Factors associated with duration of new antidepressant treatment

analysis of a large primary care database

Christopher Burton, Niall Anderson, Katie Wilde, Colin R Simpson

    Research output: Contribution to journalArticle

    33 Citations (Scopus)

    Abstract

    Background:

    It is not known how much the duration of newly prescribed antidepressant treatment is influenced by patient characteristics or practice variation.

    Aim:

    To describe the relationship between patient characteristics and the duration of new antidepressant treatment by general practices.

    Design and setting:

    Large primary care database cohort study of all patients with a newly initiated course of eligible antidepressant treatment during 1 year, from a database of 237 Scottish practices.

    Method:

    Detailed prescription data were used to estimate the duration of new antidepressant treatment for each patient. Cox proportional hazards regression was used to estimate the influence of patient characteristics on continuation of treatment and, by multilevel modelling, the variation between practices.

    Results:

    A total of 28 027 (2.2%) patients commenced antidepressant treatment during the year; 75% continued beyond 30 days, 56% beyond 90 days, and 40% beyond 180 days. Treatment was less likely to be continued in patients from areas of high socioeconomic deprivation: hazard ratio 1.22 (95% confidence interval [CI] = 1.16 to 1.29); in patients under 35 years, 1.33 (95% CI = 1.28 to 1.37); and in those for whom the GP recorded no relevant diagnostic code, 1.16 (95% CI = 1.13 to 1.18). Models accounted for between 2.2% and 3.9% of the variation in treatment duration.

    Conclusion:

    Patient demographic characteristics account for relatively little variation in the duration of new antidepressant treatment, though treatment was shorter in younger patients and those with greater socioeconomic deprivation. There is variation in treatment duration between practices and according to whether patients have a depression diagnosis coded in their records.
    Original languageEnglish
    Pages (from-to)e104-112
    Number of pages9
    JournalThe British Journal of General Practice
    Volume62
    Issue number595
    DOIs
    Publication statusPublished - Feb 2012

    Fingerprint

    Antidepressive Agents
    Primary Health Care
    Databases
    Therapeutics
    Confidence Intervals
    General Practice
    Prescriptions
    Cohort Studies
    Demography

    Keywords

    • Adult
    • Aged
    • Antidepressive Agents
    • Databases, Factual
    • Depressive Disorder
    • Female
    • General Practice
    • Humans
    • Kaplan-Meier Estimate
    • Male
    • Medication Adherence
    • Middle Aged
    • Physician's Practice Patterns
    • Scotland
    • Socioeconomic Factors

    Cite this

    Factors associated with duration of new antidepressant treatment : analysis of a large primary care database. / Burton, Christopher; Anderson, Niall; Wilde, Katie; Simpson, Colin R.

    In: The British Journal of General Practice, Vol. 62, No. 595, 02.2012, p. e104-112.

    Research output: Contribution to journalArticle

    @article{d115c0174f6c44a082f8de052a338ba8,
    title = "Factors associated with duration of new antidepressant treatment: analysis of a large primary care database",
    abstract = "Background: It is not known how much the duration of newly prescribed antidepressant treatment is influenced by patient characteristics or practice variation. Aim: To describe the relationship between patient characteristics and the duration of new antidepressant treatment by general practices. Design and setting: Large primary care database cohort study of all patients with a newly initiated course of eligible antidepressant treatment during 1 year, from a database of 237 Scottish practices. Method: Detailed prescription data were used to estimate the duration of new antidepressant treatment for each patient. Cox proportional hazards regression was used to estimate the influence of patient characteristics on continuation of treatment and, by multilevel modelling, the variation between practices. Results: A total of 28 027 (2.2{\%}) patients commenced antidepressant treatment during the year; 75{\%} continued beyond 30 days, 56{\%} beyond 90 days, and 40{\%} beyond 180 days. Treatment was less likely to be continued in patients from areas of high socioeconomic deprivation: hazard ratio 1.22 (95{\%} confidence interval [CI] = 1.16 to 1.29); in patients under 35 years, 1.33 (95{\%} CI = 1.28 to 1.37); and in those for whom the GP recorded no relevant diagnostic code, 1.16 (95{\%} CI = 1.13 to 1.18). Models accounted for between 2.2{\%} and 3.9{\%} of the variation in treatment duration. Conclusion: Patient demographic characteristics account for relatively little variation in the duration of new antidepressant treatment, though treatment was shorter in younger patients and those with greater socioeconomic deprivation. There is variation in treatment duration between practices and according to whether patients have a depression diagnosis coded in their records.",
    keywords = "Adult, Aged, Antidepressive Agents, Databases, Factual, Depressive Disorder, Female, General Practice, Humans, Kaplan-Meier Estimate, Male, Medication Adherence, Middle Aged, Physician's Practice Patterns, Scotland, Socioeconomic Factors",
    author = "Christopher Burton and Niall Anderson and Katie Wilde and Simpson, {Colin R}",
    year = "2012",
    month = "2",
    doi = "10.3399/bjgp12X625166",
    language = "English",
    volume = "62",
    pages = "e104--112",
    journal = "The British Journal of General Practice",
    issn = "0960-1643",
    publisher = "Royal College of General Practitioners",
    number = "595",

