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Helping people discontinue long-term antidepressants: views of health professionals in UK primary care

Helping people discontinue long-term antidepressants: views of health professionals in UK primary care
Helping people discontinue long-term antidepressants: views of health professionals in UK primary care

Objective The aims of this paper were to identify, characterise and explain clinician factors that shape decision-making around antidepressant discontinuation in UK primary care.

Design Four focus groups and three interviews were conducted and analysed using thematic analysis.

Participants Twenty-one general practitioners (GPS), four GP assistants, seven nurses and six community mental health team workers and psychotherapists took part in focus groups and interviews. 

Setting Participants were recruited from seven primary care regions and two National Health Service Trusts providing community mental health services in the South of England.

Results Participants highlighted a number of barriers and enablers to discussing discontinuation with patients. They held a range of views around responsibility, with some suggesting it was the responsibility of the health professional (HP) to broach the subject, and others suggesting responsibility rested with the patients. HPs were concerned about destabilising the current situation, discussed how continuity and knowing the patient facilitated discontinuation talks, and discussed how confidence in their professional skills and knowledge affected whether they elected to raise discontinuation in consultations.

Conclusions Findings indicate a need to consider support for HPs in the management of antidepressant medication and discussions of discontinuation in particular. They may also benefit from support around their fears of patient relapse and awareness of when and how to initiate discussions about discontinuation with their patients.

Antidepressants, Health professional, Primary care
2044-6055
1-8
Bowers, Hannah M.
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Williams, Samantha J.
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Geraghty, Adam W.A.
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Maund, Emma
c9733167-eafe-44e5-b418-5ace79161402
O'brien, Wendy
4681130e-626d-4dcb-9785-3550f20e8e34
Leydon, Geraldine
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May, Carl R.
17697f8d-98f6-40d3-9cc0-022f04009ae4
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Bowers, Hannah M.
c81d418d-3cd7-4da5-bd09-0eee862bd49f
Williams, Samantha J.
7cec7c3e-7247-473e-8121-f26b625893e1
Geraghty, Adam W.A.
2c6549fe-9868-4806-b65a-21881c1930af
Maund, Emma
c9733167-eafe-44e5-b418-5ace79161402
O'brien, Wendy
4681130e-626d-4dcb-9785-3550f20e8e34
Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
May, Carl R.
17697f8d-98f6-40d3-9cc0-022f04009ae4
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5

Bowers, Hannah M., Williams, Samantha J., Geraghty, Adam W.A., Maund, Emma, O'brien, Wendy, Leydon, Geraldine, May, Carl R. and Kendrick, Tony (2019) Helping people discontinue long-term antidepressants: views of health professionals in UK primary care. BMJ Open, 9 (7), 1-8, [e027837]. (doi:10.1136/bmjopen-2018-027837).

Record type: Article

Abstract

Objective The aims of this paper were to identify, characterise and explain clinician factors that shape decision-making around antidepressant discontinuation in UK primary care.

Design Four focus groups and three interviews were conducted and analysed using thematic analysis.

Participants Twenty-one general practitioners (GPS), four GP assistants, seven nurses and six community mental health team workers and psychotherapists took part in focus groups and interviews. 

Setting Participants were recruited from seven primary care regions and two National Health Service Trusts providing community mental health services in the South of England.

Results Participants highlighted a number of barriers and enablers to discussing discontinuation with patients. They held a range of views around responsibility, with some suggesting it was the responsibility of the health professional (HP) to broach the subject, and others suggesting responsibility rested with the patients. HPs were concerned about destabilising the current situation, discussed how continuity and knowing the patient facilitated discontinuation talks, and discussed how confidence in their professional skills and knowledge affected whether they elected to raise discontinuation in consultations.

Conclusions Findings indicate a need to consider support for HPs in the management of antidepressant medication and discussions of discontinuation in particular. They may also benefit from support around their fears of patient relapse and awareness of when and how to initiate discussions about discontinuation with their patients.

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e027837.full - Version of Record
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More information

Accepted/In Press date: 29 May 2019
e-pub ahead of print date: 4 July 2019
Keywords: Antidepressants, Health professional, Primary care

Identifiers

Local EPrints ID: 432665
URI: http://eprints.soton.ac.uk/id/eprint/432665
ISSN: 2044-6055
PURE UUID: f39748da-09e1-45e3-bf77-229dd56d85b7
ORCID for Samantha J. Williams: ORCID iD orcid.org/0000-0001-9505-6485
ORCID for Adam W.A. Geraghty: ORCID iD orcid.org/0000-0001-7984-8351
ORCID for Geraldine Leydon: ORCID iD orcid.org/0000-0001-5986-3300
ORCID for Carl R. May: ORCID iD orcid.org/0000-0002-0451-2690
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

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Date deposited: 24 Jul 2019 16:30
Last modified: 18 Feb 2021 17:15

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