Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/25507
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dc.contributor.authorJohnson, Chris Fen_UK
dc.contributor.authorWilliams, Brianen_UK
dc.contributor.authorMacGillivray, Steveen_UK
dc.contributor.authorDougall, Nadineen_UK
dc.contributor.authorMaxwell, Margareten_UK
dc.date.accessioned2017-07-05T22:54:57Z-
dc.date.available2017-07-05T22:54:57Z-
dc.date.issued2017-06-17en_UK
dc.identifier.other72en_UK
dc.identifier.urihttp://hdl.handle.net/1893/25507-
dc.description.abstractBackground  Antidepressant prescribing continues to increase, with 5-16% of adults receiving antidepressants annually. Total prescribing growth is due in part to increased long-term use, greater selective serotonin re-uptake inhibitor (SSRI) use and the use of higher SSRI doses. Evidence does not support routine use of higher SSRI doses for depression treatment, and factors influencing the use of such doses are not well known. The aim of this study was to explore factors influencing GPs’ use of antidepressants and their doses to treat depression.  Methods  Semi-structured interviews with a purposive sample of 28 practising GPs; sampled by antidepressant prescribing volume, practice size and deprivation level. A topic guide drawing on past literature was used with enough flexibility to allow additional themes to emerge. Interviews were audio-recorded and transcribed verbatim. Framework analysis was employed. Constant comparison and disconfirmation were carried out across transcripts, with data collection being interspersed with analysis by three researchers. The thematic framework was then systematically applied to the data and conceptualised into an overarching explanatory model.  Results  Depression treatment involved ethical and professional imperatives of ‘doing the right thing’ for individuals by striving to achieve the ‘right care fit’. This involved medicalised and non-medicalised patient-centred approaches. Factors influencing antidepressant prescribing and doses varied over time from first presentation, to antidepressant initiation and longer-term treatment. When faced with distressed patients showing symptoms of moderate to severe depression GPs were confident prescribing SSRIs which they considered as safe and effective medicines, and ethically and professionally appropriate.  Many GPs were unaware that higher doses lacked greater efficacy and onset of action occurred within 1-2weeks, preferring to wait 8-12weeks before increasing or switching. Ongoing pressures to maintain prescribing (e.g. fear of depression recurrence), few perceived continuation problems (e.g. lack of safety concerns) and lack of proactive medication review (e.g. patients only present in crisis), all combine to further drive antidepressant prescribing growth over time.  Conclusions  GPs strive to ‘do the right thing’ to help people. Antidepressants are only a single facet of depression treatment. However, increased awareness of drug limitations and regular proactive reviews may help optimise care.en_UK
dc.language.isoenen_UK
dc.publisherBioMed Centralen_UK
dc.relationJohnson CF, Williams B, MacGillivray S, Dougall N & Maxwell M (2017) 'Doing the right thing': factors influencing GP prescribing of antidepressants and prescribed doses. <i>BMC Family Practice</i>, 18, Art. No.: 72. https://doi.org/10.1186/s12875-017-0643-zen_UK
dc.rights© The Author(s). 2017 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.en_UK
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_UK
dc.subjectGeneral practiceen_UK
dc.subjectPrimary health careen_UK
dc.subjectDepressionen_UK
dc.subjectAntidepressive agentsen_UK
dc.subjectDoctor-patient relationshipen_UK
dc.subjectQualitative researchen_UK
dc.title'Doing the right thing': factors influencing GP prescribing of antidepressants and prescribed dosesen_UK
dc.typeJournal Articleen_UK
dc.identifier.doi10.1186/s12875-017-0643-zen_UK
dc.identifier.pmid28623894en_UK
dc.citation.jtitleBMC Family Practiceen_UK
dc.citation.issn1471-2296en_UK
dc.citation.volume18en_UK
dc.citation.publicationstatusPublisheden_UK
dc.citation.peerreviewedRefereeden_UK
dc.type.statusVoR - Version of Recorden_UK
dc.citation.date17/06/2017en_UK
dc.contributor.affiliationFHSS Management and Supporten_UK
dc.contributor.affiliationEdinburgh Napier Universityen_UK
dc.contributor.affiliationUniversity of Dundeeen_UK
dc.contributor.affiliationEdinburgh Napier Universityen_UK
dc.contributor.affiliationNMAHPen_UK
dc.identifier.isiWOS:000403401800001en_UK
dc.identifier.scopusid2-s2.0-85027891180en_UK
dc.identifier.wtid526597en_UK
dc.contributor.orcid0000-0002-6006-6605en_UK
dc.contributor.orcid0000-0003-3318-9500en_UK
dc.date.accepted2017-06-05en_UK
dcterms.dateAccepted2017-06-05en_UK
dc.date.filedepositdate2017-06-19en_UK
rioxxterms.apcpaiden_UK
rioxxterms.typeJournal Article/Reviewen_UK
rioxxterms.versionVoRen_UK
local.rioxx.authorJohnson, Chris F|0000-0002-6006-6605en_UK
local.rioxx.authorWilliams, Brian|en_UK
local.rioxx.authorMacGillivray, Steve|en_UK
local.rioxx.authorDougall, Nadine|en_UK
local.rioxx.authorMaxwell, Margaret|0000-0003-3318-9500en_UK
local.rioxx.projectInternal Project|University of Stirling|https://isni.org/isni/0000000122484331en_UK
local.rioxx.freetoreaddate2017-06-19en_UK
local.rioxx.licencehttp://creativecommons.org/licenses/by/4.0/|2017-06-19|en_UK
local.rioxx.filenameJohnson_etal_BMCFamilyPractice_2017.pdfen_UK
local.rioxx.filecount1en_UK
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