/treatment to reduce the possible prejudices generated by beliefs. Maintaining greater contact and monitoring of patients/caregivers to help therapeutic adherence in patients with depressive disorders was also identified as being of great importance.