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Biomedical subjects

Tony Kendrick

Publications and source records attributed to Tony Kendrick.

13 recordsLinked to original sources
PubMed2007

Protocol for the THREAD (THREshold for AntiDepressants) study: a randomised controlled trial to determine the clinical and cost-effectiveness of antidepressants plus supportive care, versus supportive care alone, for mild to moderate depression in UK general practice.

BACKGROUND: Depression guidelines in the UK recommended a policy of watchful waiting for mild depression due to a lack of evidence for the effectiveness of antidepressant treatment for mild cases. However there has been relatively little research carried out in primary care to help establish the severity threshold at which antidepressant treatment is effective and cost-effective. METHODS/DESIGN: The THREAD (THREshold for AntiDepressants) study is a multi-centre randomised controlled trial designed to determine the clinical and cost effectiveness of a selective serotonin reuptake inhibitor (SSRI) plus general practitioner (GP) supportive care, versus supportive care alone, for mild to moderate depression in primary care. The aim is to recruit 300 patients from three centres (Southampton, London and Liverpool). Depressive symptoms will be assessed at baseline, 12 weeks and 26 weeks, using the 17-item Hamilton Depression Rating Scale (HDRS). Two severity sub-groups of patients will be recruited, with HDRS scores of 12-15, and 16-19. Possible predictors of response will be explored including life events and difficulties and alcohol consumption. Analysis of covariance, controlling for baseline value, severity group and centre will be used to estimate the overall treatment effectiveness (difference in HDRS score) at final follow up. The primary analysis will be by 'intention to treat' using double sided tests. The interaction between severity sub-group and treatment will be tested, and if appropriate, effects within separate severity sub-groups estimated. The economic analysis will compare the two treatment groups in terms of mean costs and cost-effectiveness. DISCUSSION: The results of this study will give GPs important information to help them determine the severity of depression at which antidepressant treatment is likely to be cost-effective.

Antidepressive Agents↗
PubMed2006

Cost-effectiveness and cost-utility of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine: randomised controlled trial.

BACKGROUND: The cost-effectiveness of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) has not been compared in a prospective study in primary care. AIMS: To determine the relative cost-effectiveness of TCAs, SSRIs and lofepramine in UK primary care. METHOD: An open-label, three-arm randomised trial with a preference arm. Practitioners referred 327 patients with incident depression. RESULTS: No significant differences were found in effectiveness or cost-effectiveness. The numbers of depression-free weeks over 12 months (on the Hospital Anxiety and Depression Scale) were 25.3 (95% CI 21.3-29.0) for TCAs, 28.3 (95% CI 24.3-32.2) for SSRIs and 24.6 (95% CI 20.6-28.9) for lofepramine. Mean health service costs per patient were pound 762 (95% CI 553-1059) for TCAs, pound 875 (95% CI 675-1355) for SSRIs and pound 867 (95% CI 634-1521) for lofepramine. Cost-effectiveness acceptability curves suggested SSRIs were most cost-effective (with a probability of up to 0.6). CONCLUSIONS: The findings support a policy of recommending SSRIs as first-choice antidepressants in primary care.

Adolescent↗
PubMed2006

Ever been HAD?

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Antidepressive Agents↗
PubMed2005

GP treatment decisions for patients with depression: an observational study.

BACKGROUND: GPs are prescribing more antidepressants than previously, but not in accordance with guidelines. The reasons why they prescribe are not well understood. AIM: To explore associations between GP treatment and severity of depression, patients' life difficulties, previous history of illness and treatment, and patient attitudes. DESIGN: Observational study in two phases, 3 years apart. SETTING: Seven practices in Southampton, UK. METHOD: Adult attenders who consented were screened for depression in the waiting room. After the consultation, the 17 participating GPs completed questionnaires on the perceived presence and severity of depression, patients' life difficulties, previous problems and treatment, patient attitudes towards antidepressants, and their treatment decisions. Patients returned postal questionnaires on sociodemographics, life events, physical health, and attitudes towards antidepressants. RESULTS: Of 694 patients screened in the two phases, the GPs rated 101 (15%) as depressed, acknowledged depression in 44 cases (6%), and offered treatment in 27 (4%), including antidepressants in 14 (2%). Offers of antidepressants were more likely in both phases where the GPs rated the depression as moderate rather than mild, and where they perceived a positive patient attitude to antidepressants. However, GP ratings of severity did not agree well with the validated screening instrument, and their assessments of patients' attitudes to treatment were only moderately related to patients' self-reports. CONCLUSIONS: In line with current guidelines, GPs base prescribing decisions on the perceived severity of depression, taking patients' preferences into account, but they do not accurately identify which patients are likely to benefit from treatment. Better ways to assess depression severity and patient attitudes towards antidepressants are needed in order to target treatment more appropriately.

Adult↗
PubMed2004

Randomised controlled trial of effect of leaflets to empower patients in consultations in primary care.

OBJECTIVE: To assess the impact of leaflets encouraging patients to raise concerns and to discuss symptoms or other health related issues in the consultation. DESIGN: Randomised controlled trial. SETTING: Five general practices in three settings in the United Kingdom. PARTICIPANTS: 636 consecutive patients, aged 16-80 years, randomised to receive a general leaflet, a depression leaflet, both, or neither. MAIN OUTCOMES: Mean item score on the medical interview satisfaction scale, consultation time, prescribing, referral, and investigation. RESULTS: The general leaflet increased patient satisfaction and was more effective with shorter consultations (leaflet 0.64, 95% confidence interval 0.19 to 1.08; time 0.31, 0.0 to 0.06; interaction between both -0.045, -0.08 to-0.009), with similar results for subscales related to the different aspects of communication. Thus for a 10 minute consultation the leaflet increased satisfaction by 7% (seven centile points) and for a five minute consultation by 14%. The leaflet overall caused a small non-significant increase in consultation time (0.36 minutes, -0.54 to 1.26). Although there was no change in prescribing or referral, a general leaflet increased the numbers of investigations (odds ratio 1.43, 1.00 to 2.05), which persisted when controlling for the major potential confounders of perceived medical need and patient preference (1.87, 1.10 to 3.19). Most of excess investigations were not thought strongly needed by the doctor or the patient. The depression leaflet had no significant effect on any outcome. CONCLUSIONS: Encouraging patients to raise issues and to discuss symptoms and other health related issues in the consultation improves their satisfaction and perceptions of communication, particularly in short consultations. Doctors do, however, need to elicit expectations to prevent needless investigations.

