Background: The number of people receiving antidepressants has increased in the past 3 decades, mainly because of people staying on them longer. However, in many cases long-term treatment is not evidence based and risks increasing side effects. Additionally, prompting general practitioners (GPs) to review medication does not improve the rate of appropriate discontinuation. Therefore, GPs and other health professionals may need help to support patients discontinuing antidepressants in primary care. Objective: This study aims to develop a digital intervention to support practitioners in helping 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 (ADvisor HP) was planned and developed using theory, evidence, and a person-based approach. The following elements informed development: a literature review and qualitative synthesis, an in-depth qualitative study, the development of guiding principles for design elements, and theoretical behavioral analyses. The intervention was then optimized through think-aloud qualitative interviews with health professionals while they were 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 to practitioners. The development work highlighted a need for further guidance on drug tapering schedules for practitioners and clarity about who is responsible for broaching the subject of discontinuation. Practitioners highlighted the need to have information in easily and quickly accessible formats because of 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 they would use ADvisor HP 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 HP is a digital intervention that has been developed using theory, evidence, and a person-based approach. The optimization work suggests that practitioners may find this tool to be useful in supporting the reduction of long-term antidepressant use. Further quantitative and qualitative evaluation through a randomized controlled trial is needed to examine the feasibility, effectiveness, and cost-effectiveness of the intervention.

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中文翻译：

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初级保健从业者支持停用抗抑郁药的数字干预（卫生专业人员顾问）：发展研究

背景：在过去的 30 年里，服用抗抑郁药的人数有所增加，主要是因为人们服用抗抑郁药的时间更长。然而，在许多情况下，长期治疗不是基于证据的，并且有增加副作用的风险。此外，促使全科医生 (GP) 审查药物并不会提高适当停药率。因此，全科医生和其他卫生专业人员可能需要帮助来支持患者在初级保健中停用抗抑郁药。目标：本研究旨在开发一种数字干预措施，以支持从业者帮助患者停用不适当的长期抗抑郁药（作为更广泛的干预措施的一部分，包括患者数字干预和患者电话支持）。方法：使用理论、证据和基于人的方法规划和开发了一个名为“卫生专业人员顾问”(ADvisor HP) 的原型数字干预。以下元素为开发提供了信息：文献综述和定性综合、深入的定性研究、设计元素指导原则的发展以及理论行为分析。然后，在卫生专业人员使用原型干预时，通过与他们进行深思熟虑的定性访谈来优化干预。结果：对 19 名卫生专业人员的大声思考定性访谈表明，数字干预包含有用的信息，并且从业人员很容易获得。开发工作强调需要为从业者提供关于药物逐渐减量时间表的进一步指导，并明确谁负责提出停药问题。从业者强调，由于日常实践中的时间有限，需要以易于快速访问的格式获取信息。一些全科医生认为他们已经知道一些信息，但理解为什么要包含这些信息。从业者对于如何在实践中使用 ADvisor HP 的想法各不相同，有些人更喜欢完整地阅读资源，而另一些人则希望根据需要深入了解。根据所提供的反馈，对干预的措辞和结构进行了更改。结论：ADvisor HP 是一种使用理论、证据、和以人为本的方法。优化工作表明，从业者可能会发现该工具有助于减少长期抗抑郁药的使用。需要通过随机对照试验进行进一步的定量和定性评估，以检查干预措施的可行性、有效性和成本效益。

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