A qualitative study exploring how GPs decide to prescribe antidepressants.
A qualitative study exploring how GPs decide to prescribe antidepressants.
复制标题
一项定性研究，探讨全科医生如何决定开抗抑郁药。
DOI：
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发表时间：
2005
期刊：
影响因子：
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通讯作者：
D. Sharp
中科院分区：
文献类型：
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作者：
J. Hyde;M. Calnan;L. Prior;G. Lewis;D. Kessler;D. Sharp
背景
为了影响全科医生的处方政策和做法，有必要了解他们如何做出决定。现有的有限证据表明，全科医生不仅发现诊断抑郁症和开抑郁症处方的决策有问题，而且这些决策受到缺乏资源的严重限制。因此，人们可能会认为，全科医生，根据目前的指导方针，将不可避免地处方抗抑郁药的患者表现出焦虑和抑郁的症状。本研究旨在验证这一观点的准确性。
目的
探索全科医生如何决定开抗抑郁药。
设计
焦点小组与自选的全科医生。
设置
布里斯托及其周边地区。
方法
五个焦点小组与27个GP的定性研究。
结果
全科医生关于抗抑郁药是否是一种适当的管理形式的决定是由一套基于“临床”和“社会”标准的规则形成的。首选的策略是“等待和观望”，但当症状被认为是持续的，未解决的，严重的和“经典的”时，抗抑郁药会更早地被处方。处方的决定也受到时间的组织限制，缺乏可访问的替代管理选项，处方成本和感知患者态度的影响。
结论
这项研究的证据几乎没有支持全科医生在面对不确定性时采取简单的抗抑郁药处方的观点。有证据表明，全科医生的处方是谨慎的，这表明，全科医生将支持最近的指南草案有关观察等待的倡议。然而，这一指南需要明确什么是轻度抑郁症，并解决给正在经历社会逆境的患者开处方的问题。此外，还需要容易和公平地获得咨询等抗抑郁药的替代品。此外，全科医生需要确信，抗抑郁药的替代品至少对所谓的“轻度抑郁”患者同样有效。
BACKGROUND
To influence GPs' prescribing policies and practices it is necessary to have an understanding of how they make decisions. The limited evidence available suggests that not only do GPs find making decisions about diagnosing and prescribing for depression problematic, but that decisions are severely constrained by lack of resources. As a result, it might be thought that GPs, in line with current guidelines, will inevitably prescribe antidepressants for patients presenting with symptoms of anxiety and depression. This study examines the accuracy of this view.
AIM
To explore how GPs decide to prescribe antidepressants.
DESIGN
Focus groups with self-selected GPs.
SETTING
Bristol and the surrounding district.
METHOD
Qualitative study of five focus groups with 27 GPs.
RESULTS
GPs' decisions about whether an antidepressant would be an appropriate form of management are shaped by a set of rules based on 'clinical' and 'social' criteria. The preferred strategy is to 'wait and see', but antidepressants are prescribed earlier when symptoms are perceived to be persistent, unresolving, severe and 'classic'. Decisions to prescribe are also shaped by organisational constraints of time, lack of accessible alternative management options, cost of prescribing and perceived patient attitude.
CONCLUSION
The evidence from this study provides little support for the view that GPs take the easy option of prescribing antidepressants in the face of uncertainty. Evidence suggests that the GPs' prescribing was cautious, which indicates that GPs would support the initiative of recent draft guidelines regarding watchful waiting. This guidance, however, needs to be clear about what constitutes mild depression and address the question of prescribing to patients who are experiencing social adversity. Furthermore, alternatives to antidepressants such as counselling would need to be readily and equitably accessible. In addition, GPs need to be convinced that alternatives to antidepressants are at least as effective for patients with so-called 'mild depression'.