08 November 2007
REPORT HIGHLIGHTS IMPORTANCE OF REVIEWING USE
The rate at which antidepressants are dispensed has increased four-fold over the last ten years, a major new report from NHS Quality Improvement Scotland (NHS QIS) revealed today (Thursday).
The ‘Clinical Indicators 2007’ report – the twelfth in a series presenting clinical indicators for NHSScotland – presents data on three long-term conditions: depression, arthritis, and upper gastro-intestinal conditions. Among its key findings is that between 1992 and 2006 antidepressant prescribing levels rose from 19 to 85 defined daily doses per 1,000 of the population. The Scottish Government has a target for the annual rate of increase in antidepressant prescribing to be reduced to zero by 2009-10, and there may be signs that the rate of increase is beginning to level off.
Clinical indicators can draw attention to areas where further investigation and quality improvement activities might be beneficial. However, clinical indicators do not provide a direct measure of performance, and so cannot be used to make reliable external judgments about the quality of patient care.
The report also found that:
- The rate at which people consulted a general practitioner for depression was higher for women than for men – and also rose steadily as the level of social deprivation increased.
- Depression is seen commonly in primary care and only a small proportion of people with the illness receive care in a psychiatric hospital.
- Electroconvulsive therapy was given to a very small percentage of people with depression whose illness was very severe, and improved clinical outcomes were observed in the vast majority (93%).
- The report also highlights that there are no Scotland-wide data about waiting times for, or the delivery and outcomes of, psychological (or talking) therapies.
On arthritis and upper-gastrointestinal conditions the key findings include:
- Between 1998-9 and 2005-6, the rate of people consulting a general practitioner for osteoarthritis decreased by about a third – and this rate was consistently higher for females than for males. These broad trends were also observed for rheumatoid arthritis, although the overall consultation rate was somewhat lower than for osteoarthritis.
- Between 1998-9 and 2005-6, the rate of people consulting a general practitioner for peptic ulcer disease decreased by over 80%.
Commenting on the report, NHS QIS Medical Advisor Dr Harpreet Kohli said:
“In this report we can see there has been a sharp rise in the prescribing of antidepressants. Part of this rise is due to the introduction of the latest generation of antidepressants, providing a treatment option with fewer side-effects. It is likely, however, that a range of social and medical issues will have contributed to this rise and these data therefore pose significant questions.
“Clinical Indicators present data that the NHS can use to ask important questions about health and healthcare. They do not always provide readily available answers and do not allow us to make judgements on the quality of care, but they do provide an important set of trends that are often worth further investigation. Publication of these clinical indicators on depression complement other work that NHS QIS is doing in this area – for example the development of standards for an integrated care pathway for depression, and the development of a guideline on the non-pharmacological management of mild to moderate depression in primary care.”
Editors Note:
- Depression is a common mental illness, characterised by low mood and loss of interests. Depressive episodes affect about 1 in 5 people at some time in their lives. The severity of depression varies from person to person. Some are able to carry on with their day-to-day lives without too much difficulty, whereas for others the illness is very distressing and disabling – and potentially life threatening.
- A clinical indicator is a quantitative measure that provides some information about a specific aspect of health or healthcare at a particular time. Drawn from centrally maintained national datasets, clinical indicators can flag up areas where further investigation and quality improvement activities might be beneficial. However, clinical indicators do not provide a direct measure of performance, and so cannot be used to make reliable external judgments about the quality of patient care.
- A full copy of today’s report - entitled ‘Clinical Indicators 2007’ - is available on our website at www.nhshealthquality.org
- The figures from the full report are available to download – together with some supplementary tables – from the website of the Clinical Indicators Support Team at the Information Services Division of NHS National Services Scotland: www.indicators.scot.nhs.uk
- Mental health is one of the key themes in our organisation’s work. We are currently developing standards for an integrated care pathway for depression, and the Scottish Intercollegiate Guidelines Network (SIGN) is developing a guideline on the non-pharmacological management of mild to moderate depression in primary care.
- NHS Quality Improvement Scotland has been established to lead in improving the quality of care and treatment delivered by NHSScotland. To do this it sets standards and monitors performance, and provides NHSScotland with advice, guidance and support on effective clinical practice and service improvements.
Media Contact: Stephen Ferguson on 07779 329 689