Are Antidepressants Overprescribed? Patients' Experiences of the Prescribing Process

2020 ◽  
Vol 22 (2) ◽  
pp. 83-97
Author(s):  
John Read ◽  
Claire Cartwright ◽  
Kerry Gibson
Keyword(s):  
New Zealand ◽  
Informed Consent ◽  
Adverse Effects ◽  
General Practitioners ◽  
Online Survey ◽  
Severe Depression ◽  
Evidence Based ◽  
Withdrawal Effects

An online survey was completed by 1,829 New Zealand adults prescribed antidepressants. Only 43% were experiencing self-reported “severe” depression when first prescribed antidepressants. Thus, most prescriptions were for depression that was self-reported as mild or moderate, despite studies suggesting that antidepressants are no more effective than placebo at these levels. General practitioners (GPs) prescribed at lower depression levels than psychiatrists and spent less time with patients. Thirty-five percent of GPs and 42% of psychiatrists reportedly gave no information about adverse effects. Almost no prescribers gave information about adverse effects in the personal and interpersonal domains, or about withdrawal effects. Closer adherence to evidence-based prescribing and to the principle of informed consent may lead to a reduction in unnecessary, ineffective, and potentially harmful prescribing.

scholarly journals A survey of UK general practitioners about depression, antidepressants and withdrawal: implementing the 2019 Public Health England report

2020 ◽  
Vol 10 ◽  
pp. 204512532095012 ◽  
Author(s):  
John Read ◽  
Julia Renton ◽  
Christopher Harrop ◽  
Jim Geekie ◽  
Christopher Dowrick
Keyword(s):  
Public Health ◽  
Online Survey ◽  
Severe Depression ◽  
Small Sample ◽  
Mild Depression ◽  
Psychological Therapies ◽  
To Come ◽  
Training Programmes ◽  
The Uk ◽  
Withdrawal Effects

Background: In 2019, a literature review indicated that more than half of people who try to come off antidepressants experience withdrawal effects. Both the National Institute of Health and Care Excellence and the Royal College of Psychiatrists updated their positions in line with that review, and Public Health England published a 152-page report called Dependence and withdrawal associated with some prescribed medicines: an evidence review. The report made several recommendations relevant to general practice. Method: In order to facilitate implementation of these recommendations, an online survey was designed to explore United Kingdom general practitioner (GP) experiences, opinions, knowledge and needs in relation to depression, ADs and withdrawal. A total of 66 GPs had completed the survey when COVID-19 occurred. Results: In keeping with previous findings, this small sample of GPs had a predominantly psycho-social perspective on the causes of, and treatments for, depression. They broadly considered ADs effective for moderate/severe depression and ineffective for minimal/mild depression, for which they preferred psychological therapies and social prescribing. There was a marked lack of consistency in GPs’ knowledge about the incidence and duration of withdrawal effects. Only a minority (29%) felt their knowledge about withdrawal was ‘adequate’ and fewer (17%) believed this about their ‘Ability to distinguish between withdrawal effects and return of the original problem (e.g. depression)’. Two-thirds (68%) would like more training on these matters. Conclusion: It is hoped that even this small sample will be helpful when designing, and seeking funding for, GP training programmes, and when implementing the PHE recommendations for support services, based in the primary care system, for the millions of people contemplating or initiating withdrawal from ADs every year in the UK.

scholarly journals Impact of guideline awareness on the counseling of patients with acute cough among general practitioners and pharmacy personnel

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0254086
Author(s):  
Peter Kardos ◽  
Kai-Michael Beeh ◽  
Ulrike Sent ◽  
Guido Bissmann
Keyword(s):  
Decision Making ◽  
General Practitioners ◽  
Online Survey ◽  
Clinical Decision Making ◽  
Daily Practice ◽  
Clinical Decision ◽  
Case Vignette ◽  
Guideline Recommendation ◽  
Evidence Based ◽  
Acute Cough

