Theory of planned behaviour: General Practitioners' prescribing and referral behaviour

Rationale and aims: The vast majority of patients seen in general practice present with a mental health component to their illness. Despite current clinical guidelines, suggesting referral to psychological-based treatments being a more appropriate course of action, anti-depressant prescription remains high for those suffering common mental health problems (CMHPs). This study aimed to investigate General Practitioners’ (GPs) behaviour regarding the prescription of antidepressants and referral to psychological-based treatment for individuals with CMHPs, using the Theory of Planned Behaviour (TPB). Method: Online and postal questionnaires were developed in line with the TPB model following consultation, pilot study and cognitive debriefing. Questionnaires were distributed to all working GPs in Wales, UK. Data underwent statistical analysis. Results: Analysis of responses (n=127) showed a GP’s decision to prescribe antidepressants to patients with CMHPs is significantly influenced by both ‘attitude’ and ‘subjective norm’, while perceived behavioural control was non-significant. Over half of the study GPs did not feel in control of prescribing antidepressants to those with CMHPs. GPs’ intention to refer for psychological-based treatment was significantly influenced by attitude, while further analysis showed GPs did not feel in control of referring for psychological-based treatment. Conclusion: Using TPB helped to explain GPs’ antidepressant prescribing and referral to psychological-based treatment behaviours. GPs’ intention to prescribe and refer were shown to be moderated by behavioural and normative beliefs, while control beliefs were non-significant. The presence of personal experience as a predictable feature to prescribing and referral behaviour is something that could figure more prominently within early phases of medical training