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Improving general practitioners’ referral details of antidepressant use for patients referred for depression to primary mental health care: re-audit
Published online by Cambridge University Press: 20 January 2015
Abstract
Background
This audit cycle looked at details of antidepressants given in general practitioners’ (GPs) referral letters to Primary Mental Health Care (PMHC). With adequate information when patients are referred, time spent in clarifying details could be put into better use by clinicians and prompt effective treatment would help to reduce the direct and indirect costs of depression.
Objective
To evaluate how effective our intervention was 7 months after a previous audit and identify areas that need improvement.
Method
Audit of 33 referral letters of patients referred for depression from GPs to a PMHC service in Northern Ireland, followed by the intervention (feedback and pro forma) and re-audit after 7 months.
Results
The April audit showed 100% documentation of current antidepressant treatment and dose, but showed poor documentation of previous antidepressant use (33%), dose or duration (15%) and the reason for stopping the treatment (3%). Following intervention, the re-audit showed 25% and 24% rise in documenting previous antidepressant used and maximum dose reached, respectively, and 20% rise in documenting the reason for stopping.
Conclusions
Our interventions made modest improvement in providing relevant data in referral letters. This study adds to the existing evidence that relying mainly on feedback as a method of implementing change is ineffective. Lack of enthusiasm for using the newly introduced pro forma suggests that mental health services should obtain more effective ways of engaging GPs in service development. Using a systematic approach, which includes identifying local barriers to change and providing a supportive environment are important before the next re-audit.
- Type
- Audit Paper
- Information
- Copyright
- © College of Psychiatrists of Ireland 2015
References
Aguis, M, Vyas, V (2011). Differences between training GPs to manage depression in primary care and issuing them with guidelines, and a system of collaborative care in the treatment of depression between primary and secondary care. Psychiatria Danubina 23 (Suppl. 1): S79–S82.Google Scholar
Akbari, A, Mayhew, A, Al-Alawi, MA, Grimshaw, J, Winkens, R, Glidewel, E, Pritchard, C, Thomas, R, Fraser, C (2008). Interventions to improve outpatient referrals from primary care to secondary care. Cochrane Database of Systematic Reviews 8, CD005471.Google Scholar
Akiskal, H (1986). A developmental perspective on recurrent mood disorders: a review of studies in man. Psychopharmacology Bulletin 22, 579–586.Google ScholarPubMed
Chew-Graham, C, Slade, M, Montâna, C, Stewart, M, Gask, L (2008). Loss of doctor-to-doctor communication: lessons from the reconfiguration of mental health services in England. Journal of Health Services Research and Policy 13, 6–12.CrossRefGoogle ScholarPubMed
Copty, M, Whitford, D (2005). Mental health in general practice: assessment of current state and future needs. Irish Journal of Psychological Medicine 22, 83–86.CrossRefGoogle ScholarPubMed
Craven, M, Bland, R (2006). Better practices in collaborative mental health care: an analysis of the evidence base. Canadian Journal of Psychiatry 51 (6 Suppl. 1): 7S–72S.Google ScholarPubMed
DHSSPSNI (2011). Department of Health, Social Services and Public Safety, Transforming Your Care. A Review of Health and Social Care in Northern Ireland (http://www.dhsspsni.gov.uk/transforming-your-care-review-of-hsc-ni-final-report.pdf). Accessed 14 March 2013.Google Scholar
Durbin, J, Barnsley, J, Finlayson, B, Jaakkimainen, L, Lin, E, Berta, W, McMurray, J (2012). Quality of communication between primary health care and mental health care: an examination of referral and discharge letters. Journal of Behavioural Health Services & Research 39, 445–461.CrossRefGoogle ScholarPubMed
Fuller, JD, Perkins, D, Parker, S, Holdsworth, L, Kelly, B, Roberts, R, Martinez, L, Fragar, L (2011). Building effective service linkages in primary mental health care: a narrative review part 1 & 2. BMC Health Services Research 25, 66.CrossRefGoogle Scholar
Gask, L, Khanna, T (2011). Ways of working at the interface between primary and specialist mental healthcare. British Journal of Psychiatry 198, 3–5.CrossRefGoogle ScholarPubMed
Hopwood, J, Aguis, M (2013). Establishing outcome measures for shared care in the treatment of depression. Psychiatria Danubina 25 (Suppl. 2): S291–S294.Google ScholarPubMed
Kelly, BJ, et al. (2011). Shared care in mental illness: a rapid review to inform implementation. International Journal of Mental Health Systems 5, 31.CrossRefGoogle ScholarPubMed
Kupfer, D (1991). Long-term treatment of depression. Journal of Clinical Psychiatry 52 (Suppl. 5): 28–34.Google ScholarPubMed
Murray, C, Lopez, A (1997). Global mortality, disability, and the contribution of risk factors: global burden of disease study. The Lancet 349, 1436–1442.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (NICE) (2002). Principles for Best Practice in Clinical Audit. National Institute for Health and Clinical Excellence. Radcliffe Medical Press Ltd.(http://www.nice.org.uk/niceMedia/pdf/BestPracticeClinicalAudit.pdf. Radcliffe Medical Press Ltd: United KingdomGoogle Scholar
National Institute for Health and Care Excellence (NICE) (2010). The Treatment and Management of Depression in Adults (Updated Edition). National Clinical Practice Guideline 90. National Collaborating Centre for Mental Health. NICE. The British Psychological Society & the Royal College of Psychiatrists. (http://guidance.nice.org.uk/CG90/Guidance/pdf/English. The British Psychological Society: Great Britain.Google Scholar
Office for National Statistics (2011). Office for National Statistics Study Shows Rise in Antidepressant Use (http://www.nelm.nhs.uk/en/NeLM-Area/News/2011---July/18/ONS-study). Accessed 14 March 2013.Google Scholar
Richards, DA, Lovell, K, Gilbody, S, Gask, L, Torgerson, D, Barkham, M, Bland, M, Bower, P, Lankshear, AJ, Simpson, A, Fletcher, J, Escott, D, Hennessy, S, Richardson, R (2008). Collaborative care for depression in UK primary care: a randomized controlled trial. Psychological Medicine 38, 279–287.CrossRefGoogle ScholarPubMed
Russell, V, Kelly, M (2010). Primary care mental health – a new direction? Irish Journal of Psychological Medicine 27, 63–65.CrossRefGoogle ScholarPubMed
Slade, M, et al. (2008). Failure to improve appropriateness of referrals to adult community mental health services – lessons from a multi-site cluster randomized controlled trial. Family Practice 25, 181–190.CrossRefGoogle ScholarPubMed
Towobola, A, Cotter, P (2014). Single Point of Entry Referral System (Triage) Improves GP and Psychiatry Staff Satisfaction (yet to be published).Google Scholar
Wiles, NJ, Mulligan, J, Peters, TJ, Cowen, PJ, Mason, V, Nutt, D, Sharp, D, Tallon, D, Thomas, L, O'Donovan, MC, Lewis, G (2012). Severity of depression and response to antidepressants: GENPOD randomised controlled trial. British Journal of Psychiatry 200, 130–136.CrossRefGoogle ScholarPubMed
World Bank (1993). World Development Report: Investing in Health Research Development. World Bank: Geneva, Switzerland (http://wdronline.worldbank.org/worldbank/a/c.html/world_development_report_1993/). Accessed 14 March 2013.Google Scholar