Antidepressant Medication Adherence Research Articles

Patient Characteristics and Adherence to Antidepressant Medication Treatment at PsychiatricOutpatient Department of Mardan Medical Complex, Pakistan

Background: Adherence to antidepressant treatment is an important factor in the treatment and effective management of depressed patients. Characteristics of patients can help in determining compliance to treatment protocols. In order to find link between compliance and demographic characteristics of patients, insight can be obtained through exploration of these variables.Objectives: To determine the association between patient characteristics and antidepressant medication adherence. To identify characteristics of patients that may improve or worsen compliance to antidepressant medication. Material and Methods: This study was a descriptive, cross-sectional study aiming to find the link between personal characteristics and adherence to anti-depressant medications. The study was conducted at Psychiatry outpatient department of a tertiary care hospital, Mardan Medical Complex, Mardan Pakistan, from 05th September 2018 to 08th February 2021. Data was collected from 660 patients who presented with depressive symptoms to Psychiatry OPD. The main objective was to identify characteristics of patients leading to poor compliance to antidepressant medication. Results: Total study population was 660. Majority of the study population 82.9 % (n-549) were female. Uneducated were, 56.6 % (375), 81.1 % (n-537) were unemployed, and 65.9 % (n-436) were married. Follow up interviews were conducted in 316 (47.7 %) patients at 3rd week, 186 (28.1 %) patients at 6th week, 130 (19.6 %) patients at 9th week, 96 (14.5 %) patients at 12th week, and 31 (4.7 %) patients at 6 months. There was no significant difference found on the basis of patient characteristics and adherence. However, compliance was better among patients who had longer duration of illness. Conclusion: Medication adherence is a common problem among depressed patients and leads to impaired daily life functioning. Our study could not found any significant difference regarding patient characteristics among compliant and non compliant patients. Educating patients regarding the use of antidepressant medication treatment should be added to routine practice. Keywords: Anti depressants, Depression, Non-adherence, Poor compliance.

0477 Positive Airway Pressure Therapy and Antidepressant Medication Adherence in Patients with Obstructive Sleep Apnea and Depression

Abstract Introduction Previous studies have shown that treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy in patients with OSA and comorbid depression may improve response to antidepressant medication therapy. At the same time, scant evidence has examined the impact of medication and PAP adherence in patients with OSA and comorbid depression. Patients that adhere to one therapy may be more likely to adhere to other therapies or healthy behaviors in a so-called “healthy user effect.” This retrospective study investigated the association between antidepressant medication adherence and PAP therapy adherence in patients with newly diagnosed OSA and comorbid depression. Methods Our data source was a national sample of administrative claims data linked to objective PAP therapy usage. Included patients either had two healthcare encounters or one hospitalization with a depression ICD-10 diagnosis code the year prior to being diagnosed with OSA and initiated on PAP therapy. Adherence to antidepressant medication was defined as ≥80% of proportion of days covered (PDC), and non-adherence was defined as < 80% PDC within a 180-day exposure window during the year prior to starting PAP therapy. Adherence to PAP therapy was categorized as consistently adherent, intermediately adherent, or not adherent based on objective usage over 2 years. Results 36,668 patients with OSA and comorbid depression were included. 27% were classified as consistently adherent, 45% intermediately adherent, and 28% non-adherent to PAP therapy. 68.6% of patients used antidepressant medication in the year prior to PAP initiation. 67.7% used a selective serotonin reuptake inhibitor, 43.8% atypical antidepressants, 32.1% serotonin and norepinephrine reuptake inhibitor, 10.7% tricyclic antidepressant, and 0.1% monoamine oxidase inhibitor. Relative to patients not adherent to antidepressant medication (22.2% consistently adherent, 43.8% intermediately adherent, 33.9% not adherent), those adherent to antidepressant medication in the year prior were also more adherent to PAP therapy over 2 years (29.2% consistently adherent, 45.2% intermediately adherent, 25.6% not adherent). Conclusion Patients that were adherent to antidepressant medication in the year prior to starting PAP therapy have slightly better adherence to PAP therapy over 2 years. In real-world studies, medication adherence may be an important confounder to adjust for when comparing patient outcomes. Support (if any)

Psychosocial interventions to improve adherence in depressed and anxious older adults prescribed antidepressant pharmacotherapy: a scoping review.

