Supporting antidepressant discontinuation: the development and optimisation of a digital intervention for patients in UK primary care using a theory, evidence and person-based approach

Bowers, Hannah; Kendrick, Tony; Glowacka, Marta; Williams, Samantha; Leydon, Geraldine; May, Carl; Dowrick, Chris; Laine, Rebecca; Nestoriuc, Yvonne; Andersson, Gerhard; Geraghty, Adam W A

doi:10.1136/bmjopen-2019-032312

Cited by 22 publications

(19 citation statements)

References 32 publications

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“…The patient intervention (called 'ADvisor' as it provides advice on antidepressants) has been developed by psychologists Geraghty and Bowers, drawing on theory, evidence and in-depth systematic qualitative research with patients. 49,70 The aim is to increase patients' selfefficacy for stopping antidepressants in a way that is safe and suited to their preferences. It focuses on increasing patients' reflective motivation for stopping, and supporting their psychological and physical capability to do so through modules that include: Reducing and Detailed reduction schedules for all antidepressants are included in the ADvisor for Health Professionals intervention, grouped under four plans.…”

Section: Psychological Support For Patients To Manage Without Drug Treatmentmentioning

confidence: 99%

Strategies to reduce use of antidepressants

Kendrick

2020

Brit J Clinical Pharma

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Antidepressant prescribing has increased year on year since the introduction of the selective serotonin reuptake inhibitors (SSRIs) in the 1980s. More than 10% of adults in England are now taking antidepressants for depression/anxiety, with a median length of treatment of more than 2 years, but antidepressants can cause side effects and withdrawal symptoms which increase with longer use. Surveys of antidepressant users suggest 30-50% have no evidence-based indication to continue, but coming off antidepressants is often difficult due to fears of relapse, withdrawal symptoms and a lack of psychological treatments to replace maintenance treatment and prevent relapse. GPs should not prescribe antidepressants routinely for mild depressive/anxiety symptoms. Patients starting antidepressants should be advised that they are to be taken for a limited period only, and that there is a risk of withdrawal problems on stopping them. Prescribers should actively review long-term antidepressant use and suggest coming off them slowly to patients who are well. The relationship between SSRI dose and serotonin transporter receptor occupancy suggests that hyperbolic tapering regimes may be helpful for patients with troubling withdrawal symptoms who cannot stop treatment within 4-8 weeks, and tapering strips can allow carefully titrated slower dose reduction over some months. Internet and telephone support to patients wanting to reduce their antidepressants is being trialled in the REDUCE programme. More research is needed to establish the incidence of withdrawal symptoms in representative samples of patients coming off antidepressants, and large randomised controlled trials are needed to test different tapering strategies.

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Section: Psychological Support For Patients To Manage Without Drug Treatmentmentioning

confidence: 99%

Strategies to reduce use of antidepressants

Kendrick

2020

Brit J Clinical Pharma

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“…Our 2 broad design objectives were (1) to build confidence that discontinuing antidepressant medication is safe and achievable in the long term and (2) to be an accessible, motivational resource that supports patients in managing their withdrawal, which aligns with their preferences. These objectives were achieved through the development of the patient digital intervention (which is described elsewhere [ 24 ]) and through the health professional intervention (eg, patients’ views on enabling empathy and GP support informed the section for GPs to build their confidence that discontinuation is safe). The design features that support these objectives are presented in Textbox 1 .…”

Section: Resultsmentioning

confidence: 99%

A Digital Intervention for Primary Care Practitioners to Support Antidepressant Discontinuation (Advisor for Health Professionals): Development Study