    }

    TY - JOUR

    T1 - Factors associated with duration of new antidepressant treatment

    T2 - analysis of a large primary care database

    AU - Burton, Christopher

    AU - Anderson, Niall

    AU - Wilde, Katie

    AU - Simpson, Colin R

    PY - 2012/2

    Y1 - 2012/2

    N2 - Background: It is not known how much the duration of newly prescribed antidepressant treatment is influenced by patient characteristics or practice variation. Aim: To describe the relationship between patient characteristics and the duration of new antidepressant treatment by general practices. Design and setting: Large primary care database cohort study of all patients with a newly initiated course of eligible antidepressant treatment during 1 year, from a database of 237 Scottish practices. Method: Detailed prescription data were used to estimate the duration of new antidepressant treatment for each patient. Cox proportional hazards regression was used to estimate the influence of patient characteristics on continuation of treatment and, by multilevel modelling, the variation between practices. Results: A total of 28 027 (2.2%) patients commenced antidepressant treatment during the year; 75% continued beyond 30 days, 56% beyond 90 days, and 40% beyond 180 days. Treatment was less likely to be continued in patients from areas of high socioeconomic deprivation: hazard ratio 1.22 (95% confidence interval [CI] = 1.16 to 1.29); in patients under 35 years, 1.33 (95% CI = 1.28 to 1.37); and in those for whom the GP recorded no relevant diagnostic code, 1.16 (95% CI = 1.13 to 1.18). Models accounted for between 2.2% and 3.9% of the variation in treatment duration. Conclusion: Patient demographic characteristics account for relatively little variation in the duration of new antidepressant treatment, though treatment was shorter in younger patients and those with greater socioeconomic deprivation. There is variation in treatment duration between practices and according to whether patients have a depression diagnosis coded in their records.

    AB - Background: It is not known how much the duration of newly prescribed antidepressant treatment is influenced by patient characteristics or practice variation. Aim: To describe the relationship between patient characteristics and the duration of new antidepressant treatment by general practices. Design and setting: Large primary care database cohort study of all patients with a newly initiated course of eligible antidepressant treatment during 1 year, from a database of 237 Scottish practices. Method: Detailed prescription data were used to estimate the duration of new antidepressant treatment for each patient. Cox proportional hazards regression was used to estimate the influence of patient characteristics on continuation of treatment and, by multilevel modelling, the variation between practices. Results: A total of 28 027 (2.2%) patients commenced antidepressant treatment during the year; 75% continued beyond 30 days, 56% beyond 90 days, and 40% beyond 180 days. Treatment was less likely to be continued in patients from areas of high socioeconomic deprivation: hazard ratio 1.22 (95% confidence interval [CI] = 1.16 to 1.29); in patients under 35 years, 1.33 (95% CI = 1.28 to 1.37); and in those for whom the GP recorded no relevant diagnostic code, 1.16 (95% CI = 1.13 to 1.18). Models accounted for between 2.2% and 3.9% of the variation in treatment duration. Conclusion: Patient demographic characteristics account for relatively little variation in the duration of new antidepressant treatment, though treatment was shorter in younger patients and those with greater socioeconomic deprivation. There is variation in treatment duration between practices and according to whether patients have a depression diagnosis coded in their records.

    KW - Adult

    KW - Aged

    KW - Antidepressive Agents

    KW - Databases, Factual

    KW - Depressive Disorder

    KW - Female

    KW - General Practice

    KW - Humans

    KW - Kaplan-Meier Estimate

    KW - Male

    KW - Medication Adherence

    KW - Middle Aged

    KW - Physician's Practice Patterns

    KW - Scotland

    KW - Socioeconomic Factors

    U2 - 10.3399/bjgp12X625166

    DO - 10.3399/bjgp12X625166

    M3 - Article

    VL - 62

    SP - e104-112

    JO - The British Journal of General Practice

    JF - The British Journal of General Practice

    SN - 0960-1643

    IS - 595

    ER -