title: How do GP practices and patient characteristics influence the prescription of antidepressants? A cross-sectional study.
abstract: BACKGROUND
  Under-prescription of antidepressants (ADs) among people meeting the criteria for major depressive episodes and excessive prescription in less symptomatic patients have been reported. The reasons influencing general practitioners' (GPs) prescription of ADs remain little explored. This study aimed at assessing the influence of GP and patient characteristics on AD prescription.
  
  
  METHODS
  This cross-sectional study was based on a sample of 816 GPs working within the main health care insurance system in the Seine-Maritime district of France during 2010. Only GPs meeting the criteria for full-time GP practice were included. The ratio of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP, using the defined daily dose (DDD) concept. Associations of this AD prescription ratio with GPs' age, gender, practice location, number of years of practice, number of days of sickness certificates prescribed, number of home visits and consultations, number and mean age of registered patients, mean patient income, and number of patients with a chronic condition were assessed using univariate and multivariate analysis.
  
  
  RESULTS
  The high prescribers were middle-aged (40-59) urban GPs, with a moderate number of consultations and fewer low-income and chronic patients. GPs' workload (e.g., volume of prescribed drug reimbursement and number of consultations) had no influence on the AD prescription ratio. GPs with more patients with risk factors for depression prescribed fewer ADs, however, which could suggest the medications were under-prescribed among the at-risk population.
  
  
  CONCLUSIONS
  Our study described a profile of the typical higher AD prescriber that did not include heavy workload. In future work, a more detailed assessment of all biopsychosocial components of the consultation and other influences on GP behavior such as prior training would be useful to explain AD prescription in GP's practice.
authors: Department of General Practice, Rouen University, CIC Inserm 0204, 1 rue de Germont, 76031 Rouen Cedex, France ; Department of General Practice, University Paris 13, Sorbonne Paris Cité, Bobigny, France ; Department of Family practice, Faculty of Medicine, Rouen University, 20 Bd Gambetta, 76000 Rouen, France.
authors: Alain
authors: A
authors: Mercier
authors: Department of Biostatistics, Inserm U 657, University of Rouen, Rouen University Hospital, 1 rue de Germont, 76031 Rouen Cedex, France.
authors: Jacques
authors: J
authors: Benichou
authors: Department of General Practice, Département de médecine générale, Université Paris Diderot, Sorbonne Paris Cité, Paris, France ; EA Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), 75010 Paris, France.
authors: Isabelle
authors: I
authors: Auger-Aubin
authors: Department of General Practice, Tours University, 10, Boulevard Tonnellé, B.P. 3223, 37032 Tours Cedex 1, France.
authors: Jean-Pierre
authors: JP
authors: Lebeau
authors: Department of Biostatistics, Inserm U 657, University of Rouen, Rouen University Hospital, 1 rue de Germont, 76031 Rouen Cedex, France.
authors: Estelle
authors: E
authors: Houivet
authors: Department of Primary and Interdisciplinary Care, Faculty of Medicine, Health Science University of Antwerp, Antwerp, Belgium.
authors: Paul
authors: P
authors: Van Royen
authors: Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium.
authors: Lieve
authors: L
authors: Peremans
keywords: Antidepressants; Cross-sectional study; General practice; General practitioners; Pharmaco-epidemiology
references: Encephale. 2005 Mar-Apr;31(2):195-206
references: 15959446
references: Eur J Clin Pharmacol. 2003 Jun;59(2):143-9
references: 12721774
references: Psychiatr Serv. 2009 Jan;60(1):74-9
references: 19114574
references: J Clin Psychiatry. 2008 Jul;69(7):1064-74
references: 18399725
references: Acta Psychiatr Scand. 2010 Feb;121(2):84-93
references: 19624573
references: Cochrane Database Syst Rev. 2009 Jul 08;(3):CD000072
references: 19588316
references: Med Care. 1993 Mar;31(3):219-29
references: 8450680
references: Soc Psychiatry Psychiatr Epidemiol. 2013 Jan;48(1):137-49
references: 22644000
references: BMC Fam Pract. 2006 Jan 30;7:5
references: 16445855
references: Cochrane Database Syst Rev. 2009 Jul 08;(3):CD007954
references: 19588448
references: Br J Gen Pract. 2009 Feb;59(559):e25-31
references: 19192364
references: Br J Gen Pract. 2011 Feb;61(583):e72-80
references: 21276327
references: Bull Acad Natl Med. 2006 Jun;190(6):1139-44; discussion 1144-5
references: 17195398
references: Res Social Adm Pharm. 2008 Sep;4(3):244-57
references: 18794035
references: Can J Psychiatry. 2006 May;51(6 Suppl 1):7S-72S
references: 16786824
references: Fam Pract. 2002 Feb;19(1):45-52
references: 11818349
references: JAMA. 2004 Jun 2;291(21):2581-90
references: 15173149
references: Encephale. 2010 Jun;36 Suppl 2:D73-82
references: 20513464
references: Int Clin Psychopharmacol. 1997 Jul;12(4):217-23
references: 9347383
references: Health Aff (Millwood). 2011 Aug;30(8):1434-42
references: 21821561
references: Gen Hosp Psychiatry. 2010 May-Jun;32(3):240-5
references: 20430226
references: J Clin Psychiatry. 2011 Apr;72(4):494-501
references: 21294990
references: J Clin Psychiatry. 2002 Sep;63(9):817-25
references: 12363124
references: Res Social Adm Pharm. 2011 Mar;7(1):64-80
references: 21397882
references: Encephale. 2008 Sep;34(4):352-9
references: 18922237
references: J Neurol Neurosurg Psychiatry. 2010 Dec;81(12):1372-3
references: 20543189
references: Soc Sci Med. 2003 Mar;56(6):1335-44
references: 12600369
references: BMC Fam Pract. 2011 Sep 24;12:99
references: 21943348
references: Eur J Neurol. 2010 Sep;17(9):1113-e88
references: 20402746