GPs' prescribing of antidepressants in France: a critical analysis on attitudes and behavior

Datum: 23 mei 2014

Locatie: University of Antwerp - Campus Drie Eiken - Building Q - Promotiezaal - Universiteitsplein 1 - 2610 Wilrijk

Tijdstip: 16.30 uur

Organisatie / co-organisatie: Faculty of Medicine and Health Sciences

Promovendus: Alain Mercier

Promotor: Prof L. Peremans and Prof P. Van Royen

Korte beschrijving: PhD defense Alain Mercier - Faculty of Medicine and Health Sciences

Abstract: Roughly 10% of the population receives a reimbursement for an antidepressant (AD) in Europe, probably more in France. Depressed people are underdiagnosed and undertreated, but ADs seem to be overprescribed among non-depressed patients. GPs are responsible for 80 % of the prescriptions, although their role is questioned. Some studies underlined off-label use. One third of the prescriptions probably doesn't correspond with clinical practice guidelines and 20% might not be related to any psychiatric diagnosis. Other data suggest no evidence of important misuse.
The aim of this thesis was to understand better GPs' attitudes and actual behavior on AD prescription.

Methods
In a qualitative focus group and interview study , we explored the viewpoints of 60 GPs regarding reasons and conditions to prescribe AD. We reviewed the mentioned conditions in the literature to give an overview on the evidence for ADs use in non-psychiatric diseases. A database cross sectional study assessed the influence of GPs and patients' demographic characteristics on the ratio of AD prescriptions. A cross sectional pilot study assessed the AD prescription rate and explored the context for prescribing them, including all influencing factors on it.

Results
The decision to prescribe was mainly influenced by patient's background and history. ADs were prescribed in 24 non-psychiatric conditions. A high level of evidence for AD prescription was found for 15 of them in the literature review. The AD prescription rate was not influenced by a particular practice style or by increased medical activity. In the pilot 8.90% of all patients were taking an AD. We found an 18% rate for non-psychiatric prescriptions, influenced by a past history of depression and several psychosocial factors.

Conclusion
Complex and multiple factors influence GPs decisions to prescribe ADs. Bio-psychosocial context of patients' past history, personal and professional factors, psychological (anxiety and major depression) and physical conditions. This knowledge should be used to enhance inter-professional collaboration, improve students' skills, and design future research.