Mental illness in primary care: a narrative review of patient, GP and population factors that affect prescribing rates

2018 ◽  
Vol 37 (1) ◽  
pp. 59-66
Author(s):  
H. Tobin ◽  
G. Bury ◽  
W. Cullen
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
General Practice ◽  
Psychotropic Drugs ◽  
Social Deprivation ◽  
Narrative Review ◽  
The United Kingdom ◽  
Prisma Statement ◽  
General Practices ◽  
And Gender

BackgroundMental illness poses a large and growing disease burden worldwide. Its management is increasingly provided by primary care. The prescribing of psychotropic drugs in general practice has risen in recent decades, and variation in prescribing rates has been identified by a number of studies. It is unclear which factors lead to this variation.AimTo describe the variables that cause variation in prescribing rates for psychotropic drugs between general practices.MethodsA narrative review was conducted in January 2018 by searching electronic databases using the PRISMA statement. Studies investigating causal factors for variation in psychotropic prescribing between at least two general practice sites were eligible for inclusion.ResultsTen studies met the inclusion criteria. Prescribing rates varied considerably between practices. Positive associations were found for many variables, including social deprivation, ethnicity, patient age and gender, urban location, co-morbidities, chronic diseases and GP demographics. However studies show conflicting findings, and no single regression model explained more than 57% of the variation in prescribing rates.DiscussionThere is no consensus on the factors that most predict prescribing rates. Most research was conducted in countries with central electronic databases, such as the United Kingdom; it is unclear whether these findings apply in other healthcare systems. More research is needed to determine the variables that explain prescribing rates for psychotropic medications.

scholarly journals Cross sectional study estimating prevalence of heart failure and left ventricular systolic dysfunction in community patients at risk

Heart ◽  
2001 ◽  
Vol 86 (2) ◽  
pp. 172-178 ◽  
Author(s):  
O W Nielsen ◽  
J Hilden ◽  
C T Larsen ◽  
J F Hansen
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Heart Disease ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Cross Sectional ◽  
General Practices

OBJECTIVETo examine a general practice population to measure the prevalence of signs and symptoms of heart failure (SSHF) and left ventricular systolic dysfunction (LVSD).DESIGNCross sectional screening study in three general practices followed by echocardiography.SETTING AND PATIENTSAll patients ⩾ 50 years in two general practices and ⩾ 40 years in one general practice were screened by case record reviews and questionnaires (n = 2158), to identify subjects with some evidence of heart disease. Among these, subjects were sought who had SSHF (n = 115). Of 357 subjects with evidence of heart disease, 252 were eligible for examination, and 126 underwent further cardiological assessment, including 43 with SSHF.MAIN OUTCOME MEASURESPrevalence of SSHF as defined by a modified Boston index, LVSD defined as an indirectly measured left ventricular ejection fraction ⩽ 0.45, and numbers of subjects needing an echocardiogram to detect one case with LVSD.RESULTSSSHF afflicted 0.5% of quadragenarians and rose to 11.7% of octogenarians. Two thirds were handled in primary care only. At ⩾ 50 years of age 6.4% had SSHF, 2.9% had LVSD, and 1.9% (95% confidence interval 1.3% to 2.5%) had both. To detect one case with LVSD in primary care, 14 patients with evidence of heart disease without SSHF and 5.5 patients with SSHF had to be examined.CONCLUSIONSSHF is extremely prevalent in the community, especially in primary care, but more than two thirds do not have LVSD. The number of subjects with some evidence of heart disease needing an echocardiogram to detect one case of LVSD is 14.

scholarly journals Mental Illness in Primary Care Settings

1985 ◽  
Vol 9 (1) ◽  
pp. 12-13 ◽  
Author(s):  
Greg Wilkinson
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
General Practice ◽  
Social Security ◽  
General Practitioners ◽  
Research Unit ◽  
Practice Research ◽  
Policy Makers ◽  
Department Of Health ◽  
Primary Care Settings

A Conference on the above topic took place at the Institute of Psychiatry, London, on 17 and 18 July 1984. The Conference was sponsored by the Department of Health and Social Security and was organized by the General Practice Research Unit. Over 100 invited clinicians, research workers and policy-makers took part. The majority of the participants were either psychiatrists or general practitioners, but representatives of all relevant disciplines attended.

scholarly journals Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035087
Author(s):  
Karen Cardwell ◽  
Susan M Smith ◽  
Barbara Clyne ◽  
Laura McCullagh ◽  
Emma Wallace ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Pilot Study ◽  
Medication Review ◽  
Controlled Trial ◽  
Cost Savings ◽  
Practice Team ◽  
Patient Reported ◽  
General Practices ◽  
Medication Changes

