JMIR Publications

ABSTRACT

Background:

The number of people on antidepressants has increased in the past three decades, mainly due to people staying on them longer, but in many cases long-term treatment is not evidence-based and risks increasing side effects. Prompting GPs to review medication does not improve rates of appropriate discontinuation. GPs and other health professionals may need help to support patients discontinuing antidepressants in primary care.

Objective:

To develop a digital intervention to support practitioners to help patients discontinue inappropriate long-term antidepressants, as part of a wider intervention package including a patient digital intervention and patient telephone support.

Methods:

A prototype digital intervention (called ‘ADvisor for Health Professionals’) was planned and developed using a theory, evidence and person-based approach. The following elements informed development: a literature review and qualitative synthesis, an in-depth qualitative study, development of guiding principles for design elements, and theoretical behavioural analyses. The intervention was then optimised through think-aloud qualitative interviews with health professionals while using the prototype intervention.

Results:

Think-aloud qualitative interviews with 19 health professionals suggested that the digital intervention contained useful information and was readily accessible for practitioners. The development work highlighted a need for further guidance on drug tapering schedules for practitioners, as well as clarity around who is responsible for broaching the subject of discontinuation. Practitioners highlighted the need to have information in easily and quickly accessible formats due to time constraints in day-to-day practice. Some GPs felt that some information was already known to them but understood why this was included. Practitioners differed in their ideas about how it would be used in practice, with some preferring to read the resource in its entirety and others wanting to ‘dip in and out’ as needed. Changes were made to the wording and structure of the intervention in response to the feedback provided.

Conclusions:

ADvisor for Health Professionals is a digital intervention which has been developed using theory, evidence and a person-based approach. The optimisation work suggests that practitioners may find this tool useful in supporting reduction of long-term antidepressant use. Further quantitative and qualitative evaluation through a randomised controlled trial is needed to examine the feasibility, effectiveness and cost-effectiveness of the intervention.