How do GP practices and patient characteristics influence the prescription of antidepressants? A cross-sectional study
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PRIMARY RESEARCH
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How do GP practices and patient characteristics influence the prescription of antidepressants? A cross-sectional study Alain Mercier1,8,9*, Jacques Benichou2, Isabelle Auger-Aubin3,4, Jean-Pierre Lebeau5, Estelle Houivet2, Paul Van Royen6 and Lieve Peremans7
Abstract Background: Under-prescription of antidepressants (ADs) among people meeting the criteria for major depressive episodes and excessive prescription in less symptomatic patients have been reported. The reasons influencing general practitioners’ (GPs) prescription of ADs remain little explored. This study aimed at assessing the influence of GP and patient characteristics on AD prescription. Methods: This cross-sectional study was based on a sample of 816 GPs working within the main health care insurance system in the Seine-Maritime district of France during 2010. Only GPs meeting the criteria for full-time GP practice were included. The ratio of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP, using the defined daily dose (DDD) concept. Associations of this AD prescription ratio with GPs’ age, gender, practice location, number of years of practice, number of days of sickness certificates prescribed, number of home visits and consultations, number and mean age of registered patients, mean patient income, and number of patients with a chronic condition were assessed using univariate and multivariate analysis. Results: The high prescribers were middle-aged (40–59) urban GPs, with a moderate number of consultations and fewer low-income and chronic patients. GPs’ workload (e.g., volume of prescribed drug reimbursement and number of consultations) had no influence on the AD prescription ratio. GPs with more patients with risk factors for depression prescribed fewer ADs, however, which could suggest the medications were under-prescribed among the at-risk population. Conclusions: Our study described a profile of the typical higher AD prescriber that did not include heavy workload. In future work, a more detailed assessment of all biopsychosocial components of the consultation and other influences on GP behavior such as prior training would be useful to explain AD prescription in GP’s practice. Keywords: Antidepressants, General practice, General practitioners, Cross-sectional study, Pharmaco-epidemiology
Background Antidepressants (ADs) are increasingly prescribed and used worldwide, especially in all industrialized countries. In the USA, Medicaid programs’ spending on antidepressants increased from $159 million in 1991 to $2 billion in 2005 [1] and reached $9.6 billion in 2008 [2]. AD prescription in France increased sixfold, from € 84 million * Correspondence: [email protected] 1 Department of General Practice, Rouen University, CIC Inserm 0204, 1 rue de Germont, 76031 Rouen Cedex, France 8 Department of General Practice, University Paris 13, Sorbonne Paris Cité, Bobigny, France Full list of author information is available at the end of the article
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