Long-term antidepressant use: a qualitative study on perspectives of patients and GPs in primary care

IntroductionPeople presenting with shoulder pain considered to be of musculoskeletal origin is common in primary care but diagnosing the cause of the pain is contentious, leading to uncertainty in management. To inform optimal primary care for patients with shoulder pain, the study aims to (1) to investigate the short-term and long-term outcomes (overall prognosis) of shoulder pain, (2) estimate costs of care, (3) develop a prognostic model for predicting individuals’ level and risk of pain and disability at 6 months and (4) investigate experiences and opinions of patients and healthcare professionals regarding diagnosis, prognosis and management of shoulder pain.Methods and analysisThe Prognostic And Diagnostic Assessment of the Shoulder (PANDA-S) study is a longitudinal clinical cohort with linked qualitative study. At least 400 people presenting to general practice and physiotherapy services in the UK will be recruited. Participants will complete questionnaires at baseline, 3, 6, 12, 24 and 36 months. Short-term data will be collected weekly between baseline and 12 weeks via Short Message Serevice (SMS) text or software application. Participants will be offered clinical (physiotherapist) and ultrasound (sonographer) assessments at baseline. Qualitative interviews with ≈15 dyads of patients and their healthcare professional (general practitioner or physiotherapist).Short-term and long-term trajectories of Shoulder Pain and Disability Index (using SPADI) will be described, using latent class growth analysis. Health economic analysis will estimate direct costs of care and indirect costs related to work absence and productivity losses. Multivariable regression analysis will be used to develop a prognostic model predicting future levels of pain and disability at 6 months using penalisation methods to adjust for overfitting. The added predictive value of prespecified physical examination tests and ultrasound findings will be examined. For the qualitative interviews an inductive, exploratory framework will be adopted using thematic analysis to investigate decision making, perspectives of patients and clinicians on the importance of diagnostic and prognostic information when negotiating treatment and referral options.Ethics and disseminationThe PANDA-S study has ethical approval from Yorkshire and The Humber-Sheffield Research Ethics Committee, UK (18/YH/0346, IRAS Number: 242750). Results will be disseminated through peer-reviewed publications, social and mainstream media, professional conferences, and the patient and public involvement and engagement group supporting this study, and through newsletters, leaflets and posters in participating sites.Trial registration numberISRCTN46948079.

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‘I wouldn't push that further because I don't want to lose her’: a multiperspective qualitative study of behaviour change for long‐term conditions in primary care

Health Expectations ◽

10.1111/hex.12304 ◽

2014 ◽

Vol 18 (6) ◽

pp. 1995-2010 ◽

Cited By ~ 6

Author(s):

Cheryl Hunter ◽

Carolyn A. Chew‐Graham ◽

Susanne Langer ◽

Jessica Drinkwater ◽

Alexandra Stenhoff ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Behaviour Change ◽

Long Term Conditions

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Understanding Clinicians’ Decisions to Assume Prescriptions for Inherited Patients on Long-term Opioid Therapy: A Qualitative Study

Pain Medicine ◽

10.1093/pm/pnaa045 ◽

2020 ◽

Vol 21 (11) ◽

pp. 3187-3198 ◽

Cited By ~ 1

Author(s):

Michelle S Keller ◽

Alma Jusufagic ◽

Teryl K Nuckols ◽

Jack Needleman ◽

MarySue Heilemann

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Primary Care Physicians ◽

Quality Care ◽

Opioid Therapy ◽

Outpatient Setting ◽

Specialized Training ◽

Primary Care Clinicians ◽

Opioid Medications

Abstract Objective Given the changing political and social climate around opioids, we examined how clinicians in the outpatient setting made decisions about managing opioid prescriptions for new patients already on long-term opioid therapy. Methods We conducted in-depth interviews with 32 clinicians in Southern California who prescribed opioid medications in the outpatient setting for chronic pain. The study design, interview guides, and coding for this qualitative study were guided by constructivist grounded theory methodology. Results We identified three approaches to assuming a new patient’s opioid prescriptions. Staunch Opposers, mostly clinicians with specialized training in pain medicine, were averse to continuing opioid prescriptions for new patients and often screened outpatients seeking opioids. Cautious and Conflicted Prescribers were wary about prescribing opioids but were willing to refill prescriptions if they perceived the patient as trustworthy and the medication fell within their comfort zone. Clinicians in the first two groups felt resentful about other clinicians “dumping” patients on opioids on them. Rapport Builders, mostly primary care physicians, were the most willing to assume opioid prescriptions and were strategic in their approach to transitioning patients to safer doses. Conclusions Clinicians with the most training in pain management were the least willing to assume responsibility for opioid prescriptions for patients already on long-term opioid therapy. In contrast, primary care clinicians were the most willing to assume this responsibility. However, primary care clinicians face barriers to providing high-quality care for patients with complex pain conditions, such as short visit times and less specialized training.