Medication nonadherence in depressed and anxious older adults is prevalent and associated with non-response to antidepressant pharmacotherapy. Evidence-based options to improve medication adherence are limited in this population. To review the state of the literature on the types and efficacy of psychosocial interventions for improving antidepressant pharmacotherapy adherence in depressed and anxious older adults. We conducted a scoping review according to PRISMA-ScR guidelines. PubMed/Medline and article references starting in 1980 up to 28 February 2023 were reviewed. Of the 710 records screened, 4 psychosocial interventions were included in the review. All studies included depressed older adults, and none included anxious older adults. Samples included racial and ethnic minorities and were primarily women. The psychosocial interventions consisted mainly of psychoeducation with usual care as the control comparison. Measures of antidepressant adherence included self-reported adherence or pill counting. Three of the four randomized controlled trials improved medication adherence rates and reduced depression symptom burden. Effective interventions exist for improving antidepressant medication adherence in depressed older adults. Improved adherence can reduce depression symptom burden. The lack of interventions for anxious older adults highlights the need to develop and deliver interventions for anxious older adults prescribed antidepressant pharmacotherapy.

A cross-sectional study of factors associated with anti-depressant medication adherence in women attending an out patient psychiatry department

Introduction: Treatment adherence and illness may not be related only by the severity of the illness but by so many other factors which impact on seeking and continuing treatment; yet severity of the illness will be one of the major factors influencing treatment adherence. Methods: Female patients attending the psychiatric OPD, diagnosed with depression as per ICD-10 guidelines and provided informed consent participated in this questionnaire-based study. A total of 135 patients who attended the OPD in 9 months were assessed for the severity of depression and medication adherence by administering scales to assess the severity of depression and medication adherence was assessed by questioning about the drug taking and hospital attending behaviour. Out of this, thirty-one were attending for the first episode and hence were excluded from the analysis. Results: Out of the 104 female patients diagnosed with depression of more than one episode, 44 (42.3%) had mild depression, 52 (50%) had moderate depression and 8 (7.7%) had severe depression. Twenty-nine women (27.9%) were on medications and 75 (72.1%) women were not taking their medications. While greater proportion of women with mild depression were adherent to medication (51.7%), more women with moderate depression didn’t adhere to medication (54.7%), even though such difference was statistically not significant. Older age, having a paid work and married status were significantly associated with medication (antidepressants) adherence. Conclusions: Our results indicate that medication adherence is associated with factors other than severity of depression. Work and marital status played a significant role in determining the adherence to antidepressant medications among women.

Impact of pharmacist intervention on antidepressant medication adherence and disease severity in patients with major depressive disorder in fragile north-east Nigeria

AbstractObjectivesMedication adherence is emerging as a major public health challenge particularly in patients with depression. The aim of this study was to explore the usefulness of a pharmacist intervention to improve antidepressant medication adherence and disease severity in patients with major depressive disorder.MethodsThis prospective interventional study was conducted between April 2019 and March 2020 among 101 patients at the Federal Neuro-Psychiatric Hospital, Maiduguri, Nigeria. Consenting patients were randomised into usual care or intervention groups using a computer-generated list. Data were collected at baseline, 3 months and 6 months. Medication adherence and depression severity were assessed using the Medication Adherence Rating Scale and Beck Depression Inventory respectively.Key findingsAt baseline, both the usual care and intervention groups had low mean scores for medication adherence [5.22 (SD = 1.51) versus 5.46 (SD = 1.46)] and high mean scores for depression severity [24.16 (SD = 13.50) versus 27.07 (SD = 16.12)]. At 6 months, there was a significant difference (P < 0.001) between the mean medication adherence scores of 5.22 (SD = 1.90) and 9.15 (SD = 1.62), in the usual care and intervention groups respectively. A significant difference (P = 0.033) was also observed at 6 months between the mean depression severity scores of the usual care and intervention groups [21.40 (SD = 11.52) and 17.34 (SD = 6.96)]. Medication adherence (P < 0.001, Partial eta squared = 0.279) and depression severity (P < 0.001, Partial eta squared = 0.170) positively changed with time in the presence of the intervention.ConclusionsThe intervention significantly improved antidepressant medication adherence and disease severity in patients with major depressive disorder.

