a1 General Practitioner Registrar, Bootham Park Hospital, York, UK
a2 General Practitioner, Gillygate Surgery, York, UK
a3 Research Administrator, Bootham Park Hospital, York, UK
a4 Consultant Psychiatrist and Honorary Senior Lecturer, Hull York Medical School, York, UK
Background Guidelines may improve clinical outcomes for depression, but whether they are followed in primary care is uncertain.
Aim To assess general practioners (GPs’) adherence to the National Institute for Health and Clinical Excellence (NICE) guidelines for managing depression in adults (2004).
Design of study Anonymized Questionnaire Survey.
Setting Thirty-eight partnerships within one primary care trust in England.
Method Focused questionnaire incorporating measurable criteria, posted to GPs in May 2007.
Results The response rate was 67% (143/215 GPs). GPs followed NICE guidelines when screening for depression in patients with physical illness, using selective serotonin reuptake inhibitor antidepressants appropriately and referring to counselling and secondary care. However, 48% GPs did not screen patients with a history of depression, 44% discontinued medication too soon and 38% avoided prescribing for ‘understandable’ moderate depression. GPs identified poor access to cognitive behaviour therapy (CBT) as the greatest barrier to implementing guidelines. Only 41% personally used CBT. Adherence to NICE guidelines was significantly higher for GPs trained in psychiatry and in younger GPs, but was not associated with gender, practice size, possessing the Membership of the Royal College of General Practitioners or reading guidelines. Less than half (38%) of the GPs rated NICE as having a moderate or substantial impact upon their clinical management. The Quality and Outcomes Framework (QOF) had more influence than NICE guidelines upon detection and recording of care, especially in larger practices.
Conclusion Training more cognitive behaviour therapists, making psychiatry experience mandatory for future GPs and focusing QOF incentives upon treatment outcomes as well as screening may improve adherence to NICE depression guidelines.
(Received July 21 2009)
(Accepted November 01 2009)
(Online publication December 10 2009)