ObjectiveLimited evidence suggests integration of pharmacists into the general practice team could improve medicines management for patients, particularly those with multimorbidity and polypharmacy. This study aimed to develop and assess the feasibility of an intervention involving pharmacists, working within general practices, to optimise prescribing in Ireland.DesignNon-randomised pilot study.SettingPrimary care in Ireland.ParticipantsFour general practices, purposively sampled and recruited to reflect a range of practice sizes and demographic profiles.InterventionA pharmacist joined the practice team for 6 months (10 hours/week) and undertook medication reviews (face to face or chart based) for adult patients, provided prescribing advice, supported clinical audits and facilitated practice-based education.Outcome measuresAnonymised practice-level medication (eg, medication changes) and cost data were collected. Patient-reported outcome measure (PROM) data were collected on a subset of older adults (aged ≥65 years) with polypharmacy using patient questionnaires, before and 6 weeks after medication review by the pharmacist.ResultsAcross four practices, 786 patients were identified as having 1521 prescribing issues by the pharmacists. Issues relating to deprescribing medications were addressed most often by the prescriber (59.8%), compared with cost-related issues (5.8%). Medication changes made during the study equated to approximately €57 000 in cost savings assuming they persisted for 12 months. Ninety-six patients aged ≥65 years with polypharmacy were recruited from the four practices for PROM data collection and 64 (66.7%) were followed up. There were no changes in patients’ treatment burden or attitudes to deprescribing following medication review, and there were conflicting changes in patients’ self-reported quality of life.ConclusionsThis non-randomised pilot study demonstrated that an intervention involving pharmacists, working within general practices is feasible to implement and has potential to improve prescribing quality. This study provides rationale to conduct a randomised controlled trial to evaluate the clinical and cost-effectiveness of this intervention.

scholarly journals A Psychiatric Clinic in General Practice

1987 ◽  
Vol 11 (4) ◽  
pp. 114-117 ◽  
Author(s):  
Sally M. Browning ◽  
Michael F. Ford ◽  
Cait A. Goddard ◽  
Alexander C. Brown
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
General Practice ◽  
Psychiatric Disorder ◽  
Personality Disorders ◽  
Psychiatric Service ◽  
Significant Degree ◽  
Care Team ◽  
Primary Care Team ◽  
Psychiatric Clinic

Only a minority suffering from mental illness are treated by the specialist psychiatric service. The majority of psychiatrically ill patients seen in general practice suffer from minor neuroses, personality disorders and situational reactions and can be appropriately treated by the primary care team. However, a significant degree of morbidity, some of it severe, fails to be identified in general practice and the identification and treatment of psychiatric disorder varies according to the GP's interest and attitudes.

scholarly journals The links between the amount of antipsychotic medication prescribed at GP practice level, local demographic factors and medication selection

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S165-S166
Author(s):  
Adrian Heald ◽  
Mike Stedman ◽  
Sanam Farman ◽  
Mark Davies ◽  
Roger Gadsby ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Antipsychotic Medication ◽  
Demographic Factors ◽  
Mental Illnesses ◽  
World Health ◽  
Pharmacological Intervention ◽  
Practice Population ◽  
General Practices ◽  
Antipsychotic Prescribing

AimsTo examine the factors that relate to antipsychotic prescribing in general practices across England and how these relate to cost changes in recent years.BackgroundAntipsychotic medications are the first-line pharmacological intervention for severe mental illnesses(SMI) such as schizophrenia and other psychoses, while also being used to relieve distress and treat neuropsychiatric symptoms in dementia.Since 2014 many antipsychotic agents have moved to generic provision. In 2017_18 supplies of certain generic agents were affected by substantial price increases.MethodThe study examined over time the prescribing volume and prices paid for antipsychotic medication by agent in primary care and considered if price change affected agent selection by prescribers.The NHS in England/Wales publishes each month the prescribing in general practice by BNF code. This was aggregated for the year 2018_19 using Defined Daily doses (DDD) as published by the World Health Organisation Annual Therapeutic Classification (WHO/ATC) and analysed by delivery method and dose level. Cost of each agent year-on-year was determined.Monthly prescribing in primary care was consolidated over 5 years (2013-2018) and DDD amount from WHO/ATC for each agent was used to convert the amount to total DDD/practice.ResultDescriptionIn 2018_19 there were 10,360,865 prescriptions containing 136 million DDD with costs of £110 million at an average cost of £0.81/DDD issued in primary care. We included 5,750 GP Practices with practice population >3000 and with >30 people on their SMI register.Effect of priceIn 2017_18 there was a sharp increase in overall prices and they had not reduced to expected levels by the end of the 2018_19 evaluation year. There was a gradual increase in antipsychotic prescribing over 2013-2019 which was not perturbed by the increase in drug price in 2017/18.RegressionDemographic factorsThe strongest positive relation to increased prescribing of antipsychotics came from higher social disadvantage, higher population density(urban), and comorbidities e.g. chronic obstructive pulmonary disease(COPD). Higher %younger and %older populations, northerliness and non-white (Black and Minority Ethnic (BME)) ethnicity were all independently associated with less antipsychotic prescribing.Prescribing FactorsHigher DDD/general practice population was linked with higher %injectable, higher %liquid, higher doses/prescription and higher %zuclopenthixol. Less DDD/population was linked with general practices using higher %risperidone and higher spending/dose of antipsychotic.ConclusionHigher levels of antipsychotic prescribing are driven by social factors/comorbidities. The link with depot medication prescriptions, alludes to the way that antipsychotics can induce receptor supersensitivity with consequent dose escalation.