On-Site Prescription Dispensing Improves Antidepressant Adherence among Uninsured Depressed Patients.

The successful treatment of depressive disorders critically depends on adherence to prescribed treatment regimens. Despite increasing rates of antidepressant medication prescription, adherence to the full treatment course remains poor. Rates of antidepressant non-adherence are higher for uninsured patients and members of some marginalized racial and ethnic communities due to factors such as inequities in healthcare and access to insurance. Among patients treated in a free, student-run and faculty-supervised clinic serving uninsured patients in a majority Hispanic community in East Harlem, adherence rates are lower than those observed in patients with private or public New York State health insurance coverage. A prior study of adherence in these patients revealed that difficulty in obtaining medications from an off-site hospital pharmacy was a leading factor that patients cited for non-adherence. To alleviate this barrier to obtaining prescriptions, we tested the effectiveness of on-site, in-clinic medication dispensing for improving antidepressant medication adherence rates among uninsured patients. We found that dispensing medications directly to patients in clinic was associated with increased visits at which patients self-reported proper adherence and increased overall adherence rates. Furthermore, we found evidence that higher rates of antidepressant medication adherence were associated with more favorable treatment outcomes. All patients interviewed reported increased satisfaction with on-site dispensing. Overall, this study provides promising evidence that on-site antidepressant dispensing in a resource-limited setting improves medication adherence rates and leads to more favorable treatment outcomes with enhanced patient satisfaction.

“A link to the outside:” Patient perspectives on a mobile texting program to improve depression self-management

BackgroundThe effectiveness of technology-assisted interventions designed to ameliorate depressive symptoms and improve antidepressant medication adherence is hampered by diminished usage over time and poor integration with clinical care. ObjectiveThis manuscript presents patient perspectives on a texting and secure messaging intervention designed to engage providers and patients during a targeted transition period when patients were initiating a new antidepressant medication. Patient involvementDevelopment of the intervention was guided by feedback from a presentation and discussion with an engagement panel of local stakeholders, including patients, who meet quarterly with research investigators. MethodsSemi-structured, qualitative, telephone interviews were conducted with 21 participants. Interviews were designed to identify the themes of self-determination and planned behavior in using the text messaging intervention. Qualitative analysis of participants’ experiences used inductive and deductive coding, as well as pile sorting. ResultsThe intervention prompted participants to reflect about how they manage their mood, engage in behaviors guided by their values, and commit to making positive changes in how they acted in real-time. Elements of the intervention facilitated participant conversations with trusted friends and family over time about what had influenced their actions and feelings. DiscussionThe texting intervention appeared to help participants live a life consistent with their values. However, we were unable to recruit mental health providers to participate. Practical valueTechnology to promote self-reflection and an “observing self” may work best when done in dialogue with important others, including mental health providers. Future directions of this research should find ways to understand provider buy-in, or lack thereof, in e-health interventions.

Glycaemic trajectory and predictors of suboptimal glycaemic control in people with type 2 diabetes.

