Did NICE guidelines and the Quality Outcomes Framework change GP antidepressant prescribing in England? Observational study with time trend analyses 2003–2013

Kendrick, Tony; Stuart, Beth; Newell, Colin; Geraghty, Adam W A; Moore, Michael

doi:10.1016/j.jad.2015.06.052

Cited by 56 publications

(58 citation statements)

References 23 publications

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“…In keeping with previous research (Kendrick et al 2015 a ), no significant trend over time was found in recording of depression diagnosis or symptoms when analysing quarterly time points in the 24 months either side of the 2006 QOF performance indicators for depression or in relation to the 2008 recession in 15- to 18-year-olds. Similarly the non-significant increasing trend in incident antidepressant prescriptions seen following the issue of 2004 and 2005 NICE guidance is in keeping with previous research (Kendrick et al 2015 b ) where no significant change was found in both recurrent and overall episodes of depression treated with antidepressants related to NICE guidance. The positive results reported in this study refer to the number of incident episodes of depression treated following the issue of the guidance.…”

Section: Discussionsupporting

confidence: 89%

“…Quarterly rates were calculated using person-quarters at risk as a denominator, in keeping with previous research of this type (Kendrick et al 2015 b ). An interrupted time-series analysis was undertaken to assess the significance of changes based on quarterly data using segmented regression (Wagner et al 2002).…”

Section: Methodsmentioning

confidence: 99%

“…An interrupted time-series analysis was undertaken to assess the significance of changes based on quarterly data using segmented regression (Wagner et al 2002). This analysis divides the time series into two periods before and after a given event to assess whether there was a significant step change or change in slope of the line following an event (futher details are available in Kendrick et al 2015 b ). An autoregressive, integrated moving-average time-series model was implemented accounting for autocorrelation.…”

Section: Methodsmentioning

confidence: 99%

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Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study

et al. 2016

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BackgroundConcerns relating to increased use of psychotropic medication contrast with those of under-treatment and under-recognition of common mental disorders in children and young people (CYP) across developed countries. Little is known about the indications recorded for antidepressant prescribing in primary care in CYP.MethodThis was an electronic cohort study of routinely collected primary-care data from a population of 1.9 million, Wales, UK. Poisson regression was undertaken to model adjusted counts of recorded depression symptoms, diagnoses and antidepressant prescriptions. Associated indications were explored.Results3 58 383 registered patients aged 6–18 years between 1 January 2003 and 31 December 2013 provided a total of 19 20 338 person-years of follow-up. The adjusted incidence of antidepressant prescribing increased significantly [incidence rate ratio (IRR) for 2013 = 1.28], mainly in older adolescents. The majority of new antidepressant prescriptions were for citalopram. Recorded depression diagnoses showed a steady decline (IRR = 0.72) while depression symptoms (IRR = 2.41) increased. Just over half of new antidepressant prescriptions were associated with depression (diagnosis or symptoms). Other antidepressant prescribing, largely unlicensed, was associated with diagnoses such as anxiety and pain.ConclusionAntidepressant prescribing is increasing in CYP while recorded depression diagnoses decline. Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose. Unlicensed antidepressant prescribing is associated with a wide range of diagnoses, and while accepted practice, is often not supported by safety and efficacy studies. New strategies to implement current guidance for the management of depression in CYP are required.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study

et al. 2016

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“…Local stakeholders (patient, family, physician, and consultant) and global stakeholders (industry, regulators, academics, and the public) interact in complex ways (social media, literature, lay press, guidelines, advertising, formularies, package inserts, and direct interaction) to generate choices based on a variety of inputs (indication, feasibility, preference, and cost) (11)(12)(13)(14)(15)(16). Because of this complexity, actual practice can be characterized only empirically, answering questions such as what treatment choices are being made in clinical practice, how many patients experience which combination of therapies, and how patterns may change over time or across different locations and practice types.…”

mentioning

confidence: 99%

Characterizing treatment pathways at scale using the OHDSI network

Hripcsak

Ryan

Duke

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

285

222

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Observational research promises to complement experimental research by providing large, diverse populations that would be infeasible for an experiment. Observational research can test its own clinical hypotheses, and observational studies also can contribute to the design of experiments and inform the generalizability of experimental research. Understanding the diversity of populations and the variance in care is one component. In this study, the Observational Health Data Sciences and Informatics (OHDSI) collaboration created an international data network with 11 data sources from four countries, including electronic health records and administrative claims data on 250 million patients. All data were mapped to common data standards, patient privacy was maintained by using a distributed model, and results were aggregated centrally. Treatment pathways were elucidated for type 2 diabetes mellitus, hypertension, and depression. The pathways revealed that the world is moving toward more consistent therapy over time across diseases and across locations, but significant heterogeneity remains among sources, pointing to challenges in generalizing clinical trial results. Diabetes favored a single first-line medication, metformin, to a much greater extent than hypertension or depression. About 10% of diabetes and depression patients and almost 25% of hypertension patients followed a treatment pathway that was unique within the cohort. Aside from factors such as sample size and underlying population (academic medical center versus general population), electronic health records data and administrative claims data revealed similar results. Large-scale international observational research is feasible.observational research | data network | treatment pathways A learning health system (1) must systematically evaluate the effects of medical interventions to enable evidence-based medical decision-making. Randomized clinical trials serve as the cornerstone for causal evidence about medical products (2, 3), but evidence from these trials may be limited by an insufficient number of persons exposed, insufficient length of exposure, and inadequate coverage of the target population, factors that limit external generalizability. Observational studies can contribute to the larger goal of causal inference at three stages: (i) the design of experiments, such as determining what are the current therapies that should be compared with a new therapy; (ii) the direct testing of clinical hypotheses on observational data (4-8) using methods to correct for nonrandom treatment assignment as part of the effect estimation process; and (iii) better understanding of population characteristics to improve the extrapolation of both observational and experimental results to new groups.Without sufficiently broad databases available in the first stage, randomized trials are designed without explicit knowledge of actual disease status and treatment practice. Literature reviews are restricted to the population choices of previous investigations, and pilot studi...

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“…1,2 Antidepressant use has been rising steadily since the early 1990s and GPs have been accused of over-prescribing, with approximately 70% of depressed patients in primary care being prescribed antidepressants. 3 National Institute for Health and Care Excellence (NICE) guidance recommends reductions in prescription of antidepressants and increased access to talking therapies. 4 However, the flagship government programme Improving Access to Psychological Therapies (IAPT) currently has long waiting lists and inconsistencies across clinical commissioning groups (CCGs).…”

Section: Introductionmentioning

confidence: 99%