Objective The aims of this paper were to identify, characterise and explain clinician factors that shape decision-making around antidepressant discontinuation in UK primary care.
Design Four focus groups and three interviews were conducted and analysed using thematic analysis.
Participants Twenty-one general practitioners (GPs), four GP assistants, seven nurses and six community mental health team workers and psychotherapists took part in focus groups and interviews.
Setting Participants were recruited from seven primary care regions and two National Health Service Trusts providing community mental health services in the South of England.
Results Participants highlighted a number of barriers and enablers to discussing discontinuation with patients. They held a range of views around responsibility, with some suggesting it was the responsibility of the health professional (HP) to broach the subject, and others suggesting responsibility rested with the patients. HPs were concerned about destabilising the current situation, discussed how continuity and knowing the patient facilitated discontinuation talks, and discussed how confidence in their professional skills and knowledge affected whether they elected to raise discontinuation in consultations.
Conclusions Findings indicate a need to consider support for HPs in the management of antidepressant medication and discussions of discontinuation in particular. They may also benefit from support around their fears of patient relapse and awareness of when and how to initiate discussions about discontinuation with their patients.
- primary care
- health professional
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Contributors HMB is a research fellow working on the REDUCE programme and contributed towards analysis and second coding of data, and the writing of this paper. SJW is the qualitative researcher currently working on the REDUCE programme and led the research, data collection, analysis and contributed to the writing of this paper. AWAG and GL are co-applicants on the REDUCE programme and contributed towards the analysis. WOB is the programme manager on the REDUCE programme, had oversight of the research and data collection. TK is the chief investigator of the research thereby leading on the programme and contributed towards analysis and interpretation of data. All coauthors (HMB, SJW, AWAG, GL, CRM, EM, WOB and TK) have substantially contributed to the writing of this article, provided critical revision and gave final approval of the published version. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This report is independent research funded by the National Institute for Health Research (Programme Grants for Applied Research, REDUCE RP-PG-1214-20004).
Competing interests None declared.
Ethics approval Ethical approval to conduct the study was granted by the South Central Berkshire BResearch Ethics Committee and the Health Research Authority (Reference Number 16/SC/0472).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement This is a qualitative study and therefore the data are not suitable for sharing beyond what is contained within the report. Further information can be requested from the corresponding author.
Patient consent for publication Not required.
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