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1.  How do GP practices and patient characteristics influence the prescription of antidepressants? A cross-sectional study 
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.
Electronic supplementary material
The online version of this article (doi:10.1186/s12991-015-0041-7) contains supplementary material, which is available to authorized users.
doi:10.1186/s12991-015-0041-7
PMCID: PMC4308843  PMID: 25632295
Antidepressants; General practice; General practitioners; Cross-sectional study; Pharmaco-epidemiology
2.  Why do general practitioners prescribe antidepressants to their patients? A pilot study 
Background
The frequency of antidepressant (ADs) prescription is high, with general practitioners (GPs) responsible for about 80% of the prescriptions. Some studies considered prescriptions meet DSM criteria, while others stress inadequate use. The importance of biological and psychosocial determinants of GP prescription behaviour remains little explored. We aimed to describe the importance of these biological and psychosocial determinants and their weight in the daily practice of GPs’.
Methods
During a week chosen at random, 28 GPs collected the AD prescriptions made within the previous six months, regardless of the reason for the patient contact. Bio psychosocial and AD treatment characteristics were recorded for all patients. In a random sample of 50 patients, patient characteristics were assessed via a structured face-to-face interview with the GP.
Results
The frequency of AD prescription was 8.90% [3.94 -17.02]. The GPs initiated 65.6% [60.1-70.8] of the prescriptions. The rate of AD prescription for non-psychiatric conditions was 18%. Patients had from 1 to 9 conditions, showing a high level of multi-morbidity. There was a strong influence of past medical history and contextual problems, such as work related problems.
Conclusion
AD prescription is related to complex contextual situations and multi-morbid patients. GPs use a bio psycho social approach, rather than a purely biological assessment. Awareness of these influences could improve prescription by GPs.
doi:10.1186/1751-0759-8-17
PMCID: PMC4126991  PMID: 25110516
Antidepressants; Primary care; General practitioner; Prescription; Off label use
3.  What factors determine Belgian general practitioners’ approaches to detecting and managing substance abuse? A qualitative study based on the I-Change Model 
BMC Family Practice  2014;15:119.
Background
General practitioners (GPs) are considered to play a major role in detecting and managing substance abuse. However, little is known about how or why they decide to manage it. This study investigated the factors that influence GP behaviours with regard to the abuse of alcohol, illegal drugs, hypnotics, and tranquilisers among working Belgians.
Methods
Twenty Belgian GPs were interviewed. De Vries’ Integrated Change Model was used to guide the interviews and qualitative data analyses.
Results
GPs perceived higher levels of substance abuse in urban locations and among lower socioeconomic groups. Guidelines, if they existed, were primarily used in Flanders. Specific training was unevenly applied but considered useful. GPs who accepted abuse management cited strong interpersonal skills and available multidisciplinary networks as facilitators.
GPs relied on their clinical common sense to detect abuse or initiate management. Specific patients’ situations and their social, psychological, or professional dysfunctions were cited as cues to action.
GPs were strongly influenced by their personal representations of abuse, which included the balance between their professional responsibilities toward their patients and the patients’ responsibilities in managing their own health as well the GPs’ abilities to cope with unsatisfying patient outcomes without reaching professional exhaustion. GPs perceived substance abuse along a continuum ranging from a chronic disease (whose management was part of their responsibility) to a moral failing of untrustworthy people. Alcohol and cannabis were more socially acceptable than other drugs. Personal experiences of emotional burdens (including those regarding substance abuse) increased feelings of empathy or rejection toward patients.
Multidisciplinary practices and professional experiences were cited as important factors with regard to engaging GPs in substance abuse management. Time constraints and personal investments were cited as important barriers.
Satisfaction with treatment was rare.
Conclusions
Motivational factors, including subjective beliefs not supported by the literature, were central in deciding whether to manage cases of substance abuse. A lack of theoretical knowledge and training were secondary to personal attitudes and motivation. Personal development, emotional health, self-awareness, and self-care should be taught to and fostered among GPs to help them maintain a patient-centred focus. Health authorities should support collaborative care.
doi:10.1186/1471-2296-15-119
PMCID: PMC4064261  PMID: 24927958
General practitioners; Substance abuse; Attitudes of health personnel; Motivation; I-Change Model
4.  Evidence of prescription of antidepressants for non-psychiatric conditions in primary care: an analysis of guidelines and systematic reviews 
BMC Family Practice  2013;14:55.
