title: Transitions from General Practitioner to Psychiatrist Care (or vice versa) during a first antidepressant treatment episode.
abstract: BACKGROUND
  The aim of this study was to investigate how frequently patients transit from general practitioner (GP) to psychiatrist care and vice versa during a first antidepressant episode and antidepressant treatment changes associated with those transitions.
  
  
  METHODS
  Antidepressant episodes were constructed for patients (> or =18 years) initiating SSRI use in 2000 (N=10 158). Transition in care within a first treatment episode was investigated. Changes in antidepressant treatment were compared between transiting and non-transiting patients.
  
  
  RESULTS
  6.0% of patients who initiate SSRI use in GP practice transited to psychiatrist care, whereas 39.1% of those initiating use in psychiatrist care transited to GP care. Patients transiting from GP to psychiatrist care were more likely to switch to other antidepressants (RR=6.16, 95% CI: 4.90, 7.75) or to other doses (RR=4.48, 95% CI: 3.76, 5.34) than non-transiting patients. No significant differences in antidepressant treatment were found for patients transiting from psychiatric to GP care.
  
  
  CONCLUSIONS
  Approximately 9% of SSRI initiators transit in care. Transitions from GP to psychiatric care lead to antidepressant treatment changes and could potentially be used in observational studies as a disease severity indicator.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Gardarsdottir
authors.forename: A C G
authors.initials: AC
authors.lastname: Egberts
authors.forename: E R
authors.initials: ER
authors.lastname: Heerdink
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011570:Psychiatry; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents