Antidepressants are medications used to treat depression and anxiety. They work by changing levels of certain chemicals in the brain to help lift a person's mood. Guidelines from the National Institute for Health and Care Excellence (NICE) suggest if people start taking antidepressants they should see a health professional again within 2 weeks to check if the medication is working and if there are any side effects. If they continue to take the medication they should be seen at least once a year to again check if there are any side effects.
Indicators, sometimes referred to as performance measures, are used in the NHS to see whether actions are taking place and where improvements might be necessary. This study will test whether it is possible to use electronic health care records to develop indicators based on records of new and long-term use of antidepressants.
The results of this work may lead to indicators for use in general practice that can help make sure patients taking antidepressant medication are seen by healthcare professionals.
The National Institute for Health and Care Excellence (NICE) are commissioned by NHS England to develop indicators which are suitable for inclusion in the Quality and Outcomes Framework (QOF) subject to negotiation between NHS England and the British Medical Association’s General Practitioners Committee (GPC).
In 2017/18, 7.3 million people were prescribed antidepressants, and 4.4 million of these also received a prescription in either 2015/16 or 2016/17. The NICE guideline on depression in adults (2009) recommends that people prescribed antidepressants for anxiety or depression need early review to monitor improvement and to assess for side effects, with yearly follow up to assess again for side effects.
This study will test the feasibility of using primary care data on antidepressant prescriptions to accurately provide the cohorts necessary for the denominators of the following indicators:
a) The percentage of patients with a new course of antidepressant in the preceding 12 months who have been reviewed not later than 14 days after their first prescription
b) The percentage of patients prescribed a long-term antidepressant who have a record of a medication review in the preceding 12 months.
The study will be limited to antidepressant prescriptions between 1 January 2018 and 31 Dec 2020. Two different ways of defining both ‘new courses’ and ‘long-term use’ will be used. Resulting patient numbers per practice will be compared against each other, results from existing literature and results from an ePACT2 search to assess concordance and quantify the limitations. ePACT2 is an online application which gives authorised users access to prescription data held by NHS Prescription Services.
The results of this work will be used to assess the validity of the proposed indicators and their suitability for use in the Quality and Outcomes Framework (QOF) to improve the quality of care for patients prescribed antidepressant medication.
Antidepressant medication prescription
Definition of new courses of antidepressant medication.
Definition of long-term course of antidepressant medication.
Craig Grime - Chief Investigator - National Institute for Health and Clinical Excellence - NICE
Theresa Jennison - Corresponding Applicant - National Institute for Health and Clinical Excellence - NICE
Charlotte Fairclough - Collaborator - National Institute for Health and Clinical Excellence - NICE
Eleanor Yelland - Collaborator - CPRD
Mark Minchin - Collaborator - National Institute for Health and Clinical Excellence - NICE
Robert Willans - Collaborator - National Institute for Health and Clinical Excellence - NICE
Practice Level Index of Multiple Deprivation