Did NICE guidelines and the Quality Outcomes Framework change GP antidepressant prescribing in England? Observational study with time trend analyses 2003-2013
Did NICE guidelines and the Quality Outcomes Framework change GP antidepressant prescribing in England? Observational study with time trend analyses 2003-2013
Background: Both the 2004 NICE depression guidelines and 2006 general practice Quality Outcomes Framework (QOF) encouraged improved targeting of antidepressant treatment for depression.
Methods: Possible effects of the NICE guideline from January 2005, and QOF from April 2006, on rates of GP antidepressant prescribing were examined using time trend analyses of anonymised data from 142 English practices contributing to the Clinical Practice Research Datalink (CPRD), 2003-2013.
Results: Sustained reductions were found in the proportion of first-ever depression episodes treated within 12 months, of 4.2% (95% C.I. 1.0%-7.3%) following introduction of the NICE guideline, and 4.4% (2.3%-6.5%) following introduction of the QOF. Treatment rates for first-ever episodes fell from 72.5% (70.8%-74.1%) in Quarter 2 (Q2) 2003 to 61.0% (59.3%-62.7%) in Q1 2012, but treatment rates for recurrent episodes increased from 74.3% (72.8%-75.8%) to 77.8% (76.5%-79.1%), so overall rates remained around 70%. Mean prescriptions per patient per year doubled from 2.06 (2.05-2.07) to 3.98 (3.97-3.99).
Limitations: Participating practices were larger than average and not representative across regions. Inferences of cause and effect from time trend analyses are subject to the possibility of unidentified confounders. No data were available on depression severity or appropriateness of prescribing.
Conclusions: Rates of GP antidepressant treatment for patients with incident depression fell following introduction of NICE depression guidelines and the QOF, but treatment rates for recurrent depression increased. Prescription numbers increased due to longer treatment courses. To impact on antidepressant prescribing rates, guidelines and performance indicators must address recurrent and long-term prescribing, rather than initial treatment decisions.
depression, antidepressants, primary care, guidelines, pay for performance, QOF
171-177
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Newell, Colin
fd859e4b-b3a6-4722-b1de-2e52c8633899
Geraghty, Adam W.A.
2c6549fe-9868-4806-b65a-21881c1930af
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
1 November 2015
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Newell, Colin
fd859e4b-b3a6-4722-b1de-2e52c8633899
Geraghty, Adam W.A.
2c6549fe-9868-4806-b65a-21881c1930af
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Kendrick, Tony, Stuart, Beth, Newell, Colin, Geraghty, Adam W.A. and Moore, Michael
(2015)
Did NICE guidelines and the Quality Outcomes Framework change GP antidepressant prescribing in England? Observational study with time trend analyses 2003-2013.
Journal of Affective Disorders, 186, .
(doi:10.1016/j.jad.2015.06.052).
Abstract
Background: Both the 2004 NICE depression guidelines and 2006 general practice Quality Outcomes Framework (QOF) encouraged improved targeting of antidepressant treatment for depression.
Methods: Possible effects of the NICE guideline from January 2005, and QOF from April 2006, on rates of GP antidepressant prescribing were examined using time trend analyses of anonymised data from 142 English practices contributing to the Clinical Practice Research Datalink (CPRD), 2003-2013.
Results: Sustained reductions were found in the proportion of first-ever depression episodes treated within 12 months, of 4.2% (95% C.I. 1.0%-7.3%) following introduction of the NICE guideline, and 4.4% (2.3%-6.5%) following introduction of the QOF. Treatment rates for first-ever episodes fell from 72.5% (70.8%-74.1%) in Quarter 2 (Q2) 2003 to 61.0% (59.3%-62.7%) in Q1 2012, but treatment rates for recurrent episodes increased from 74.3% (72.8%-75.8%) to 77.8% (76.5%-79.1%), so overall rates remained around 70%. Mean prescriptions per patient per year doubled from 2.06 (2.05-2.07) to 3.98 (3.97-3.99).
Limitations: Participating practices were larger than average and not representative across regions. Inferences of cause and effect from time trend analyses are subject to the possibility of unidentified confounders. No data were available on depression severity or appropriateness of prescribing.
Conclusions: Rates of GP antidepressant treatment for patients with incident depression fell following introduction of NICE depression guidelines and the QOF, but treatment rates for recurrent depression increased. Prescription numbers increased due to longer treatment courses. To impact on antidepressant prescribing rates, guidelines and performance indicators must address recurrent and long-term prescribing, rather than initial treatment decisions.
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Accepted/In Press date: 29 June 2015
e-pub ahead of print date: 29 July 2015
Published date: 1 November 2015
Keywords:
depression, antidepressants, primary care, guidelines, pay for performance, QOF
Organisations:
Primary Care & Population Sciences
Identifiers
Local EPrints ID: 378614
URI: http://eprints.soton.ac.uk/id/eprint/378614
ISSN: 0165-0327
PURE UUID: a22e3f5d-e2f2-4a8a-ad7a-3f07300e6af6
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Date deposited: 01 Jul 2015 14:47
Last modified: 15 Mar 2024 03:36
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Author:
Colin Newell
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