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Understanding long-term opioid prescribing for non-cancer pain in primary care: a qualitative study

BMC Family Practice ◽

10.1186/s12875-015-0335-5 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 26

Author(s):

Carolyn McCrorie ◽

S. José Closs ◽

Allan House ◽

Duncan Petty ◽

Lucy Ziegler ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Cancer Pain ◽

Opioid Prescribing

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Improving long-term adherence to statin therapy: a qualitative study of GPs’ experiences in primary care

British Journal of General Practice ◽

10.3399/bjgp18x696173 ◽

2018 ◽

Vol 68 (671) ◽

pp. e401-e407 ◽

Cited By ~ 5

Author(s):

Karen Krüger ◽

Niklas Leppkes ◽

Sabine Gehrke-Beck ◽

Wolfram Herrmann ◽

Engi A Algharably ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Statin Therapy ◽

Media Coverage ◽

Qualitative Content Analysis ◽

Individual Therapy ◽

Lipid Lowering ◽

Individual Risk ◽

Lipid Lowering Therapy

BackgroundStatins substantially reduce the risk of cardiovascular disease when taken regularly. Though statins are generally well tolerated, current studies show that one-third of patients discontinue use of statins within 2 years. A qualitative approach may improve the understanding of attitudes and behaviours towards statins, the mechanisms related to discontinuation, and how they are managed in primary care.AimTo identify factors related to statin discontinuation and approaches for long-term statin adherence.Design and settingA qualitative study of German GPs’ experiences with statin therapy in rural and urban settings in primary care.MethodSemi-structured interviews (n = 16) with purposefully recruited GPs were recorded, transcribed, and analysed using qualitative content analysis.ResultsSociodemographic patient factors, the nocebo effect, patient attitudes towards primary prevention, and negative media coverage had significant impacts on statin therapy according to GPs. To overcome these barriers, GPs described useful strategies combining patient motivation and education with person-centred care. GPs used computer programs for individual risk–benefit analyses in the context of shared decision making. They encouraged patients with strong concerns or perceived side effects to continue therapy with a modified medication regimen combined with individual therapy goals.ConclusionGPs should be aware of barriers to statin therapy and useful approaches to overcome them. They could be supported by guideline recommendations that are more closely aligned to primary care as well as comprehensible patient information about lipid-lowering therapy. Future studies, exploring patients’ specific needs and involving them in improving adherence behaviour, are recommended.

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Cost-utility analysis of a treatment advice to discontinue inappropriate long-term antidepressant use in primary care

Family Practice ◽

10.1093/fampra/cmu043 ◽

2014 ◽

Vol 31 (5) ◽

pp. 578-584 ◽

Cited By ~ 12

Author(s):

R. Eveleigh ◽

J. Grutters ◽

E. Muskens ◽

R. Oude Voshaar ◽

C. van Weel ◽

...

Keyword(s):

Primary Care ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Antidepressant Use

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Childhood long-term conditions in primary care: a qualitative study of practitioners’ views

British Journal of General Practice ◽

10.3399/bjgp15x686509 ◽

2015 ◽

Vol 65 (638) ◽

pp. e593-e600 ◽

Cited By ~ 3

Author(s):

Anna Willis ◽

Jennifer Swann ◽

Joanne Thompson

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Long Term Conditions

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Bringing self-management into clinical view: a qualitative study of long-term condition management in primary care consultations

Chronic Illness ◽

10.1177/1742395309358333 ◽

2010 ◽

Vol 6 (2) ◽

pp. 136-150 ◽

Cited By ~ 44

Author(s):

Tom Blakeman ◽

Peter Bower ◽

David Reeves ◽

Carolyn Chew-Graham

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Self Management ◽

Term Condition

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“Those Conversations in My Experience Don’t Go Well”: A Qualitative Study of Primary Care Provider Experiences Tapering Long-term Opioid Medications

Pain Medicine ◽

10.1093/pm/pnx276 ◽

2017 ◽

Vol 19 (11) ◽

pp. 2201-2211 ◽

Cited By ~ 17

Author(s):

Laura C Kennedy ◽

Ingrid A Binswanger ◽

Shane R Mueller ◽

Cari Levy ◽

Daniel D Matlock ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Care Provider ◽

Primary Care Provider ◽

Provider Experiences ◽

Opioid Medications

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The care manager meeting the patients’ unique needs using the care manager model—A qualitative study of experienced care managers

BMC Family Practice ◽

10.1186/s12875-021-01523-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Irene Svenningsson ◽

Dominique Hange ◽

Camilla Udo ◽

Karin Törnbom ◽

Cecilia Björkelund ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Common Mental Disorders ◽

Controlled Trial ◽

Successful Outcome ◽

Comfort Zone ◽

Care Manager ◽

Care Managers ◽

Care And Support

Abstract Background Implementation of a care manager in a collaborative care team in Swedish primary care via a randomized controlled trial showed successful outcome. As four years have elapsed since the implementation of care managers, it is important to gain knowledge about the care managers’ long-term skills and experiences. The purpose was to examine how long-term experienced care managers perceived and experienced their role and how they related to and applied the care manager model. Method Qualitative study with a focus group and interviews with nine nurses who had worked for more than two years as care managers for common mental disorders. The analysis used Systematic Text Condensation. Results Four codes arose from the analysis: Person-centred; Acting outside the comfort zone; Successful, albeit some difficulties; Pride and satisfaction. The care manager model served as a handrail for the care manager, providing a trustful and safe environment. Difficulties sometimes arose in the collaboration with other professionals. Conclusion This study shows that long-term experience of working as a care manager contributed to an in-depth insight and understanding of the care manager model and enabled care managers to be flexible and act outside the comfort zone when providing care and support to the patient. A new concept emerged during the analytical process, i.e. the Anchored Care Manager, which described the special competencies gained through experience. Trial registration NCT02378272 Care Manager—Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM—CARE).

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