Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Rural Clinical School, Faculty of Medicine, The University of Queensland, Hervey Bay, QLD, Australia.
Br J Gen Pract. 2021 Jun 24;71(708):e508-e516. doi: 10.3399/BJGP.2020.0913. Print 2021 Jul.
There is considerable concern about increasing antidepressant use, with Australians among the highest users in the world. Evidence suggests this is driven by patients on long-term use, rather than new prescriptions. Most antidepressant prescriptions are generated in general practice, and it is likely that attempts to discontinue are either not occurring or are proving unsuccessful.
To explore GPs' insights about long-term antidepressant prescribing and discontinuation.
A qualitative interview study with Australian GPs.
Semi-structured interviews explored GPs' discontinuation experiences, decision-making, perceived risks and benefits, and support for patients. Data were analysed using reflexive thematic analysis.
Three overarching themes were identified from interviews with 22 GPs. The first, 'not a simple deprescribing decision', spoke to the complex decision-making GPs undertake in determining whether a patient is ready to discontinue. The second, 'a journey taken together', captured a set of steps GPs take together with their patients to initiate and set-up adequate support before, during, and after discontinuation. The third, 'supporting change in GPs' prescribing practices', described what GPs would like to see change to better support them and their patients to discontinue antidepressants.
GPs see discontinuation of long-term antidepressant use as more than a simple deprescribing decision. It begins with considering a patient's social and relational context, and is a journey involving careful preparation, tailored care, and regular review. These insights suggest interventions to redress long-term use will need to take these considerations into account and be placed in a wider discussion about the use of antidepressants.
人们对抗抑郁药使用量的增加表示担忧，澳大利亚人是世界上使用抗抑郁药最多的人群之一。有证据表明，这是由长期使用的患者推动的，而不是新的处方。大多数抗抑郁药处方都是在全科医生诊所开具的，而且很可能是因为试图停药的尝试没有发生，或者没有成功。
探讨全科医生对长期抗抑郁药处方和停药的看法。
这是一项针对澳大利亚全科医生的定性访谈研究。
半结构化访谈探讨了全科医生的停药经验、决策、感知到的风险和益处，以及对患者的支持。使用反思性主题分析对数据进行分析。
从对 22 名全科医生的访谈中确定了三个总体主题。第一个主题是“这不是一个简单的减药决定”，说明了全科医生在确定患者是否准备好停药时所做的复杂决策。第二个主题是“共同走过的旅程”，描述了全科医生与患者一起采取的一系列步骤，在停药前、停药期间和停药后为他们提供足够的支持。第三个主题是“支持全科医生的处方实践的改变”，描述了全科医生希望看到哪些改变，以更好地支持他们和他们的患者停止使用抗抑郁药。
全科医生认为长期抗抑郁药的停药不仅仅是一个简单的减药决定。它始于考虑患者的社会和关系背景，是一个涉及精心准备、量身定制的护理和定期审查的旅程。这些观点表明，为了纠正长期使用的问题，干预措施需要考虑到这些因素，并将其纳入更广泛的关于抗抑郁药使用的讨论中。
