Morrison Jill, Anderson Mary-Jane, Sutton Matt, Munoz-Arroyo Rosalia, McDonald Sara, Maxwell Margaret, Power Andrew, Smith Michael, Wilson Philip
Section of General Practice, University of Glasgow, Glasgow.
Br J Gen Pract. 2009 Feb;59(559):e25-31. doi: 10.3399/bjgp09X395076.
The prescribing of antidepressants has been rising dramatically in developed countries.
As part of an investigation into the reasons for the rise and variation in the prescribing of antidepressants, this study aimed to describe, and account for, the variation in an age-sex standardised rate of antidepressant prescribing between general practices.
Cross-sectional study involving analyses of routinely available data.
A total of 983 Scottish general practices.
Age-sex standardised prescribing rates were calculated for each practice. Univariate and multivariate regression analyses were undertaken to examine how the variation in prescribing was related to population, GP, and practice characteristics at individual practice level.
There was a 4.6-fold difference between the first and ninth deciles of antidepressant prescribing, standardised for registered patients' age and sex composition. The multivariate model explained 49.4% of the variation. Significantly higher prescribing than expected was associated with more limiting long-term illness (highly correlated with deprivation and the single most influential factor), urban location, and a greater proportion of female GPs in the practices. Significantly lower prescribing than expected was associated with single-handed practices, a higher than average list size, a greater proportion of GP partners born outside the UK, remote rural areas, a higher proportion of patients from minority ethnic groups, a higher mean GP age, and availability of psychology services. None of the quality-of-care indicators investigated was associated with prescribing levels.
Almost half of the variation in the prescription of antidepressants can be explained using population, GP, and practice characteristics. Initiatives to reduce the prescribing of antidepressants should consider these factors to avoid denying appropriate treatment to patients in some practices.
在发达国家，抗抑郁药的处方量一直在急剧上升。
作为一项关于抗抑郁药处方量上升及变化原因调查的一部分，本研究旨在描述并解释各全科医疗诊所之间按年龄和性别标准化的抗抑郁药处方率的差异。
涉及对常规可得数据进行分析的横断面研究。
983家苏格兰全科医疗诊所。
计算每家诊所的年龄和性别标准化处方率。进行单变量和多变量回归分析，以检验处方差异与个体诊所层面的人口、全科医生及诊所特征之间的关系。
按注册患者的年龄和性别构成标准化后，抗抑郁药处方量的第一个十分位数与第九个十分位数之间存在4.6倍的差异。多变量模型解释了49.4%的差异。处方量显著高于预期与更多的限制性长期疾病（与贫困高度相关且是最具影响力的单一因素）、城市地区以及诊所中女性全科医生比例较高有关。处方量显著低于预期与单人执业诊所、高于平均水平的患者名单规模、出生在英国境外的全科医生合伙人比例较高、偏远农村地区、少数族裔患者比例较高、全科医生平均年龄较高以及有心理服务有关。所调查的任何医疗质量指标均与处方水平无关。
抗抑郁药处方量近一半的差异可用人口、全科医生及诊所特征来解释。减少抗抑郁药处方量的举措应考虑这些因素，以避免在某些诊所拒绝为患者提供适当治疗。
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