We aimed to describe the glycaemic trajectory and define characteristics associated with suboptimal glycaemic control in the type 2 diabetes clinic. Higher glycosylated haemoglobin (HbA1c) at 1 year was associated with higher baseline HbA1c, concurrent anti-depressant or antipsychotic medication, higher bodyweight and low treatment adherence. These characteristics may help identify patients unlikely to attain HbA1c treatment targets and be better served by a different model of care.

Effect of income level on adherence to antidepressant treatment in first onset depression outpatients.

Clinical guidelines for depression management recommend continuous antidepressant medication; however, poor adherence to medication is commonly seen in the treatment of depression. Income is an important factor influencing antidepressant medication adherence. The purpose of this study was to investigate the relationship between income level and adherence to antidepressant medication in outpatients with depression. This was a retrospective cohort study using National Health Insurance claim data for services provided between January 1 and December 31, 2012. We examined data from a total of 142,336 individuals aged 18 years or older who were continuously enrolled in treatment after a new episode of major depression and who had initiated antidepressant treatment. The operational definition of adherence to antidepressant treatment was medication being dispensed to the patient at least 80% of the time during 3 and 6 months (ie. MPR ≥80%). To investigate the relationship between income level and adherence to antidepressants, we estimated adjusted odds ratios and 95% confidence intervals using hierarchical logistic regression analysis, adjusting for sociodemographic, clinical, and medical use characteristics. A total of 22.64% and 15.13% of depression patients showed adherence to antidepressants during 3 and 6 months, respectively. A statistically significant association was found between income level and adherence to antidepressants over 3 and 6 months for individuals with employee and self-employed subscribers. In addition, adherence to antidepressants was lower among those with a lower income than those with a higher income. We confirmed that social disparities exist in adherence to antidepressant treatment by income level in this Korean population-based retrospective cohort of depression outpatients.

Large posttraumatic stress disorder improvement and antidepressant medication adherence

BackgroundPatients with vs. without posttraumatic stress disorder (PTSD) are more likely to have poor antidepressant medication (ADM) adherence but it is unclear if improved PTSD is associated with ADM adherence. We determined if clinically meaningful PTSD symptom reduction was associated with ADM adherence. MethodsElectronic health record data (2008–2015) was obtained from 742 Veterans Health Affairs (VHA) patients using PTSD specialty clinics with a PTSD diagnosis and PTSD checklist (PCL) score ≥50. The last PCL in the exposure year after the first PCL≥50 was used to identify patients with a clinically meaningful PCL decrease (≥20 point) versus those without (< 20 point). Patients had a depression diagnosis in the 12-months before the exposure year and received an ADM in the exposure year. Proportion of days covered ≥80% in exposure year defined adherence. Confounding was controlled using propensity scores and inverse probability of treatment weighting. ResultsPatients were 42.2 ± 13.1 years of age, 63.9% white and 18.9% had a clinically meaningful PCL decrease. After controlling for confounding variables, patients with vs. without a clinically meaningful PCL decrease were significantly more likely to be adherent (OR = 1.78; 95% CI:1.16–2.73). However, adherence remained low in both patients with and without meaningful PCL decrease (53.5% vs. 39.3%). LimitationsThe sample was limited to VHA patients. Patients may not have taken medication as prescribed. ConclusionsLarge reductions in PTSD symptoms are associated with ADM adherence. Prior literature suggests ADM adherence improves depression symptoms. Thus, PTSD symptom reduction may lead to better depression outcomes.

Behavioral Health Integration With Primary Care: Implementation Experience and Impacts From the State Innovation Model Round 1 States.

