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A digital intervention for primary care practitioners to support antidepressant discontinuation (advisor for health professionals): Development Study

A digital intervention for primary care practitioners to support antidepressant discontinuation (advisor for health professionals): Development Study
A digital intervention for primary care practitioners to support antidepressant discontinuation (advisor for health professionals): Development Study

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.

Antidepressive Agents/therapeutic use, Cost-Benefit Analysis, General Practitioners, Humans, Primary Health Care, Qualitative Research
1438-8871
e25537
Bowers, Hannah
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Kendrick, Tony
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van Ginneken, Nadja
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Glowacka, Marta
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Williams, Samantha
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Leydon, Geraldine M
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May, Carl
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Dowrick, Christopher
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Moncrieff, Joanna
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Johnson, Chris F
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Moore, Michael
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Laine, Rebecca
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Geraghty, Adam W A
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Bowers, Hannah
c81d418d-3cd7-4da5-bd09-0eee862bd49f
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
van Ginneken, Nadja
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Glowacka, Marta
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Williams, Samantha
7cec7c3e-7247-473e-8121-f26b625893e1
Leydon, Geraldine M
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Dowrick, Christopher
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Moncrieff, Joanna
02891f66-8e9a-4af0-b56f-482041b23a72
Johnson, Chris F
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Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Laine, Rebecca
963a62a6-ab30-40b4-8f7a-ff56fda86cd8
Geraghty, Adam W A
2c6549fe-9868-4806-b65a-21881c1930af

Bowers, Hannah, Kendrick, Tony, van Ginneken, Nadja, Glowacka, Marta, Williams, Samantha, Leydon, Geraldine M, May, Carl, Dowrick, Christopher, Moncrieff, Joanna, Johnson, Chris F, Moore, Michael, Laine, Rebecca and Geraghty, Adam W A (2021) A digital intervention for primary care practitioners to support antidepressant discontinuation (advisor for health professionals): Development Study. Journal of Medical Internet Research, 23 (7), e25537, [e25537]. (doi:10.2196/25537).

Record type: Article

Abstract

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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e-pub ahead of print date: 4 January 2021
Published date: 16 July 2021
Additional Information: Funding Information: The ADvisor HP intervention was developed using LifeGuide software and/or methodologies, which was partly funded by the NIHR Southampton Biomedical Research Centre. The authors would like to acknowledge Emma Maund who conducted the 2 systematic reviews that informed the intervention development. Publisher Copyright: © Hannah Bowers, Tony Kendrick, Nadja van Ginneken, Marta Glowacka, Samantha Williams, Geraldine M Leydon, Carl May, Christopher Dowrick, Joanna Moncrieff, Chris F Johnson, Michael Moore, Rebecca Laine, Adam W A Geraghty. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: Antidepressive Agents/therapeutic use, Cost-Benefit Analysis, General Practitioners, Humans, Primary Health Care, Qualitative Research

Identifiers

Local EPrints ID: 453600
URI: http://eprints.soton.ac.uk/id/eprint/453600
ISSN: 1438-8871
PURE UUID: 211ce560-20d3-418a-af0b-6b3b02bd6fcb
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381
ORCID for Samantha Williams: ORCID iD orcid.org/0000-0001-9505-6485
ORCID for Geraldine M Leydon: ORCID iD orcid.org/0000-0001-5986-3300
ORCID for Carl May: ORCID iD orcid.org/0000-0002-0451-2690
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Adam W A Geraghty: ORCID iD orcid.org/0000-0001-7984-8351

Catalogue record

Date deposited: 20 Jan 2022 17:35
Last modified: 10 Jun 2022 01:40

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Contributors

Author: Hannah Bowers
Author: Tony Kendrick ORCID iD
Author: Nadja van Ginneken
Author: Marta Glowacka
Author: Carl May ORCID iD
Author: Christopher Dowrick
Author: Joanna Moncrieff
Author: Chris F Johnson
Author: Michael Moore ORCID iD
Author: Rebecca Laine

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