Background
Antidepressants (ADs) are commonly prescribed in primary care and are mostly indicated for depression. According to the literature, they are now more frequently prescribed for health conditions other than psychiatric ones. Due to their many indications in a wide range of medical fields, assessing the appropriateness of AD prescription seems to be a challenge for GPs. The aim of this study was to review evidence from guidelines for antidepressant prescription for non-psychiatric conditions in Primary Care (PC) settings.
Methods
Data were retrieved from French, English and US guideline databases. Guidelines or reviews were eligible if keywords regarding 44 non-psychiatric conditions related to GPs’ prescription of ADs were encountered. After excluding psychiatric and non-primary care conditions, the guidelines were checked for keywords related to AD use. The latest updated version of the guidelines was kept. Recent data was searched in the Cochrane Database of Systematic Reviews and in PubMed for updated reviews and randomized control trials (RCTs).
Results
Seventy-eight documents were retrieved and were used to assess the level of evidence of a potential benefit to prescribing an AD. For 15 conditions, there was a consensus that prescribing an AD was beneficial. For 5 others, ADs were seen as potentially beneficial. No proof of benefit was found for 15 conditions and proof of no benefit was found for the last 9. There were higher levels of evidence for pain conditions, (neuropathic pain, diabetic painful neuropathy, central neuropathic pain, migraine, tension-type headaches, and fibromyalgia) incontinence and irritable bowel syndrome. There were difficulties in summarizing the data, due to a lack of information on the level of evidence, and due to variations in efficacy between and among the various classes of ADs.
Conclusions
Prescription of ADs was found to be beneficial for many non-psychiatric health conditions regularly encountered in PC settings. On the whole, the guidelines were heterogeneous, seemingly due to a lack of trials assessing the role of ADs in treatment strategies.
doi:10.1186/1471-2296-14-55
PMCID: PMC3648410  PMID: 23641784
Antidepressants; Literature review; Therapeutic use; Family practice
5.  Routine dipstick urinalysis in daily practice of Belgian occupational physicians 
Archives of Public Health  2012;70(1):15.
Background
Little work has been done to assess the quality of health care and the use of evidence-based methods by occupational physicians in Belgium. Therefore, the main objective is to describe one aspect of occupational health assessments, namely the common use of dipstick urinalysis, and to compare the current practice with international guidelines.
Methods
A self-administered questionnaire was mailed to 211 members of the Scientific Association of Occupational Medicine in the Dutch speaking part of Belgium.
Results
A total of 120 occupational physicians responded, giving a response rate of 57%. Dipstick urinalysis was a routine investigation for the vast majority of physicians (69%). All test strips screened for protein and in 90% also for blood. Occupational health services offered clinical tests to satisfy customer wants as international guidelines do not recommend screening for haematuria and proteinuria in asymptomatic adults. A lack of knowledge concerning positive testing and referral criteria was demonstrated in almost half of the study participants.
Conclusions
Belgian occupational physicians still routinely perform dipstick testing although there is no evidence to support this screening in healthy workers. To practice evidence-based medicine, occupational physicians need more instruction and training. Development and implementation of more guidelines is not only of use for the individual practitioner, it may also enhance professionalization and efficiency of occupational health care.
doi:10.1186/0778-7367-70-15
PMCID: PMC3436716  PMID: 22958323
Evidence-based practice; Occupational health; Guidelines; Health surveillance
6.  Understanding the prescription of antidepressants: a Qualitative study among French GPs 
BMC Family Practice  2011;12:99.
Background
One-tenth of France's population is prescribed at least one antidepressant, primarily by General Practitioners. The reasons for this high prescription rate remain unclear. One-third of these prescriptions may not comply with clinical practice guidelines, and 20% are potentially unrelated to any psychiatric condition. Our aim was to explore how GPs declare they use antidepressants in daily practice and understand their reasons for prescribing them.
Method
Six focus groups including a total of 56 rural and urban GPs, with four interviews were performed. The topic guide focused on reasons for prescribing antidepressants in various primary care situations. Phenomenological analysis was performed by four researchers.
Results
Antidepressants were seen as useful and not harmful. Personal assessment based on experience and feeling determined the GPs' decisions rather than the use of scales. Twenty-four "non-psychiatric" conditions possibly leading to prescription of antidepressants in primary care were found.