scholarly journals Links between the amount of antipsychotic medication prescribed per population at general practice level, local demographic factors and medication selection

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
A. H. Heald ◽  
M. Stedman ◽  
S. Farman ◽  
C. Khine ◽  
M. Davies ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Antipsychotic Medication ◽  
Mental Illnesses ◽  
Pharmacological Intervention ◽  
Defined Daily Dose ◽  
Practice Level ◽  
Practice Population ◽  
General Practices ◽  
Antipsychotic Prescribing

Abstract Background Antipsychotic medications are the first-line pharmacological intervention for severe mental illnesses (SMI) such as schizophrenia and other psychoses, while also being used to relieve distress and treat neuropsychiatric symptoms in dementia. Our aim was to examine the factors relating to antipsychotic prescribing in general practices across England and how cost changes in recent years have impacted on antipsychotic prescribing. Methods The study examined over time the prescribing volume and prices paid for antipsychotic medication by agent in primary care. Monthly prescribing in primary care was consolidated over 5 years (2013–2018) and DDD amount from WHO/ATC for each agent was used to convert the amount to total DDD/practice. The defined Daily Dose (DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. Results We included 5750 general practices with practice population > 3000 and with > 30 people on their SMI register. In 2018/19 there were 10,360,865 prescriptions containing 136 million DDD with costs of £110 million at an average cost of £0.81/DDD issued in primary care. In 2017/18 there was a sharp increase in overall prices and they had not reduced to expected levels by the end of the 2018/19 evaluation year. There was a gradual increase in antipsychotic prescribing over 2013–2019 which was not perturbed by the increase in drug price in 2017/18. The strongest positive relation to increased prescribing of antipsychotics came from higher social disadvantage, higher population density (urban), and comorbidities e.g. chronic obstructive pulmonary disease (COPD). Higher % younger and % older populations, northerliness and non-white (Black and Minority Ethnic(BAME)) ethnicity were all independently associated with less antipsychotic prescribing. Higher DDD/general practice population was linked with higher proportion(%) injectable, higher %liquid, higher doses/prescription and higher %zuclopenthixol depot. Less DDD/population was linked with general practices using higher % risperidone and higher spending/dose of antipsychotic. Conclusions The levels of antipsychotic prescribing at general practice level are driven by social factors/comorbidities. We found a link between depot prescriptions with higher antipsychotic DDD and risperidone prescriptions with lower antipsychotic DDD. It is important that all prescribers are aware of these drivers / links.

Behavioural change in primary care professionals undertaking online education in dementia care in general practice

2019 ◽  
Vol 25 (3) ◽  
pp. 244 ◽  
Author(s):  
Michael W. Bentley ◽  
Rohan Kerr ◽  
Margaret Ginger ◽  
Jacob Karagoz
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Online Education ◽  
Behavioural Change ◽  
Dementia Care ◽  
Practice Nurses ◽  
People With Dementia ◽  
General Practices ◽  
Primary Care Professionals ◽  
Systematic Framework

A challenge facing general practice is improving the diagnosis, management and care of people with dementia. Training and education for primary care professionals about knowledge and attitudes about dementia is needed. Online resources can provide educational opportunities for health professionals with limited access to dementia training. An online educational resource (four modules over 3 h) was designed to assist primary care practitioners to develop a systematic framework to identify, diagnose and manage patients with dementia within their practice. Interviews and questionnaires (knowledge, attitudes, confidence and behavioural intentions), with practice nurses and international medical graduates working in general practices, were used to evaluate the resource. Participants’ knowledge, confidence and attitudes about dementia increased after completing the modules. Participants had strong intentions to apply a systematic framework to identify and manage dementia. In post-module interviews, participants reported increased awareness, knowledge and confidence in assessing and managing people with dementia, corroborating the questionnaire results. This project has demonstrated some early changes in clinical behaviour around dementia care in general practice. Promoting the value of applying a systematic framework with colleagues and co-workers could increase awareness of, and participation in, dementia assessment by other primary care professionals within general practices.

scholarly journals Forthcoming Events

1984 ◽  
Vol 8 (3) ◽  
pp. 59-60
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
General Practice ◽  
Treatment Effectiveness ◽  
Research Unit ◽  
Practice Research ◽  
Future Trends ◽  
Department Of Health ◽  
Primary Care Settings ◽  
Research And Policy

The Department of Health and Social Security is sponsoring a conference on ‘Mental Illness in Primary Care Settings’ which will be held at the Institute of Psychiatry on 17 and 18 July 1984. The conference is being organized by the General Practice Research Unit. Topics will include classification, screening, treatment effectiveness, patterns of collaboration, international developments and future trends for research and policy. Although attendance will be by invitation only, limited places may be available. Those interested should contact Dr D. G. Wilkinson, General Practice Research Unit, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AZ, from whom further information is available.

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