Objective To explore the awareness and knowledge of applicable guidelines on acute cough among general practitioners, pharmacists and pharmacy technicians and to compare their recommendation behavior and clinical decision making to the evidence-based recommendation in the applicable guidelines. Methods An anonymous online survey was performed among 303 members of an existing panel of healthcare professionals (HCPs). They were presented with a hypothetical case vignette representative of their daily practice and asked for their treatment recommendations. After being shown an excerpt from the applicable guidelines, these questions were repeated. Results Forty-six % of participants reported to seek information on cough and respiratory conditions very often or often. Among 12 non-prescription treatments-commonly used over-the-counter-products for acute cough, HCPs most often recommended various plant extract-based products (phytotherapeutic remedies) for the acute cough case, whereas chemically defined options such as ambroxol or N-acetyl-cysteine were recommended less often. Following presentation of the guidelines excerpt, recommendations of the phytotherapeutic remedies decreased moderately whereas that of the guideline-recommended ambroxol more than doubled. Among stated reasons for the recommendation guideline conformity increased from 5% to 35% among the top-3 reasons. Conclusions The recommendations for the treatment of acute cough by professionals involved in primary healthcare deviated considerably from the applicable guideline recommendation but changed after presentation of a guidelines excerpt and knowledge thereof. We conclude that dissemination of applicable guideline knowledge is relevant to improve evidence-based healthcare and clinical decision making.

Book Review: Jolly, J.L., & Jarvis, J.M. (Eds). (2018). Exploring Gifted Education: Australian and New Zealand Perspectives. Melbourne, Australia: Routledge.

2020 ◽  
pp. 54-59
Keyword(s):  
New Zealand ◽  
Gifted Education ◽  
Research Agenda ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Central Thesis ◽  
Research Findings ◽  
Areas Of Concern

In this first edition book, editors Jolly and Jarvis have compiled a range of important, contemporary gifted education topics. Key areas of concern focus on evidence-based practices and research findings from Australia and New Zealand. Other contributors include 14 gifted education experts from leading Australian and New Zealand Universities and organisations. Exploring Gifted Education: Australian and New Zealand Perspectives, introduced by the editors, is well organised. Jolly and Jarvis’s central thesis in their introduction is to acknowledge the disparity between policy, funding and practice in Australia and New Zealand. Specifically, in relation to Australia, they note that a coordinated, national research agenda is absent, despite recommendations published by the Australian Senate Inquiry almost 20 years ago.

Cola Beverages: Clinical Uses versus Adverse Effects

2019 ◽  
Vol 15 (2) ◽  
pp. 130-139
Author(s):  
Ehsan T. Moghaddam ◽  
Ali Tafazoli
Keyword(s):  
Adverse Effects ◽  
Health Risks ◽  
Feeding Tube ◽  
Evidence Based ◽  
Journal Articles ◽  
Healthcare Settings ◽  
Pubmed Database ◽  
Excessive Consumption ◽  
Points Of View ◽  
Medical Articles

Background: Excessive consumption of cola beverages is accompanied by numerous public health risks. But besides these well-known adverse effects, recently, several medical articles have been published that show some indications for cola beverages in clinical practice like resolution of gastrointestinal or feeding tube obstructions, increasing bioavailability and palatability of other medications, rehydration and other uses in healthcare settings. These approaches are not without shortcomings and complications. Methods: In this systematic review we tried to explore these new uses for practitioners and also reemphasize on the most evidence-based complications of cola consumption like bone loss and metabolic and cardiovascular adverse effects in cases of misuse and overuse from both clinical and nutritional points of view via searching the PubMed database. Results: We chose 145 journal articles from the most relevant ones plus 30 extra references and categorized their topics in two classes of medical uses and adverse effects. Conclusion: It could be stated that cola beverages have demonstrated interesting uses and benefits in medicine but their use should be regulated as strict as possible.

scholarly journals Development, piloting, and evaluation of an evidence-based informed consent form for total knee arthroplasty (EvAb-Pilot): a protocol for a mixed methods study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Alina Weise ◽  
Julia Lühnen ◽  
Stefanie Bühn ◽  
Felicia Steffen ◽  
Sandro Zacher ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Informed Consent ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Evidence Based ◽  
Nocebo Effect ◽  
Legal Requirements ◽  
Consent Forms ◽  
Link Type ◽  
Total Knee

