Article type
Year
Abstract
Introduction/Objective: In 1993/4 all UK GPs received advice based on a systematic overview of all available evidence on the clinical and cost effectiveness of the new antidepressants, the selective serotonin reuptake inhibitors (SSRIS). This study examines the impact of that information on SSRI prescribing, and describes the major advertising campaigns used by the pharmaceuticals industry to promote the SSRIs over this period.
Methods: Design: Descriptive study of the volume of prescribing of SSRIs and other primary care prescribed antidepressants. Summary of the advertising campaigns for antidepressants derived from a hand search of the British Medical Journal, and the General Practice press. Setting: UK primary care. Subjects: General Practitioners prescribing antidepressants (dispensing and nondispensing), in England. Main Outcome Measure: Previously unpublished English PACT data (prescribing activity and cost tabulations), supplied by the Prescriptions Pricing Authority (Newcastle), reporting both the cost of primary care prescriptions dispensed and activity corrected for volume (28 day treatment units) using the World Health Authorities tables of Defined Daily Doses. Summary of advertising activity (number of adverts and main messages).
Results: The rate of SSRI prescribing continues to increase dramatically in spite of the absence of good evidence to support their increased use in primary care. Providing evidence on the relative effectiveness of antidepressants to General Practitioners and their professional advisors is insufficient to modify practice amongst the majority of GPs. Advertising campaigns selectively report the merits of the products detailed, and appear to respond to available evidence from other sources.
Discussion: Providing information in an accessible form is insufficient to promote rational prescribing among general practitioners. The existing network of medical and pharmaceutical advisors is insufficient to counter the resources available to the pharmaceutical industry, whose activities promote practice which is not cost effective for the NHS. The new NHS internal market would appear unable to promote cost effective prescribing. Prescribing interventions based upon techniques shown to be effective in well designed evaluations should be attempted and subject to further evaluation in UK primary care to promote greater effectiveness and cost effectiveness in prescribing.
Methods: Design: Descriptive study of the volume of prescribing of SSRIs and other primary care prescribed antidepressants. Summary of the advertising campaigns for antidepressants derived from a hand search of the British Medical Journal, and the General Practice press. Setting: UK primary care. Subjects: General Practitioners prescribing antidepressants (dispensing and nondispensing), in England. Main Outcome Measure: Previously unpublished English PACT data (prescribing activity and cost tabulations), supplied by the Prescriptions Pricing Authority (Newcastle), reporting both the cost of primary care prescriptions dispensed and activity corrected for volume (28 day treatment units) using the World Health Authorities tables of Defined Daily Doses. Summary of advertising activity (number of adverts and main messages).
Results: The rate of SSRI prescribing continues to increase dramatically in spite of the absence of good evidence to support their increased use in primary care. Providing evidence on the relative effectiveness of antidepressants to General Practitioners and their professional advisors is insufficient to modify practice amongst the majority of GPs. Advertising campaigns selectively report the merits of the products detailed, and appear to respond to available evidence from other sources.
Discussion: Providing information in an accessible form is insufficient to promote rational prescribing among general practitioners. The existing network of medical and pharmaceutical advisors is insufficient to counter the resources available to the pharmaceutical industry, whose activities promote practice which is not cost effective for the NHS. The new NHS internal market would appear unable to promote cost effective prescribing. Prescribing interventions based upon techniques shown to be effective in well designed evaluations should be attempted and subject to further evaluation in UK primary care to promote greater effectiveness and cost effectiveness in prescribing.