Original StudyAntidepressant Prescribing in Older Primary Care Patients in Community and Care Home Settings in England and Wales
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Data Source
The Health Improvement Network is an established primary care database collecting anonymized data from UK general (family) practices using the Vision computer system.18 It includes a full longitudinal registration, consultation, diagnosis and prescribing record and allows anonymized patient postcode (zip code) linkage. A UK postcode identifies on average 15 residential addresses; communal establishments may be the only address in a postcode. We commissioned postcode linkage to identify patients
Prevalence of Antidepressant Prescribing
The prevalence of antidepressant prescribing was very similar in nursing and residential homes, so these have been combined into a single care home category (Table 1 and Figure 1): 10.3% (95% confidence interval [CI] 10.0%–10.6%) of community and 37.5% (36.2%–38.9%) of care home patients were prescribed an antidepressant in the last 3 months; after excluding low-dose TCAs these figures were 7.3% (7.1%–7.5%) and 33.6% (32.3%–34.9%) respectively. Most of these antidepressant prescriptions were
Statement of Principal Findings
This nationally representative study confirms the high prevalence of antidepressant prescribing to older people and directly demonstrates the higher prescribing rates to those living in care homes compared with the community. The strong associations found between chronic diseases, including dementia, and antidepressant prescribing do not explain the higher care home prescribing rate and high levels of comorbidity do not strongly predict antidepressant prescribing in care homes. In both settings
Conclusion
We believe that our findings provide an important direct comparison of antidepressant prescribing to older people in care homes and the community. They suggest high levels of prescribing, frequently without a documented indication, particularly in care homes, and continued prescribing of inappropriate antidepressants, particularly in the community.
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The study was supported by a grant from the BUPA Foundation, an independent medical research charity. The funder had no role in the design, execution, analysis, interpretation or writing of this paper. Researchers were independent from funders and had access to all the data.
None of the authors have any financial involvement or affiliation with any organization whose financial interests may be affected by material in the manuscript, or which might potentially bias it. The study was approved by the UK South-East Multicentre Research Ethics Committee (Study Reference: 08/H1102/33).