Abstract Background Practitioners frequently use informed consent forms to support the physician-patient communication and the informed consent process. Informed consent for surgery often focuses on risk centered information due to high liability risks for treatment errors. This may affect patients’ anxiety of adverse events and the nocebo effect. This study focuses on the optimization of pre-surgical information on risks and complications, and at the same time reconciles these information with legal requirements. Methods The development, piloting, and evaluation of evidence-based informed consent forms for total knee arthroplasty (TKA) and related anesthesia procedures will follow the UK MRC Framework for developing and evaluating complex interventions. Conducting different sub-studies, we will (I) qualitatively explore the information acquisition and decision-making processes, (II) develop and pilot test evidence-based informed consent forms on the example of TKA and related anesthesia procedures, (III) conduct a monocentric interrupted time series (ITS) pilot study to evaluate the effects of evidence-based informed consent forms in comparison with standard consent forms, and (IV) perform a process evaluation to identify barriers and facilitators to the implementation of the intervention and to analyze mechanisms of impact. Discussion The evidence-based and understandable presentation of risks in informed consent forms aims at avoiding distorted risk depiction and strengthening the patients’ competencies to correctly assess the risks of undergoing surgery. This might reduce negative expectations and anxiety of adverse events, which in turn might reduce the nocebo effect. At the same time, the practitioners’ acceptance of evidence-based informed consent forms meeting legal requirements could be increased. Trial registration ClinicalTrials.gov, NCT04669483. Registered 15 December 2020. German Clinical Trials Registry, DRKS00022571. Registered 15 December 2020

scholarly journals Exploring the Frequency of Anxiety and Depression Symptoms in a Brazilian Sample during the COVID-19 Outbreak

2021 ◽  
Vol 18 (9) ◽  
pp. 4847
Author(s):  
Fabiana Silva Ribeiro ◽  
Flávia H. Santos ◽  
Luis Anunciação ◽  
Lucas Barrozo ◽  
Jesus Landeira-Fernandez ◽  
...  
Keyword(s):  
Mental Health Professionals ◽  
Online Survey ◽  
Age Groups ◽  
Health Sector ◽  
Severe Depression ◽  
Well Being ◽  
Sociodemographic Factors ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
Brazilian Sample

The COVID-19 pandemic is a public health emergency of international concern, and the main measures to contain the spread of the coronavirus causing COVID-19 were social distancing, quarantine, and self-isolation. Although these policies are effective in containing the spread of the virus, they might represent a challenge to psychological well-being, increasing levels of depressive and anxiety-related symptoms. Aims: We explored the frequency of anxiety and depression symptoms during COVID-19 restrictions and associations with sociodemographic factors in a Brazilian sample. Method: Data of a total of 936 Brazilian adults (68.2% women) aged 18 to 77 years old (M = 38.95, SD = 13.91) were collected through an online survey. Results: In general, we observed a frequency of 17.36% for severe anxiety and 66.13% for severe depression symptoms, in which younger participants (18–39 years old) and women showed higher scores in anxiety and depression scales compared to older age groups. Logistic regressions showed that women were more likely to present severe symptoms of anxiety (20.4%) compared to men (10.9%), as well as respondents in the educational sector (24.3%) compared to those in the health sector (10%). Conclusions: We highlight the importance of mental health professionals in developing strategies to help younger adults to mitigate the effects of social restriction.

scholarly journals Older and Wiser? The Need to Reexamine the Impact of Health Professionals Age and Experience on Competency-Based Practices

2021 ◽  
Vol 7 ◽  
pp. 237796082110290
Author(s):  
Jing Xu ◽  
Kristen Hicks-Roof ◽  
Chloe E. Bailey ◽  
Hanadi Y. Hamadi
Keyword(s):  
Health Professionals ◽  
Online Survey ◽  
Evidence Based Practice ◽  
Core Competencies ◽  
Healthcare Services ◽  
Interdisciplinary Teams ◽  
Evidence Based ◽  
Health Providers ◽  
Cross Sectional ◽  
The Impact