et al. 2021

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Background The number of people receiving antidepressants has increased in the past 3 decades, mainly because of people staying on them longer. However, in many cases long-term treatment is not evidence based and risks increasing side effects. Additionally, prompting general practitioners (GPs) to review medication does not improve the rate of appropriate discontinuation. Therefore, GPs and other health professionals may need help to support patients discontinuing antidepressants in primary care. Objective This study aims to develop a digital intervention to support practitioners in helping patients discontinue inappropriate long-term antidepressants (as part of a wider intervention package including a patient digital intervention and patient telephone support). Methods A prototype digital intervention called Advisor for Health Professionals (ADvisor HP) was planned and developed using theory, evidence, and a person-based approach. The following elements informed development: a literature review and qualitative synthesis, an in-depth qualitative study, the development of guiding principles for design elements, and theoretical behavioral analyses. The intervention was then optimized through think-aloud qualitative interviews with health professionals while they were using the prototype intervention. Results Think-aloud qualitative interviews with 19 health professionals suggested that the digital intervention contained useful information and was readily accessible to practitioners. The development work highlighted a need for further guidance on drug tapering schedules for practitioners and clarity about who is responsible for broaching the subject of discontinuation. Practitioners highlighted the need to have information in easily and quickly accessible formats because of time constraints in day-to-day practice. Some GPs felt that some information was already known to them but understood why this was included. Practitioners differed in their ideas about how they would use ADvisor HP in practice, with some preferring to read the resource in its entirety and others wanting to dip in and out as needed. Changes were made to the wording and structure of the intervention in response to the feedback provided. Conclusions ADvisor HP is a digital intervention that has been developed using theory, evidence, and a person-based approach. The optimization work suggests that practitioners may find this tool to be useful in supporting the reduction of long-term antidepressant use. Further quantitative and qualitative evaluation through a randomized controlled trial is needed to examine the feasibility, effectiveness, and cost-effectiveness of the intervention.

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“…The person-based approach (PBA) to intervention development [ 24 ] is a target population-based approach [ 21 ] in which feedback from the target population is collected. It is complementary to BCW [ 24 ] and has been previously used alongside the BCW [ 25 ].…”

Section: Intervention Development Approachmentioning

confidence: 99%

Development of an intervention to increase adherence to nebuliser treatment in adults with cystic fibrosis: CFHealthHub

Arden

Hutchings

Whelan

et al. 2021

Pilot Feasibility Stud

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Background Cystic fibrosis (CF) is a life-limiting genetic condition in which daily therapies to maintain lung health are critical, yet treatment adherence is low. Previous interventions to increase adherence have been largely unsuccessful and this is likely due to a lack of focus on behavioural evidence and theory alongside input from people with CF. This intervention is based on a digital platform that collects and displays objective nebuliser adherence data. The purpose of this paper is to identify the specific components of an intervention to increase and maintain adherence to nebuliser treatments in adults with CF with a focus on reducing effort and treatment burden. Methods Intervention development was informed by the Behaviour Change Wheel (BCW) and person-based approach (PBA). A multidisciplinary team conducted qualitative research to inform a needs analysis, selected, and refined intervention components and methods of delivery, mapped adherence-related barriers and facilitators, associated intervention functions and behaviour change techniques, and utilised iterative feedback to develop and refine content and processes. Results Results indicated that people with CF need to understand their treatment, be able to monitor adherence, have treatment goals and feedback and confidence in their ability to adhere, have a treatment plan to develop habits for treatment, and be able to solve problems around treatment adherence. Behaviour change techniques were selected to address each of these needs and were incorporated into the digital intervention developed iteratively, alongside a manual and training for health professionals. Feedback from people with CF and clinicians helped to refine the intervention which could be tailored to individual patient needs. Conclusions The intervention development process is underpinned by a strong theoretical framework and evidence base and was developed by a multidisciplinary team with a range of skills and expertise integrated with substantial input from patients and clinicians. This multifaceted development strategy has ensured that the intervention is usable and acceptable to people with CF and clinicians, providing the best chance of success in supporting people with CF with different needs to increase and maintain their adherence. The intervention is being tested in a randomised controlled trial across 19 UK sites.

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Supporting antidepressant discontinuation: the development and optimisation of a digital intervention for patients in UK primary care using a theory, evidence and person-based approach

Cited by 22 publications

References 32 publications

Strategies to reduce use of antidepressants

Strategies to reduce use of antidepressants

A Digital Intervention for Primary Care Practitioners to Support Antidepressant Discontinuation (Advisor for Health Professionals): Development Study

Development of an intervention to increase adherence to nebuliser treatment in adults with cystic fibrosis: CFHealthHub

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