Provider and patient characteristics associated with antidepressant nonadherence: The impact of provider specialty. Journal of Clinical Psychiatry, 68, 867-873
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass, USA. The Journal of Clinical Psychiatry
(Impact Factor: 5.5).
07/2007; 68(6):867-73. DOI: 10.4088/JCP.v68n0607
Given the widespread use of anti-depressants in primary care and specialty populations, we sought to examine whether provider specialty and patient demographic and clinical characteristics were associated with nonadherence to antidepressant therapy.
We conducted an observational cohort study of 11,878 patients enrolled in Harvard Pilgrim Health Care who were newly treated with antidepressants between May 2002 and May 2004. Using generalized estimating equations, we examined predictors of 2 types of anti-depressant nonadherence: (1) immediate non-adherence: never refilling an antidepressant prescription; and (2) 6-month nonadherence: refilling an antidepressant prescription at least once, but not satisfactorily completing a 6-month treatment episode.
Compared with patients treated by primary care physicians (PCP), being treated by a psychiatrist was associated with significantly lower odds of immediate nonadherence (PCP 18% vs. psychiatrist 13%). Being treated by another type of specialist was associated with significantly higher odds of both immediate (other specialist 23%) and 6-month nonadherence (PCP 53%, psychiatrist 49%, other specialist 62%). Treatment by multiple providers was associated with lower odds of nonadherence than being treated by only 1 provider. Younger patient age and use of pain medication were associated with greater nonadherence.
Rates of both immediate and 6-month nonadherence are high, and clinicians should emphasize the importance of continuing antidepressant treatment for a sufficient duration. Patients whose depression treatment is initiated by nonpsychiatric specialists may benefit from collaborative care models. These strategies may enable providers to better manage the long-term disability associated with their patients' depression.
Available from: Richard L Kravitz
- "Prior studies have examined the predictors of poor adherence , , ,  and have tested various interventions aimed at improving patient adherence with antidepressant treatment , . Notably, collaborative care models ,  have demonstrated benefit by intervening on both clinician and patient level barriers to adherence. "
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ABSTRACT: Depression is common in primary care but often under-treated. Personal experiences with depression can affect adherence to therapy, but the effect of vicarious experience is unstudied. We sought to evaluate the association between a patient's vicarious experiences with depression (those of friends or family) and treatment preferences for depressive symptoms.
We sampled 1054 English and/or Spanish speaking adult subjects from July through December 2008, randomly selected from the 2008 California Behavioral Risk Factor Survey System, regarding depressive symptoms and treatment preferences. We then constructed a unidimensional scale using item analysis that reflects attitudes about antidepressant pharmacotherapy. This became the dependent variable in linear regression analyses to examine the association between vicarious experiences and treatment preferences for depressive symptoms.
Our sample was 68% female, 91% white, and 13% Hispanic. Age ranged from 18-94 years. Mean PHQ-9 score was 4.3; 14.5% of respondents had a PHQ-9 score >9.0, consistent with active depressive symptoms. Analyses controlling for current depression symptoms and socio-demographic factors found that in patients both with (coefficient 1.08, p = 0.03) and without (coefficient 0.77, p = 0.03) a personal history of depression, having a vicarious experience (family and friend, respectively) with depression is associated with a more favorable attitude towards antidepressant medications.
Patients with vicarious experiences of depression express more acceptance of pharmacotherapy. Conversely, patients lacking vicarious experiences of depression have more negative attitudes towards antidepressants. When discussing treatment with patients, clinicians should inquire about vicarious experiences of depression. This information may identify patients at greater risk for non-adherence and lead to more tailored patient-specific education about treatment.
Available from: Waleed Fawzi
- "Antidepressants are effective treatments for depression, but adherence is low among the elderly (Maidment et al., 2002; Cooper et al., 2005), even though older patients are more likely to adhere to medication than younger patients (Akincigil et al., 2007; Bambauer et al., 2007). Predictors of adherence are poorly understood (Osterberg and Blaschke, 2005) and studies have been Correspondence should be addressed to: Dr Waleed Fawzi, Institute of Psychiatry, Box PO70, De Crespigny Park, London, SE5 8AF, UK. "
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ABSTRACT: Adherence to treatment is a complex and poorly understood phenomenon. This study investigates the relationship between older depressed patients' adherence to antidepressants and their beliefs about and knowledge of the medication.
Assessment was undertaken of 108 outpatients over the age of 55 years diagnosed with depressive disorder and treated for at least four weeks with antidepressants. Adherence was assessed using two self-report measures: the Medication Adherence Rating Scale (MARS) and a Global Adherence Measure (GAM). Potential predictors of adherence investigated included sociodemographic, medication and illness variables. In addition, 33 carers were interviewed regarding general medication beliefs.
56% of patients reported 80% or higher adherence on the GAM. Sociodemographic variables were not associated with adherence on the MARS. Specific beliefs about medicines, such as "my health depends on antidepressants" (necessity) and being less worried about becoming dependant on antidepressants (concern) were highly correlated with adherence. General beliefs about medicines causing harm or being overprescribed, experiencing medication side-effects and severity of depression also correlated with poor adherence. Linear regression with the MARS as the dependent variable explained 44.3% of the variance and showed adherence to be higher in subjects with healthy specific beliefs who received more information about antidepressants and worse with depression severity and autonomic side-effects.
Our findings strongly support a role for specific beliefs about medicines in adherence. Challenging patients' beliefs, providing information about treatment and discussing side-effects could improve adherence. Poor response to treatment and medication side-effects can indicate poor adherence and should be considered before switching medications.
Available from: J. John Mann
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ABSTRACT: To determine whether the effect of antidepressant exposure on suicide rate is modified by age and gender in Hungary, annual antidepressant prescription rates and suicide rates of about 10 million inhabitants between 1999-2005 were analyzed by age and gender groups. The suicide rate was inversely related to the increased use of antidepressants in both genders. The strongest association was found in the oldest age groups, where the increase in antidepressant use was highest, while there was no association in the under 20 or 50-69 age groups in either gender. Antidepressant prescription rate was related to suicide rate after controlling for divorce rate or unemployment rate, but not after controlling for alcohol consumption rate.
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