DataSheet1_Concordance of the treatment patterns for major depressive disorders between the Canadian Network for Mood and Anxiety Treatments (CANMAT) algorithm and real-world practice in China.docx

Background: Antidepressant (AD) algorithm is an important tool to support treatment decision-making and improve management of major depressive disorder (MDD). However, little is known about its concordance with real-world practice. This study aimed to assess the concordance between the longitudinal treatment patterns and AD algorithm recommended by a clinical practice guideline in China.Methods: Data were obtained from the electronic medical records of Shanghai Mental Health Center (SMHC), one of the largest mental health institutions in China. We examined the concordance between clinical practice and the Canadian Network for Mood and Anxiety Treatments (CANMAT) algorithm among a cohort composed of 19,955 MDD patients. The longitudinal characteristics of treatment regimen and duration were described to identify the specific inconsistencies. Demographics and health utilizations of the algorithm-concordant and -discordant subgroups with optimized treatment were measured separately.Results: The overall proportion of algorithm-concordant treatment significantly increased from 84.45% to 86.03% during the year of 2015–2017. Among the patients who received recommended first-line drugs with subsequent optimized treatment (n = 2977), the concordance proportion was 27.24%. Mirtazapine and trazodone were the most used drugs for adjunctive strategy. Inadequate or extended duration before optimized treatment are common inconsistency. The median length of follow-up for algorithm-concordant (n = 811) and algorithm-discordant patients (n = 2166) were 153 days (Q1-Q3 = 79–328) and 368 days (Q1-Q3 = 181–577) respectively, and the average number of clinical visits per person-year was 13.07 and 13.08 respectively.Conclusion: Gap existed between clinical practice and AD algorithm. Improved access to evidence-based treatment is required, especially for optimized strategies during outpatient follow-up.

背景：抗抑郁药（AD）算法是支持治疗决策和改善重度抑郁症（MDD）管理的重要工具。然而，关于其与实际临床实践的吻合度知之甚少。本研究旨在评估中国临床实践指南推荐的纵向治疗方案与AD算法之间的吻合度。方法：数据来源于中国最大的心理健康机构之一——上海精神卫生中心（SMHC）的电子病历。我们研究了临床实践与加拿大情绪焦虑治疗网络（CANMAT）算法在由19,955名MDD患者组成的队列中的吻合度。描述了治疗方案和持续时间的纵向特征，以识别具体的差异。分别测量了算法吻合度和不吻合的优化治疗方案亚组的人口统计学和医疗利用情况。结果：2015-2017年间，算法吻合度治疗方案的整体比例显著从84.45%增加到86.03%。在接受了推荐的一线药物并随后进行优化治疗的患者中（n = 2977），吻合度比例为27.24%。米氮平（Mirtazapine）和曲唑酮（Trazodone）是辅助策略中最常用的药物。在优化治疗之前的不充分或延长持续时间是常见的差异。算法吻合度（n = 811）和不吻合的患者（n = 2166）的中位随访时间为153天（Q1-Q3 = 79–328），平均每人每年的临床访问次数分别为13.07和13.08。结论：临床实践与AD算法之间存在差距。需要提高基于证据的治疗的可及性，尤其是在门诊随访期间的优化策略。