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1.  Factors associated with duration of new antidepressant treatment: analysis of a large primary care database 
The British Journal of General Practice  2012;62(595):e104-e112.
Background
It is not known how much the duration of newly prescribed antidepressant treatment is influenced by patient characteristics or practice variation.
Aim
To describe the relationship between patient characteristics and the duration of new antidepressant treatment by general practices.
Design and setting
Large primary care database cohort study of all patients with a newly initiated course of eligible antidepressant treatment during 1 year, from a database of 237 Scottish practices.
Method
Detailed prescription data were used to estimate the duration of new antidepressant treatment for each patient. Cox proportional hazards regression was used to estimate the influence of patient characteristics on continuation of treatment and, by multilevel modelling, the variation between practices.
Results
A total of 28 027 (2.2%) patients commenced antidepressant treatment during the year; 75% continued beyond 30 days, 56% beyond 90 days, and 40% beyond 180 days. Treatment was less likely to be continued in patients from areas of high socioeconomic deprivation: hazard ratio 1.22 (95% confidence interval [CI] = 1.16 to 1.29); in patients under 35 years, 1.33 (95% CI = 1.28 to 1.37); and in those for whom the GP recorded no relevant diagnostic code, 1.16 (95% CI = 1.13 to 1.18). Models accounted for between 2.2% and 3.9% of the variation in treatment duration.
Conclusion
Patient demographic characteristics account for relatively little variation in the duration of new antidepressant treatment, though treatment was shorter in younger patients and those with greater socioeconomic deprivation. There is variation in treatment duration between practices and according to whether patients have a depression diagnosis coded in their records.
doi:10.3399/bjgp12X625166
PMCID: PMC3268489  PMID: 22520784
antidepressive agents; clinical practice variation; depressive disorder; primary care
2.  Editor’s Briefing 
doi:10.3399/bjgp12X624996
PMCID: PMC3268465
5.  Dementia: commissioning for quality 
doi:10.3399/bjgp12X625021
PMCID: PMC3268468  PMID: 22520764
6.  Shisha guidance for GPs: eliciting the hidden history 
doi:10.3399/bjgp12X625030
PMCID: PMC3268469  PMID: 22520765
9.  QOF should be more about disease and risk factors prevention 
doi:10.3399/bjgp12X625067
PMCID: PMC3268472  PMID: 22520769
10.  Let us take blood 
doi:10.3399/bjgp11X595620
PMCID: PMC3268473  PMID: 21859522
12.  What do we actually know about the referral process? 
doi:10.3399/bjgp12X625085
PMCID: PMC3268475  PMID: 22520770
14.  In memory of Stephen Lawrence 
doi:10.3399/bjgp12X625210
PMCID: PMC3268478
15.  Why bother talking to teenagers? 
doi:10.3399/bjgp12X625229
PMCID: PMC3268479  PMID: 22520776
16.  Good health has little to do with doctors, Mr Lansley 
doi:10.3399/bjgp12X625238
PMCID: PMC3268480  PMID: 22520777
17.  Choosing to die 
doi:10.3399/bjgp12X625247
PMCID: PMC3268481  PMID: 22520778
18.  Exhibition review 
doi:10.3399/bjgp12X625256
PMCID: PMC3268482
21.  Healthy New Year 
doi:10.3399/bjgp12X625292
PMCID: PMC3268485  PMID: 22520783
22.  How to afford a just health service 
doi:10.3399/bjgp12X625319
PMCID: PMC3268486  PMID: 22520785
24.  Tips for GP trainees working in respiratory medicine 
doi:10.3399/bjgp12X625337
PMCID: PMC3268488  PMID: 22520787
25.  Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisation 
The British Journal of General Practice  2012;62(595):e113-e120.
Background
Anticipatory care for older patients who are frail involves both case identification and proactive intervention to reduce hospitalisation.
Aim
To identify a population who were at risk of admission to hospital and to provide an anticipatory care plan (ACP) for them and to ascertain whether using primary and secondary care data to identify this population and then applying an ACP can help to reduce hospital admission rates.
Design and setting
Cohort study of a service intervention in a general practice and a primary care team in Scotland.
Method
The ACP sets out patients’ wishes in the event of a sudden deterioration in health. If admitted, a proactive approach was taken to transfer and discharge patients into the community. Cohorts were selected using the Nairn Case Finder, which matched patients in two practices for age, sex, multiple morbidity indexes, and secondary care outpatient and inpatient activity; 96 patients in each practice were studied for admission rate, occupied bed days and survival.
Results
Survivors from the ACP cohort (n = 80) had 510 fewer days in hospital than in the 12 months pre-intervention: a significant reduction of 52.0% (P = 0.020). There were 37 fewer admissions of the survivors from that cohort post-intervention than in the preceding 12 months, with a significant reduction of 42.5% (P = 0.002). Mortality rates in the two cohorts were similar, but the number of patients who died in hospital and the hospital bed days used in the last 3 months of life were significantly lower for the decedents with an ACP than for the controls who had died (P = 0.007 and P = 0.045 respectively).
Conclusion
This approach produced statistically significant reductions in unplanned hospitalisation for a cohort of patients with multiple morbidities. It demonstrates the potential for providing better care for patients as well as better value for health and social care services. It is of particular benefit in managing end-of-life care.
doi:10.3399/bjgp12X625175
PMCID: PMC3268490  PMID: 22520788
admission; advance care planning; end-of-life care; general practice; patient readmission

Results 1-25 (6033)