Background The first-line treatments for mild–moderate and moderate–severe depression according to the National Institute for Health and Care Excellence clinical guidelines for the management of depression in adults are psychological therapies followed by or alongside pharmacological treatment. We conducted an audit of patient records (as recorded by general practitioners (GPs)) to compare practice to the guidelines.
Methods Incident cases were retrospectively identified from electronic primary care records (SystmOne). From 40 320 registered patients, cases were identified based on previously coded new diagnoses of depression in the 2016–2017 and 2018–2019 Quality and Outcomes Framework (QOF) years. Patient notes were screened for exclusion criteria (mental health problems that would alter management pathway) and for records of management discussions (pharmacological or psychological therapies) at the diagnostic appointment.
Results In 2016–2017 (n=315), psychological therapies for depression were discussed at 63.2% of diagnostic appointments, they were most discussed at appointments with those aged 18–29 years (70.8%), but this decreased with age to 56.3% of appointments with those aged ≥65 years. In 2017–2018 (n=244), psychological therapies were discussed at 70.9% of diagnostic appointments but were discussed at more appointments with those aged 18–29 years (81.6%) and at less appointments with those aged ≥65 years (39.4%). Discussion of pharmacological management was similar for all age groups in 2016–2017 (89.9%) and 2017–2018 (93.0%).
Implications For patients aged ≥65 years, psychological therapies are featuring less in management discussions with GPs or are not being recorded. Recommendations for change implemented at the practice included feedback of results and professional reminders throughout the 2019-2020 QOF year.
- primary care
- mental health
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Contributors JPL drafted the manuscript. JPL and JP conceived the idea for this audit, developed the protocol and extracted the data. JPL, JP and NM revised the protocol and manuscript for important intellectual content and approved the final version for submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval was not required as this was an audit and was carried out by staff and students employed by or attached to the practice.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. All relevant de-identified data has been presented in the manuscript.
Author note JP and JPL are medical students at the University of Warwick and undertook this work while on placement at GPS Healthcare. NM is a qualified low-intensity psychological well-being practitioner. This work does not reflect the views of GPS Healthcare, the NHS Birmingham and Solihull CCG, the Birmingham and Solihull Mental Health NHS Foundation Trust or the Coventry and Warwickshire Partnership NHS Trust.
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