Increasing numbers of states are looking for ways to address behavioral health (BH) conditions among their residents. The first round of the State Innovation Models (SIM) Initiative provided financial and technical support to six states since 2013 to test the ability of state governments to lead health care system transformation. All six SIM states invested in integration of BH and primary care services. This study summarizes states' progress, challenges, and lessons learned on BH integration. Additionally, the study reports impacts on expenditure, utilization, and quality-of-care outcomes for persons with BH conditions across four SIM states. We use a mixed-methods design, drawing on focus groups and key informant interviews to reach conclusions on implementation and quantitative analysis using Medicaid claims data to assess impact. For three Medicaid accountable care organization (ACO) models funded under SIM, we used a difference-in-differences regression model to compare outcomes for model participants with BH conditions and an in-state comparison group before-and-after model implementation. For the behavioral health home (BHH) model in Maine, we used a pre-post design to assess how outcomes for model participants changed over time. Informal relationship building, tailored technical assistance, and the promotion of data sharing were key factors in making progress. After three years of implementation, the growth in total expenditures was less than the comparison group by $128 (-$253, -$3; p < 0.10) and $62 (-$87, -$36; p < 0.001) per beneficiary per month for beneficiaries with BH conditions attributed to an ACO in Minnesota and Vermont, respectively. Likewise, there were reductions in emergency department use for ACO participants in all three states after two to four years of implementation. However, there was no improvement in BH-related quality metrics for ACO beneficiaries in all three states. Although participants in the BHH model had increased expenditures after two years of implementation, use of primary care and specialty care services increased by 3% and 8%, respectively, and antidepressant medication adherence also improved. The SIM Round 1 states made considerable progress in integrating BH and primary care services, and there were promising findings for all models. Taken together, there is some evidence that Medicaid payment models can improve patterns of care for beneficiaries with BH conditions.

Pharmacist-led telehealth disease management program for patients with diabetes and depression

Introduction The aim of this study was to determine whether a pharmacist-led telehealth disease management program is superior to usual care of nurse-led telehealth in improving diabetes medication adherence, haemoglobin A1C (A1C), and depression scores in patients with concomitant diabetes and depression. Methods Patients with diabetes and depression were randomized to pharmacist-led or nurse-led telehealth. Veterans with type 1 or type 2 diabetes, an A1C ≥ 7.5%, diagnosis of depression, and access to a landline phone were invited to participate. Patients were randomized to usual care of nurse-led telehealth or pharmacist-led telehealth. Patients were shown how to use the telehealth equipment by the nurse or pharmacist. In the pharmacist-led group, the patients received an in-depth medication review in addition to the instruction on the telehealth equipment. Results After six months, the pharmacist-led telehealth arm showed significant improvements for cardiovascular medication adherence (14.0; 95% confidence interval (CI) 0.4 to 27.6), antidepressant medication adherence (26.0; 95% CI 0.9 to 51.2), and overall medication adherence combined (13.9; 95% CI 6.6 to 21.2) from baseline to six-month follow-up. There was a significant difference in A1C between each group at the six-month follow-up in the nurse-led telehealth group (6.9 ± 0.9) as compared to the pharmacist-led telehealth group (8.8 ± 2.0). There was no significance in the change in patient health questionnaire-9 (PHQ-9) and Center for Epidemiologic Studies Depression Scale (CES-D) from baseline to follow-up in both groups. Discussion Pharmacist-led telehealth was efficacious in improving medication adherence for cardiovascular, antidepressants, and overall medications over a six-month period as compared to nurse-led telehealth. There was no significant improvement in overall depression scores.

With a little help from my friends?: racial and gender differences in the role of social support in later-life depression medication adherence.

Social support has been shown to be an important factor in improving depression symptom outcomes, yet less is known regarding its impact on antidepressant medication adherence. This study sought to evaluate the role of perceived social support on adherence to new antidepressant medication prescriptions in later-life depression. Data from two prospective observational studies of participants ≥60 years old, diagnosed with depression, and recently prescribed a new antidepressant (N = 452). Perceived social support was measured using a subscale of the Duke Social Support Index and medication adherence was assessed using a validated self-report measure. At four-month follow up, 68% of patients reported that they were adherent to antidepressant medication. Examining the overall sample, logistic regression analysis demonstrated no significant relationship between perceived social support and medication adherence. However, when stratifying the sample by social support, race, and gender, adherence significantly differed by race and gender in those with inadequate social support: Among those with low social support, African-American females were significantly less likely to adhere to depression treatment than white females (OR = 4.82, 95% CI = 1.14-20.28, p = 0.032) and white males (OR = 3.50, 95% CI = 1.03-11.92, p = 0.045). There is a significant difference in antidepressant medication adherence by race and gender in those with inadequate social support. Tailored treatment interventions for low social support should be sensitive to racial and gender differences.