Adolescent↗
PubMed2003

A questionnaire to measure satisfaction with community services for informal carers of stroke patients: construction and initial piloting.

Stroke affects 120 000 people each year in the UK and is the most common cause of adult-onset disability. Most stroke patients are cared for at home by informal carers. Support for these carers is provided by the community services, but although single-item measures have shown that there is a relatively high level of dissatisfaction with those services, there is no specific satisfaction measurement instrument. The present study aimed to construct and initially validate a questionnaire to measure carers' satisfaction with community services for clinical and research purposes. Qualitative interviews with a purposive sample of informal carers of stroke patients identified via stroke unit discharge records gave information about content, context and language. Together with information from the carers' literature, this formed the basis of the questionnaire. A self-completion questionnaire proved unacceptable to carers with a very poor response rate (20%). Face-to-face interviews were more acceptable, with the questionnaire taking approximately 10 minutes to administer. All carers approached agreed to take part and only three carers dropped out from follow up, all because of reasons not related to the study. Initial validity and reliability testing with a sample of 44 carers identified through stroke groups and general practice showed good correlation with a single-item satisfaction measure (RHO = 0.797), test-retest reliability (RHO = 0.885) and inter-rater reliability (RHO = 0.868), and a high degree of internal consistency (Cronbach's alpha = 0.859). Further validation with larger and more diverse groups of informal carers is needed before the questionnaire can be considered to be a robust and reliable tool. Factor analysis revealed seven factors: information about community support and involving the carer; amount, appropriateness and coordination of services; information about stroke; speed of change and concern about the carer; listening to the carer and being heard; problem management; and confidence in and accuracy of information. These factors have marked similarities to those found in the field of patient satisfaction with community services.

Aged↗
PubMed2002

The role of the district nurse in bereavement support.

BACKGROUND: District nurses are frequently involved in the care of patients immediately prior to death and could therefore provide support to bereaved relatives. However, little is known about nurses' views on bereavement support or their actual involvement. AIMS OF THE STUDY: To survey a representative sample of district nurses to ascertain their current practice and perceived role in supporting bereaved people and to identify factors that influence their practice. DESIGN AND METHOD: A self-completed postal questionnaire was distributed anonymously to 522 district nurses in the central southern coastal area of Britain. It comprised five sections: interest in and education about bereavement; a Likert scale to measure nurses' views about bereavement care; information about the practice with which the nurse had links; bereavement care provided by the practice; and demographics. RESULTS: A 62% response rate was achieved following two reminders. Sixty-nine per cent reported having an interest in bereavement support. Logistic regression modelling identified older age of the nurse and district of employment as the best predictors of interest in bereavement, and older age of the nurse, district of employment and higher level of academic qualification (having a diploma or degree) as the best predictors of active follow-up bereavement visiting. Ninety five percent of district nurses believed their role should involve visiting bereaved relatives/carers of patients they have nursed, but only 19% believed they should visit bereaved people when the deceased was not their patient. CONCLUSIONS: Older age, higher qualifications and district of employment among district nurses were associated with greater interest in bereavement and more proactive care of bereaved people. The findings of this survey have important implications for the training, continued education and the extended role of the nurse in bereavement support.

Adult↗
PubMed2002

Who cares for the carers? The district nurse perspective.

BACKGROUND: Community care of elderly and disabled people is increasing. Primary care teams are expected to provide support to the informal carers essential for its success. OBJECTIVE: To explore district nurse (DN) views about roles of the primary care team and what is needed for support of informal carers. METHOD: A qualitative analysis of open-ended questions contained in a larger postal questionnaire. RESULTS: DNs viewed improved respite care, general support and information provision as priorities for supporting carers, and lack of resources and access as the main reasons why they could not be more active. They thought other team members might be better placed to take that role. GPs were seen as key members of the primary care team providing services, actively identifying carers and co-ordinating other services and team members. CONCLUSION: DNs identified several areas of support for carers that could be improved: respite, information provision and general support services. They did not feel able to be pro-active in support of informal carers themselves and viewed the GP in that role as a central co-ordinator of care and services.

Adult↗
PubMed2002

Community provision for informal live-in carers of stroke patients.

Stroke is common and disabling. Most stroke patients are cared for at home by informal carers. This study of informal carers of stroke patients measured service provision and satisfaction with different aspects of community care received by these carers. Dissatisfaction was expressed with training and information provision for carers, communication between carers and community services, speed of response and coordination of community services, and perceived support. Problems of information provision were most marked for those patients with most disability and/or older carers.

Adult↗
PubMedDate not supplied

'Antidepressants unlimited'. Are antidepressants the best option for treating depression in general practice? Debating session WONCA 2004.

Antidepressants are among the worlds' most prescribed drugs. However, there are several controversies around their extensive use in primary care, and doubts about their effects, especially in children and older people. Psychological interventions are probably at least as effective as antidepressants, and are preferred by many patients. These issues were discussed at the debating sessions at WONCA 2004 in Amsterdam.

Antidepressive Agents↗