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首页> 外文期刊>BMC Family Practice >‘Doing the right thing’: factors influencing GP prescribing of antidepressants and prescribed doses
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‘Doing the right thing’: factors influencing GP prescribing of antidepressants and prescribed doses

机译：“做正确的事情”：影响GP抗抑郁药和规定剂量的因素

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Background 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 1-2?weeks, preferring to wait 8-12?weeks 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.
机译：背景技术抗抑郁药继续增加，5-16％的成年人每年接受抗抑郁药。总规定的增长是部分归因于长期使用，更大的选择性血清素再摄取抑制剂（SSRI）使用和使用更高的SSRI剂量。证据不支持常规使用更高的SSRI剂量进行抑郁处理，而影响这种剂量的因素是不公知的。本研究的目的是探讨影响GPS使用抗抑郁药及其剂量治疗抑郁症的因素。方法采访28个练习GPS的有目的样本的半结构化访谈;通过抗抑郁药规定量进行采样，实践规模和剥夺水平。过去文学主题指南绘制有足够的灵活性，以允许额外的主题出现。访谈是音频记录和转录的逐字。框架分析采用。在成绩单上进行恒定的比较和崩溃，数据收集与三位研究人员分析进行了分析。然后系统地应用于数据并概念化为总体解释模型。结果抑郁症治疗涉及以争取“右心观契”的“为自己做正确的事”的道德和专业的必要性。这涉及医疗和非医学的患者以患者为中心的方法。影响抗抑郁药处分和剂量的因素从第一次呈现时随着时间的推移而变化，抗抑郁的起始和长期治疗。当面对患病的患者时，表现出中度至严重抑郁症GPS的症状是自信的SSRIS，它们被认为是安全有效的药物，以及道德和专业的适当。许多GPS未知，较高剂量缺乏更高的疗效，并且在1-2个周内发生的作用效果和发作发生，更倾向于等待8-12？在增加或切换前的周数。保持处方的持续压力（例如对抑郁复发的恐惧），很少有人感知的延续问题（例如，缺乏安全问题）和缺乏积极的药物审查（例如危机中只存在的患者），所有这些都结合在一段时间以进一步推动抗抑郁药的抗抑郁药。结论GPS努力“做正确的事”来帮助人们。抗抑郁药只是抑郁症治疗的单个方面。然而，增加对药物限制和定期主动评审的认识可能有助于优化护理。

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