Effect of pharmacist intervention on improving antidepressant medication adherence and depression symptomology: A systematic review and meta-analysis.

Depression is a widespread disease with effective pharmacological treatments, but low medication adherence. Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients. The aim of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders. A systematic review of controlled trials (both randomized and non-randomized) was conducted. Studies were obtained through a search of PubMed, Academic Search Premier, and Cochrane Library databases. Studies which included a pharmacist intervention to improve medication adherence in outpatients age 17 and above with a depressive disorder diagnosis and antidepressant treatment were included. Twelve publications met inclusion criteria, representing a total of 15,087 subjects: 1379 (9%) intervention and 13,708 (91%) control. The interventions in each selected publication included some level of in-person counseling and education to promote antidepressant adherence. The pooled odds ratio for medication adherence at 6 months was 2.50 (95% CI 1.62 to 3.86). There were no significant differences noted in subgroup meta-analyses except study location (US, Middle East or Europe) and setting. Only one of the identified studies reported statistically significant impacts of the pharmacist intervention on patient depression symptoms. The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms. Additional longitudinal research is recommended to investigate the multidimensional relationships between pharmacist interventions, patient adherence, and clinical outcomes. Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients. The purpose of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders. A systematic review of randomized and non-randomized controlled trials was conducted of the twelve studies which met inclusion criteria. The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms.

Pilot study of enhanced social support with automated telephone monitoring after psychiatric hospitalization for depression

Following discharge, patients hospitalized for depression are at high risk for poor retention in outpatient care and adverse outcomes. Pilot tests a post-hospital monitoring and enhanced support program for depression. 48 patients at a Veterans Affairs Medical Center discharged following a depression-related inpatient stay received weekly visits or phone calls for 6months from their choice of either a family member/friend (n=19) or a certified peer support specialist (n=29). Participants also completed weekly automated telephone monitoring calls assessing depressive symptoms and antidepressant medication adherence. Over 90% of participants were more satisfied with their care due to the service. The mean change from baseline to 6months in depression symptoms was -7.9 (p<0.05) according to the Patient Health Questionnaire and -11.2 (p<0.05) according to the Beck Depression Inventory-II for those supported by a family member/friend, whereas those supported by a peer specialist had mean changes of -3.5 (p<0.05) and -1.7 (p>0.10), respectively. Increased contact with a chosen support person coupled with automated telephone monitoring after psychiatric hospitalization is an acceptable service for patients with depression. Those who received the service, and particularly those supported by a family member/friend, experienced reductions in symptoms of depression.

4.45 PATHWAY TO DEPRESSION CARE IN CHILDREN AND ADOLESCENTS FIRST IDENTIFIED BY PRIMARY CARE PROVIDERS VERSUS PSYCHIATRISTS

The health professional contacted first for MDD diagnosis and treatment may determine the route of care-seeking pathway (CSP), as well as the receipt of care. This study evaluated CSP for pediatric patients identified by PCP or psychiatrists (PSY) for MDD with respect to follow-up visits, antidepressant medication (ADM) adherence, and mental health (MH)-related hospitalization.

Medication Adherence and Persistence in Patients with Severe Major Depressive Disorder with Psychotic Features: Antidepressant and Second-Generation Antipsychotic Therapy Versus Antidepressant Monotherapy.