Conclusions
The GPs reported prescribing antidepressants for a wide range of conditions other than depression. The GPs' decision making process is difficult and complex. They seemed to prefer to focus on their difficulties in diagnosing depression rather than on useless overtreatment. Instead of using the guidelines criteria to detect potential cases of useful prescription, physicians tend to use their own tools based on gut feelings, knowledge of the patient and contextual issues.
doi:10.1186/1471-2296-12-99
PMCID: PMC3188468  PMID: 21943348
7.  How do referring clinicians want radiologists to report? Suggestions from the COVER survey 
Insights into Imaging  2011;2(5):577-584.
Objective
To investigate what referring clinicians suggest when asked how the quality of radiology reports can be improved.
Methods
At the end of the questionnaire of the COVER survey, a bi-national quantitative survey on the radiology report among referring physicians, clinical specialists and general practitioners were able to freely enter suggestions with regard to improving the quality of the report. These suggestions were isolated from the quantitative results. Subjects and themes were identified, examined, ordered, counted, compared and analysed.
Results
Of a total of 3,884 invitations to participate, we received 735 response forms from clinicians (18.9%), 233 (31.7%) of which contained suggestions. Issues mentioned most frequently were the need for clinical information and a clinical question, for a conclusion, structuring, communicating directly with the clinician, completeness, integrating images or referring to images, mentioning relevant findings outside of the clinical question, mentioning a diagnosis or suitable differential diagnosis, and concise reporting.
Conclusion
Although these spontaneous suggestions are erratic and sometimes contradictory, they summarise the ideas as well as the emotions of these clients of the radiology department. Therefore it is advisable to take them into account when developing new ways of reporting.
doi:10.1007/s13244-011-0118-z
PMCID: PMC3259369  PMID: 22347977
Radiology report; Preferences; Structured reporting; Communication in radiology
8.  How do referring clinicians want radiologists to report? Suggestions from the COVER survey 
Insights into Imaging  2011;2(5):577-584.
Objective
To investigate what referring clinicians suggest when asked how the quality of radiology reports can be improved.
Methods
At the end of the questionnaire of the COVER survey, a bi-national quantitative survey on the radiology report among referring physicians, clinical specialists and general practitioners were able to freely enter suggestions with regard to improving the quality of the report. These suggestions were isolated from the quantitative results. Subjects and themes were identified, examined, ordered, counted, compared and analysed.
Results
Of a total of 3,884 invitations to participate, we received 735 response forms from clinicians (18.9%), 233 (31.7%) of which contained suggestions. Issues mentioned most frequently were the need for clinical information and a clinical question, for a conclusion, structuring, communicating directly with the clinician, completeness, integrating images or referring to images, mentioning relevant findings outside of the clinical question, mentioning a diagnosis or suitable differential diagnosis, and concise reporting.
Conclusion
Although these spontaneous suggestions are erratic and sometimes contradictory, they summarise the ideas as well as the emotions of these clients of the radiology department. Therefore it is advisable to take them into account when developing new ways of reporting.
doi:10.1007/s13244-011-0118-z
PMCID: PMC3259369  PMID: 22347977
Radiology report; Preferences; Structured reporting; Communication in radiology
9.  Collecting data for sexually transmitted infections (STI) surveillance: what do patients prefer in Flanders? 
Background
STI surveillance systems are subject to qualitative and quantitative underreporting. General practitioners (GPs), who are key subjects in case reporting, explain their underreporting partly by their observation that taking a sexual history is embarrassing for patients, and that patients are reluctant to disclose information on their sexual practices. In this study we examine patients' willingness to provide data for STI surveillance.
Methods
A questionnaire-based survey in a stratified population sample of 300 patients aged 18–60 years.
Results
The large majority of respondents stated to be willing to give information on their sexual practices for the purpose of STI surveillance. They preferred to answer sexual history questions to their GP; filling in a form on the internet was the second best option.
Conclusion
Based on these results, it is unlikely that the cooperation of patients would be a weak link in STI surveillance strategies. This observation, together with the fact that the majority of patients at risk for STIs have regular access to general practice services, justify renewed efforts to enliven primary care-based STI surveillance strategies.
doi:10.1186/1472-6963-7-149
PMCID: PMC2039737  PMID: 17883849

Results 1-10 (10)