Variation in general practitioners' follow-up of depressed patients starting antidepressant medication: a register-based cohort study

Abstract

Background Guidelines recommend follow-up within 2 weeks for patients starting medication for depression. Knowledge is lacking about how general practitioners’ (GPs) follow-up varies with patients’ sociodemographic characteristics. Objective To describe follow-up by GP and specialist in mental healthcare provided to men and women with depression within 3 months of starting drug therapy. Furthermore, to examine whether follow-up varied according to patients’ age and education. Methods Registry-based cohort study comprising all patients aged ≥18 years in Norway with a new depression episode in 2014 who started on antidepressants within 12 months from diagnosis. Patients’ age and educational level were the exposures. Outcomes were follow-up by GP and/or mental healthcare specialist, and talking therapy with GP, within 90 days of first prescription. Cox proportional hazard models were used to estimate the likelihood of having follow-up contacts. Log binomial regression analysis was performed to explore the likelihood of having talking therapy with a GP. Time to first contact was illustrated by Kaplan–Meier survival curves. Results The study population comprised 17 000 patients, mean age 45.7 years, 60.6% women. Only 27.8% of the patients were followed up by GP and/or specialist within 2 weeks of the first drug dispensing, 67.1% within 90 days. Older or less educated men and women received less and later contacts than the younger or more highly educated. Conclusions Differences in age and educational level were associated with follow-up of depressed patients who started medication. This may indicate unwarranted variation in depression care that GPs should consider when prescribing antidepressants.