Major depressive disorder with psychotic features, or psychotic depression, is a severe mental health disorder often associated with a worse depression-related symptom profile when compared with major depressive disorder without psychotic features. While combination pharmacotherapy with an antidepressant and an antipsychotic is recommended as first-line therapy, antidepressant monotherapy has been found to be useful and efficacious in psychotic depression. To assess the rates of antidepressant adherence and antidepressant persistence in Texas Medicaid patients with psychotic depression who used antidepressant plus second-generation antipsychotic (AD/SGA) therapy or antidepressant (AD) monotherapy. Using Texas Medicaid prescription and medical claims data from September 2007 to December 2012, adult patients aged 18-63 years were included if they had no confounding psychiatric disorders, no antidepressant claims during a 6-month pre-index period, and at least 1 diagnosis for severe major depressive disorder with psychotic features (ICD-9-CM codes 296.24 and 296.34). The first claim date for an antidepressant served as the index date. All patients were required to have at least 2 antidepressant claims, and those in the AD/SGA cohort were required to have 2 or more claims for an SGA. Study covariates included age, gender, race/ethnicity, residence, Charlson Comorbidity Index (CCI) score, and tobacco use/dependence. Statistical analyses included descriptive statistics, univariate analyses, logistic regression, and Cox proportional hazards regression. A total of 926 patients met study criteria (AD cohort = 510; AD/SGA cohort = 416). The overall sample had a mean [±SD] age of 40.5 [±13.2] years and was primarily female (66.8%) and non-Caucasian (74.8%). When compared with the AD cohort, patients in the AD/SGA cohort had a 52.3% higher likelihood of being adherent to antidepressant therapy based on proportion of days covered (PDC; OR = 1.523; 95% CI = 1.129-2.053; P = 0.006). Similarly, antidepressant adherence was 42.0% higher for the AD/SGA cohort based on medication possession ratio (MPR; OR = 1.420; 95% CI = 1.062-1.898; P = 0.018). Younger patients, African Americans, and tobacco users/dependents had significantly worse likelihoods of antidepressant medication adherence based on PDC and MPR. The risk of antidepressant nonpersistence was 23.2% lower for patients in the AD/SGA cohort (HR = 0.768; 95% CI = 0.659-0.896; P = 0.001), compared with those in the AD cohort. Antidepressant nonpersistence was significantly higher in younger patients, African Americans, Hispanics, and tobacco users/dependents. Better antidepressant adherence and persistence outcomes were associated with combination pharmacotherapy with an AD and an SGA antipsychotic. This study provides real-world estimates that support the current first-line treatment recommendations for psychotic depression; however, it should be noted that the majority of study patients used AD therapy only. Future research in psychotic depression is needed. Kim-Romo received funding to conduct this study from the PhRMA Foundation Pre-Doctoral Fellowship in Health Outcomes. Rascati, Richards, Ford, Wilson, and Beretvas declare no conflict of interest in relation to this manuscript. Kim-Romo and Rascati collaborated on the study design, data analysis, study interpretation, and writing of this manuscript. Richards, Ford, Wilson, and Beretvas provided critical evaluation of the study design, analysis, and interpretation, as well as edited this manuscript.

MedLink: A mobile intervention to improve medication adherence and processes of care for treatment of depression in general medicine.

