scholarly journals Trends in antidepressant prescriptions in children and young people in England, 1998–2017: protocol of a cohort study using linked primary care and secondary care datasets

2019 ◽  
Vol 22 (3) ◽  
pp. 129-133 ◽  
Author(s):  
Ruth H Jack ◽  
Chris Hollis ◽  
Carol Coupland ◽  
Richard Morriss ◽  
Roger David Knaggs ◽  
...  
Keyword(s):  
Primary Care ◽  
Young People ◽  
Secondary Care ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Large Population ◽  
Population Based ◽  
Population Based Study ◽  
Children And Young People ◽  
Antidepressant Prescription ◽  
Trends Over Time

IntroductionIncreasing numbers of children and young people (CYP) are receiving prescriptions for antidepressants. This is the protocol of a study aiming to describe the trends and variation in antidepressant prescriptions in CYP in England, and to examine the indications for the prescriptions recorded and whether there was contact with secondary care specialists on or around the time of the first antidepressant prescription.Methods and analysisAll eligible CYP aged between 5 and 17 years in 1998–2017 from the QResearch primary care database will be included. Incidence and prevalence rates of any antidepressant prescription in each year will be calculated. We will examine four different antidepressant classes: selective serotonin reuptake inhibitors, tricyclic and related antidepressants, serotonin and norepinephrine reuptake inhibitors and other antidepressants, as well as for individual drugs. Linked primary and secondary care data (hospital episode statistics) in the year before and up to 6 months after the first antidepressant prescription will be examined for CYP whose first antidepressant prescription was in 2006–2017. Whether there were records of indications and being seen by psychiatric or paediatric specialists will be identified. Trends over time and differences by region, deprivation and ethnicity will be examined using Poisson regression.DiscussionThis large, population-based study will give an up-to-date picture of antidepressant prescribing in CYP and identify any variation. Understanding what indications are recorded when CYP are being prescribed antidepressants, and whether this was done in partnership with secondary care specialists, will provide evidence of whether appropriate guidelines are being followed.

scholarly journals GPs’ role in caring for children and young people with life-limiting conditions: a retrospective cohort study

2020 ◽  
Vol 70 (693) ◽  
pp. e221-e229
Author(s):  
Stuart Jarvis ◽  
Roger C Parslow ◽  
Catherine Hewitt ◽  
Sarah Mitchell ◽  
Lorna K Fraser
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Young People ◽  
Retrospective Cohort Study ◽  
Secondary Care ◽  
Retrospective Cohort ◽  
Clinical Practice Research Datalink ◽  
Children And Young People ◽  
Attendance Patterns ◽  
Significant Difference

BackgroundGPs are rarely actively involved in healthcare provision for children and young people (CYP) with life-limiting conditions (LLCs). This raises problems when these children develop minor illness or require management of other chronic diseases.AimTo investigate the association between GP attendance patterns and hospital urgent and emergency care use.Design and settingRetrospective cohort study using a primary care data source (Clinical Practice Research Datalink) in England. The cohort numbered 19 888.MethodCYP aged 0–25 years with an LLC were identified using Read codes (primary care) or International Classification of Diseases 10 th Revision (ICD-10) codes (secondary care). Emergency inpatient admissions and accident and emergency (A&E) attendances were separately analysed using multivariable, two-level random intercept negative binomial models with key variables of consistency and regularity of GP attendances.ResultsFace-to-face GP surgery consultations reduced, from a mean of 7.12 per person year in 2000 to 4.43 in 2015. Those consulting the GP less regularly had 15% (95% confidence interval [CI] = 10% to 20%) more emergency admissions and 5% more A&E visits (95% CI = 1% to 10%) than those with more regular consultations. CYP who had greater consistency of GP seen had 10% (95% CI = 6% to 14%) fewer A&E attendances but no significant difference in emergency inpatient admissions than those with lower consistency.ConclusionThere is an association between GP attendance patterns and use of urgent secondary care for CYP with LLCs, with less regular GP attendance associated with higher urgent secondary healthcare use. This is an important area for further investigation and warrants the attention of policymakers and GPs, as the number of CYP with LLCs living in the community rises.

scholarly journals What were the impacts of the Committee on Safety of Medicines warning and publication of the NICE guidelines on trends in child and adolescent antidepressant prescribing in primary care? A population based study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028201 ◽  
Author(s):  
Paul A Tiffin ◽  
Jose L Mediavilla ◽  
Helen Close ◽  
Adetayo S Kasim ◽  
Patrick Welsh ◽  
...  
Keyword(s):  
Primary Care ◽  
Psychosocial Interventions ◽  
Child And Adolescent ◽  
Population Based ◽  
Diagnostic Code ◽  
Population Based Study ◽  
Nice Guidelines ◽  
Antidepressant Prescription ◽  
Prescription Rates ◽  
The Impact

ObjectivesTo assess the impact of both the Committee on Safety of Medicines (CSM) warning (December 2003) and the National Institute for Health and Care Excellence (NICE) guidance (September 2005) on antidepressant prescription rates in children and adolescents within the UK primary care service.SettingPopulation based study of primary care antidepressant prescribing using the Clinical Practice Research Datalink (CPRD).ParticipantsUnder-18s presenting to primary care with a depressive disorder or related diagnostic code recorded in the CPRD.Primary outcome measureAntidepressant prescription rates per month per 100 000 depressed 4–17 year olds.ResultsFollowing the CSM warning, the prior trend towards increased prescribing rates for selective serotonin reuptake inhibitors (SSRIs) in children was significantly reversed (β for change in trend −12.34 (95% CI −18.67 to −6.00, p<0.001)). However, after the publication of the NICE guidelines the prior trend towards increased prescribing resumed for those SSRIs mentioned as potential treatments in the guidance (fluoxetine, citalopram and sertraline) (β for change in trend 11.52 (95% CI 5.32 to 17.73, p<0.001)). Prescribing of other SSRIs and tricyclics remained low.ConclusionsDespite a strong emphasis on psychosocial interventions for child and adolescent depression, it may be that the NICE guidelines inadvertently encouraged further antidepressant prescribing, at least for those SSRIs cited. Although the guidelines gave cautions and caveats for the use of antidepressants, practitioners may have interpreted these recommendations as endorsing their use in young people with depression and related conditions. However, more accurate prevalence trend estimates for depression in this age group, and information on the use of psychosocial interventions would be needed to rule out other reasons underlying this increase in prescribing.

Sign in / Sign up

Export Citation Format

Share Document