title: Did NICE guidelines and the Quality Outcomes Framework change GP antidepressant prescribing in England? Observational study with time trend analyses 2003-2013.
abstract: BACKGROUND
  Both the 2004 NICE depression guidelines and 2006 general practice Quality Outcomes Framework (QOF) encouraged improved targeting of antidepressant treatment for depression.
  
  
  METHODS
  Possible effects of the NICE guideline from January 2005, and QOF from April 2006, on rates of GP antidepressant prescribing were examined using time trend analyses of anonymised data from 142 English practices contributing to the Clinical Practice Research Datalink (CPRD), 2003-2013.
  
  
  RESULTS
  Sustained reductions were found in the proportion of first-ever depression episodes treated within 12 months, of 4.2% (95% C.I. 1.0-7.3%) following introduction of the NICE guideline, and 4.4% (2.3-6.5%) following introduction of the QOF. Treatment rates for first-ever episodes fell from 72.5% (70.8-74.1%) in Quarter 2 (Q2) 2003 to 61.0% (59.3-62.7%) in Q1 2012, but treatment rates for recurrent episodes increased from 74.3% (72.8-75.8%) to 77.8% (76.5-79.1%), so overall rates remained around 70%. Mean prescriptions per patient per year doubled from 2.06 (2.05-2.07) to 3.98 (3.97-3.99).
  
  
  CONCLUSIONS
  Participating practices were larger than average and not representative across regions. Inferences of cause and effect from time trend analyses are subject to the possibility of unidentified confounders. No data were available on depression severity or appropriateness of prescribing.
  
  
  CONCLUSIONS
  Rates of GP antidepressant treatment for patients with incident depression fell following introduction of NICE depression guidelines and the QOF, but treatment rates for recurrent depression increased. Prescription numbers increased due to longer treatment courses. To impact on antidepressant prescribing rates, guidelines and performance indicators must address recurrent and long-term prescribing, rather than initial treatment decisions.
authors.affiliation: Primary Care and Population Sciences, University of Southampton, UK. Electronic address: A.R.Kendrick@Southampton.ac.uk.
authors.forename: Tony
authors.initials: T
authors.lastname: Kendrick
authors.affiliation: Primary Care and Population Sciences, University of Southampton, UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Stuart
authors.affiliation: Primary Care and Population Sciences, University of Southampton, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Newell
authors.affiliation: Primary Care and Population Sciences, University of Southampton, UK.
authors.forename: Adam W A
authors.initials: AW
authors.lastname: Geraghty
authors.affiliation: Primary Care and Population Sciences, University of Southampton, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressants; Depression; Guidelines; Pay for performance; Primary care; QOF