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Trends and variation in antidepressant prescribing in English primary care: a retrospective longitudinal study

BACKGROUND: Antidepressants are commonly prescribed. There are clear national guidelines in relation to treatment sequencing. This study examines trends and variation in antidepressant prescribing across English primary care. AIM: To examine trends and variation in antidepressant prescribing in Engl...

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Autores principales: Bogowicz, Paul, Curtis, Helen J, Walker, Alex J, Cowen, Philip, Geddes, John, Goldacre, Ben
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450889/
https://www.ncbi.nlm.nih.gov/pubmed/33985965
http://dx.doi.org/10.3399/BJGPO.2021.0020
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author Bogowicz, Paul
Curtis, Helen J
Walker, Alex J
Cowen, Philip
Geddes, John
Goldacre, Ben
author_facet Bogowicz, Paul
Curtis, Helen J
Walker, Alex J
Cowen, Philip
Geddes, John
Goldacre, Ben
author_sort Bogowicz, Paul
collection PubMed
description BACKGROUND: Antidepressants are commonly prescribed. There are clear national guidelines in relation to treatment sequencing. This study examines trends and variation in antidepressant prescribing across English primary care. AIM: To examine trends and variation in antidepressant prescribing in England, with a focus on: monoamine oxidase inhibitors (MAOIs); paroxetine; and dosulepin and trimipramine. DESIGN & SETTING: Retrospective longitudinal study using national and practice-level data on antidepressant items prescribed per year (1998–2018) and per month (2010–2019). METHOD: Class- and drug-specific proportions were calculated at national and practice levels. Descriptive statistics were generated, percentile charts and maps were plotted, and logistic regression analysis was conducted. RESULTS: Antidepressant prescriptions more than tripled between 1998 and 2018, from 377 items per 1000 population to 1266 per 1000. MAOI prescribing fell substantially, from 0.7% of all antidepressant items in 1998 to 0.1% in 2018. There was marked variation between practices in past year prescribing of paroxetine (median practice proportion [MPP] = 1.7%, interdecile range [IDR] = 2.6%) and dosulepin (MPP = 0.7%, IDR = 1.8%), but less for trimipramine (MPP = 0%, IDR = 0.2%). CONCLUSION: Rapid growth and substantial variation in antidepressant prescribing behaviour was found between practices. The causes could be explored using mixed-methods research. Interventions to reduce prescribing of specific antidepressants, such as dosulepin, could include review prompts, alerts at the time of prescribing, and clinician feedback through tools like OpenPrescribing.net.
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spelling pubmed-84508892021-10-06 Trends and variation in antidepressant prescribing in English primary care: a retrospective longitudinal study Bogowicz, Paul Curtis, Helen J Walker, Alex J Cowen, Philip Geddes, John Goldacre, Ben BJGP Open Research BACKGROUND: Antidepressants are commonly prescribed. There are clear national guidelines in relation to treatment sequencing. This study examines trends and variation in antidepressant prescribing across English primary care. AIM: To examine trends and variation in antidepressant prescribing in England, with a focus on: monoamine oxidase inhibitors (MAOIs); paroxetine; and dosulepin and trimipramine. DESIGN & SETTING: Retrospective longitudinal study using national and practice-level data on antidepressant items prescribed per year (1998–2018) and per month (2010–2019). METHOD: Class- and drug-specific proportions were calculated at national and practice levels. Descriptive statistics were generated, percentile charts and maps were plotted, and logistic regression analysis was conducted. RESULTS: Antidepressant prescriptions more than tripled between 1998 and 2018, from 377 items per 1000 population to 1266 per 1000. MAOI prescribing fell substantially, from 0.7% of all antidepressant items in 1998 to 0.1% in 2018. There was marked variation between practices in past year prescribing of paroxetine (median practice proportion [MPP] = 1.7%, interdecile range [IDR] = 2.6%) and dosulepin (MPP = 0.7%, IDR = 1.8%), but less for trimipramine (MPP = 0%, IDR = 0.2%). CONCLUSION: Rapid growth and substantial variation in antidepressant prescribing behaviour was found between practices. The causes could be explored using mixed-methods research. Interventions to reduce prescribing of specific antidepressants, such as dosulepin, could include review prompts, alerts at the time of prescribing, and clinician feedback through tools like OpenPrescribing.net. Royal College of General Practitioners 2021-06-30 /pmc/articles/PMC8450889/ /pubmed/33985965 http://dx.doi.org/10.3399/BJGPO.2021.0020 Text en Copyright © 2021, The Authors https://creativecommons.org/licenses/by/4.0/This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)
spellingShingle Research
Bogowicz, Paul
Curtis, Helen J
Walker, Alex J
Cowen, Philip
Geddes, John
Goldacre, Ben
Trends and variation in antidepressant prescribing in English primary care: a retrospective longitudinal study
title Trends and variation in antidepressant prescribing in English primary care: a retrospective longitudinal study
title_full Trends and variation in antidepressant prescribing in English primary care: a retrospective longitudinal study
title_fullStr Trends and variation in antidepressant prescribing in English primary care: a retrospective longitudinal study
title_full_unstemmed Trends and variation in antidepressant prescribing in English primary care: a retrospective longitudinal study
title_short Trends and variation in antidepressant prescribing in English primary care: a retrospective longitudinal study
title_sort trends and variation in antidepressant prescribing in english primary care: a retrospective longitudinal study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450889/
https://www.ncbi.nlm.nih.gov/pubmed/33985965
http://dx.doi.org/10.3399/BJGPO.2021.0020
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