Introduction Delivery of healthcare services makes up a complex system and it requires providers to be competent and to be able to integrate each of the institute of medicine’s (IOM) 5 core competencies into practice. However, healthcare providers are challenged with the task to be able to understand and apply the IOM core competencies into practice. Objective The purpose of the study was to examine the factors that influence health professional’s likelihood of accomplishing the IOM core competencies. Methods A cross-sectional study design was used to administer a validated online survey to health providers. This survey was distributed to physicians, nursing professionals, specialists, and allied healthcare professionals. The final sample included 3,940 participants who completed the survey. Results The study findings show that younger health professionals more consistently practice daily competencies than their older counterparts, especially in the use of evidence-based practice, informatics, and working in interdisciplinary teams. Less experienced health professionals more consistently applied quality improvement methods but less consistently used evidence-based practice compared to their more experienced counterparts. Conclusion There is a need to understand how health professionals’ age and experience impact their engagement with IOM’s core competencies. This study highlights the need for educational resources on the competencies to be tailored to health providers’ age and experience.

scholarly journals A survey of clinicians on the use of artificial intelligence in ophthalmology, dermatology, radiology and radiation oncology

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jane Scheetz ◽  
Philip Rothschild ◽  
Myra McGuinness ◽  
Xavier Hadoux ◽  
H. Peter Soyer ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
New Zealand ◽  
Radiation Oncology ◽  
Online Survey ◽  
New Technology ◽  
Medical Liability ◽  
Healthcare Outcomes ◽  
Medical Workforce ◽  
Artificial Intelligence Technology ◽  
Workforce Needs

AbstractArtificial intelligence technology has advanced rapidly in recent years and has the potential to improve healthcare outcomes. However, technology uptake will be largely driven by clinicians, and there is a paucity of data regarding the attitude that clinicians have to this new technology. In June–August 2019 we conducted an online survey of fellows and trainees of three specialty colleges (ophthalmology, radiology/radiation oncology, dermatology) in Australia and New Zealand on artificial intelligence. There were 632 complete responses (n = 305, 230, and 97, respectively), equating to a response rate of 20.4%, 5.1%, and 13.2% for the above colleges, respectively. The majority (n = 449, 71.0%) believed artificial intelligence would improve their field of medicine, and that medical workforce needs would be impacted by the technology within the next decade (n = 542, 85.8%). Improved disease screening and streamlining of monotonous tasks were identified as key benefits of artificial intelligence. The divestment of healthcare to technology companies and medical liability implications were the greatest concerns. Education was identified as a priority to prepare clinicians for the implementation of artificial intelligence in healthcare. This survey highlights parallels between the perceptions of different clinician groups in Australia and New Zealand about artificial intelligence in medicine. Artificial intelligence was recognized as valuable technology that will have wide-ranging impacts on healthcare.

A Survey of Neonatal Nurses on Mydriatic Regimens Used in Neonatal Retinopathy of Prematurity Eye Examinations

2021 ◽  
Author(s):  
Lisa Kremer ◽  
David Reith ◽  
Natalie J. Medlicott ◽  
Mary J. Sime ◽  
Liza Edmonds ◽  
...  
Keyword(s):  
New Zealand ◽  
Adverse Effects ◽  
Retinopathy Of Prematurity ◽  
Adverse Drug Events ◽  
Preterm Neonates ◽  
Eye Drops ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Aotearoa New Zealand ◽  
Adult Dose

Objective This study was aimed to determine mydriatic regimen(s) used in neonatal units in Aotearoa New Zealand (NZ) and Australia and to estimate the frequency of adverse drug events following mydriatic administration in preterm neonates. Study Design A cross-sectional survey was sent to neonatal nursing staff listed in the Australian and New Zealand Neonatal Network contact list. Participants were asked to state what mydriatic regimen they use, and to estimate the frequency of adverse drug events when eye drops were administered for retinopathy of prematurity eye examinations (ROPEE). Results Thirteen different mydriatic regimens were identified; phenylephrine 2.5% and cyclopentolate 0.5% (1 standard drop of each) was the most commonly used regimen. Two of the regimens exceeded adult doses and five regimens included a mydriatic that is equivalent to an adult dose. Following mydriatic instillation, the three most common adverse effects were apnea, tachycardia, and periorbital pallor. Conclusion Low-concentration single-microdrop regimens are currently in use and resulting in successful ROPEE, yet doses exceeding adult doses are in use throughout Aotearoa NZ and Australian units. We know from this dataset that neonates are experiencing unwanted and potentially preventable, adverse effects associated with mydriatics, and every effort should be made to minimize this risk. Key Points

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