RT Journal Article
SR Electronic
T1 A qualitative study exploring how GPs decide to prescribe antidepressants
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP 755
OP 762
VO 55
IS 519
A1 Julia Hyde
A1 Michael Calnan
A1 Lindsay Prior
A1 Glyn Lewis
A1 David Kessler
A1 Deborah Sharp
YR 2005
UL http://bjgp.org/content/55/519/755.abstract
AB Background To influence GPs' prescribing policies and practices it is necessary to have an understanding of how they make decisions. The limited evidence available suggests that not only do GPs find making decisions about diagnosing and prescribing for depression problematic, but that decisions are severely constrained by lack of resources. As a result, it might be thought that GPs, in line with current guidelines, will inevitably prescribe antidepressants for patients presenting with symptoms of anxiety and depression. This study examines the accuracy of this view.Aim To explore how GPs decide to prescribe antidepressants.Design Focus groups with self-selected GPs.Setting Bristol and the surrounding district.Method Qualitative study of five focus groups with 27 GPs.Results GPs' decisions about whether an antidepressant would be an appropriate form of management are shaped by a set of rules based on ‘clinical’ and ‘social’ criteria. The preferred strategy is to ‘wait and see’, but antidepressants are prescribed earlier when symptoms are perceived to be persistent, unresolving, severe and ‘classic’. Decisions to prescribe are also shaped by organisational constraints of time, lack of accessible alternative management options, cost of prescribing and perceived patient attitude.Conclusion The evidence from this study provides little support for the view that GPs take the easy option of prescribing antidepressants in the face of uncertainty. Evidence suggests that the GPs' prescribing was cautious, which indicates that GPs would support the initiative of recent draft guidelines regarding watchful waiting. This guidance, however, needs to be clear about what constitutes mild depression and address the question of prescribing to patients who are experiencing social adversity. Furthermore, alternatives to antidepressants such as counselling would need to be readily and equitably accessible. In addition, GPs need to be convinced that alternatives to antidepressants are at least as effective for patients with so-called ‘mild depression’.