Understanding the prescription of antidepressants: a Qualitative study among French GPs

BMC Family Practice, Sep 2011

Background One-tenth of France's population is prescribed at least one antidepressant, primarily by General Practitioners. The reasons for this high prescription rate remain unclear. One-third of these prescriptions may not comply with clinical practice guidelines, and 20% are potentially unrelated to any psychiatric condition. Our aim was to explore how GPs declare they use antidepressants in daily practice and understand their reasons for prescribing them. Method Six focus groups including a total of 56 rural and urban GPs, with four interviews were performed. The topic guide focused on reasons for prescribing antidepressants in various primary care situations. Phenomenological analysis was performed by four researchers. Results Antidepressants were seen as useful and not harmful. Personal assessment based on experience and feeling determined the GPs' decisions rather than the use of scales. Twenty-four "non-psychiatric" conditions possibly leading to prescription of antidepressants in primary care were found. Conclusions The GPs reported prescribing antidepressants for a wide range of conditions other than depression. The GPs' decision making process is difficult and complex. They seemed to prefer to focus on their difficulties in diagnosing depression rather than on useless overtreatment. Instead of using the guidelines criteria to detect potential cases of useful prescription, physicians tend to use their own tools based on gut feelings, knowledge of the patient and contextual issues.

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Understanding the prescription of antidepressants: a Qualitative study among French GPs

Alain Mercier 0 Isabelle Auger-Aubin 2 Jean-Pierre Lebeau 1 Paul Van Royen 4 Lieve Peremans 3 0 Department of General Practice, Rouen University and CIC Inserm 0204, Rouen University , Rouen , France 1 Department of General Practice, Tours University , Tours , France 2 Department of General Practice, Denis Diderot Paris 7 University , Paris , France 3 Department of Public Health, Vrije Universiteit of Brussels , Brussels , Belgium 4 Department of Primary and Interdisciplinary Care, Faculty of Medicine, University of Antwerp , Antwerp , Belgium Background: One-tenth of France's population is prescribed at least one antidepressant, primarily by General Practitioners. The reasons for this high prescription rate remain unclear. One-third of these prescriptions may not comply with clinical practice guidelines, and 20% are potentially unrelated to any psychiatric condition. Our aim was to explore how GPs declare they use antidepressants in daily practice and understand their reasons for prescribing them. Method: Six focus groups including a total of 56 rural and urban GPs, with four interviews were performed. The topic guide focused on reasons for prescribing antidepressants in various primary care situations. Phenomenological analysis was performed by four researchers. Results: Antidepressants were seen as useful and not harmful. Personal assessment based on experience and feeling determined the GPs' decisions rather than the use of scales. Twenty-four non-psychiatric conditions possibly leading to prescription of antidepressants in primary care were found. Conclusions: The GPs reported prescribing antidepressants for a wide range of conditions other than depression. The GPs' decision making process is difficult and complex. They seemed to prefer to focus on their difficulties in diagnosing depression rather than on useless overtreatment. Instead of using the guidelines criteria to detect potential cases of useful prescription, physicians tend to use their own tools based on gut feelings, knowledge of the patient and contextual issues. - Background According to the French health insurance system, approximately 10% of the countrys population is reimbursed for at least one antidepressant (AD) [1,2]. Between 1980 and 2008, AD sales increased sevenfold, from 84 million to 525 million [3]. Reports from the national insurance system and the European Commission have confirmed these trends [4,5]. Frances consumption of ADs ranks amongst the highest in the European Union [5]. They are mainly prescribed by General Practitioners (GPs) [6]. The reasons for this high prescription rate by French GPs remain unclear. According to the available data, this consumption is supposed to be related to a higher rate of depressed patients in France, an increase in the number of patients treated for depression, and higher demand for medical care [6,7]. Clinical practice guidelines in France officially recommend using an AD for major depressive episodes and for anxiety only when the condition has consequences on the patients life [8]. Dysthymia, isolated symptoms not fulfilling the DSM IV criteria, light or moderate episodes, or those lasting less than 15 days should not be treated by ADs. One-third of the prescriptions (30-35%) probably do not comply with these statements and 20% may not be related to any psychiatric evidence based on standardized questionnaires [9,10]. Furthermore, the data are not homogeneous: other studies have shown that in 85% of cases, the patients treated with GP-prescribed antidepressants met DSM-IV depression criteria [11]. The main indications for ADs are major depressive episodes and anxiety disorders. Other conditions, such as neuropathic pain, also result in prescription [12], but some indications remain controversial [13,14]. Similar trends have been noticed in other countries [15,16]. The aim of this study was to explore GPs viewpoints regarding their reasons for prescribing antidepressants and to determine what indications they reported using them for in daily practice. Methods Participant recruitment procedure Groups were chosen using a purposeful sampling method. This study population was drawn from two different sources. Firstly, four focus groups (FG) were held with GPs recruited from existing quality circles. These GPs already knew each other from previous professional training sessions based on the French peer group technique. In this technique one of the participants presents to the group of GPs a structured analysis of patient files with a specific medical condition (e.g. diabetes, medications for high blood pressure). The group analyses all of the issues, decisions or potential improvements to the care of the patient and provides feedback to the participant presenting the case. The dynamic interaction amongst these group members enabled us to collect reliable data on their actual practices. Secondly, we organized two focus groups with locum GPs. Locum physicians could have a different, m (...truncated)


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Alain Mercier, Isabelle Auger-Aubin, Jean-Pierre Lebeau, Paul Royen, Lieve Peremans. Understanding the prescription of antidepressants: a Qualitative study among French GPs, BMC Family Practice, 2011, pp. 99, 12, DOI: 10.1186/1471-2296-12-99