BackgroundMajor depressive disorder is a common psychological problem affecting up to 20% of adults in their lifetime. The majority of people treated for depression receive antidepressant medication through their primary care physician. This commonly results in low rates of recovery. Failure points in the process of care contributing to poor outcomes include patient non-adherence to medications, failure of physicians to optimize dose and absence of communication between patients and physicians.ObjectiveThis pilot study evaluated the feasibility of a systemic digital intervention (MedLink) designed to address failure points and improve treatment of depression in primary care among patients during the first eight weeks of initiating a new course of antidepressant therapy.MethodsParticipants were provided with the MedLink mobile app that provided dose reminders, information and surveys of symptoms and side effects. A cellularly enabled pillbox monitored antidepressant medication adherence. Reports were provided to physicians and participants to prompt changes in medication regimen. Study outcomes were assessed via self-report and interview measures at baseline, week 4 and week 8.ResultsMedication adherence detected by the MedLink system was 82%. Participants demonstrated significant decreases in depressive symptoms on the patient health questionnaire-9 (PHQ-9) (p = 0.0005) and the Quick Inventory of Depressive Symptomatology (p = 0.0008) over the eight-week trial. Usability was generally rated favorably.ConclusionsThe MedLink system demonstrated promise as an intervention to address failure points in the primary care treatment of major depressive disorder. Current findings support the further development of MedLink through a randomized controlled trial to evaluate the efficacy of improving processes of care, patient adherence and symptoms of depression.

Associations between antidepressant adherence and shared decision-making, patient-provider trust, and communication among adults with diabetes: diabetes study of Northern California (DISTANCE).

Depression and adherence to antidepressant treatment are important clinical concerns in diabetes care. While patient-provider communication patterns have been associated with adherence for cardiometabolic medications, it is unknown whether interpersonal aspects of care impact antidepressant medication adherence. To determine whether shared decision-making, patient-provider trust, or communication are associated with early stage and ongoing antidepressant adherence. Observational new prescription cohort study. Kaiser Permanente Northern California. One thousand five hundred twenty-three adults with type 2 diabetes who completed a survey in 2006 and received a new antidepressant prescription during 2006-2010. Exposures included items based on the Trust in Physicians and Interpersonal Processes of Care instruments and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) communication scale. Measures of adherence were estimated using validated methods with physician prescribing and pharmacy dispensing data: primary non-adherence (medication never dispensed), early non-persistence (dispensed once, never refilled), and new prescription medication gap (NPMG; proportion of time without medication during 12 months after initial prescription). After adjusting for potential confounders, patients' perceived lack of shared decision-making was significantly associated with primary non-adherence (RR = 2.42, p < 0.05), early non-persistence (RR = 1.34, p < 0.01) and NPMG (estimated 5% greater gap in medication supply, p < 0.01). Less trust in provider was significantly associated with early non-persistence (RRs 1.22-1.25, ps < 0.05) and NPMG (estimated NPMG differences 5-8%, ps < 0.01). All patients were insured and had consistent access to and quality of care. Patients' perceptions of their relationships with providers, including lack of shared decision-making or trust, demonstrated strong associations with antidepressant non-adherence. Further research should explore whether interventions for healthcare providers and systems that foster shared decision-making and trust might also improve medication adherence.

EPA-0910 - Medication possession ratio among depressed patients enrolled in collaborative care.

Non-adherence to antidepressant medications is a major barrier to achieving treatment response and remission in clinical practice. Medication possession ratio (MPR) has been used to reflect treatment adherence of patients with chronic conditions including depression. An MRP =/> 80% correlates with high compliance. Systematic reviews of interventions to improve antidepressant medication adherence found that education interventions failed to demonstrate clear benefit on adherence; however, proactive care and collaborative care management (CCM) were associated with significant degree of adherence and improved clinical outcomes (1, 2). We looked into MPR measured from our institution's administrative pharmacy data among patients with depression seen at Primary Care Internal Medicine and enrolled in CCM from March 2008 until July 2012; we also determined predictors of non-adherence. Data was analyzed on 515 patients who gave research consent. Yearly mean MPR was calculated at 6 month intervals beginning December 2010 until July 2012. Rate of yearly MPR =/> 80% ranged from 27% to 42% but remained consistent beyond the timeframe of CCM enrollment. Race, presence of co-morbid hypertension and hyperlipidemia were associated with significantly decreased medication adherence (MPR In conclusion, approximately one third of patients with depression enrolled in CCM exhibited high medication adherence reflected by mean MRP =/>80%. While CCM has resulted in 46% remission rate at 12 months in this patient group, medication adherence appeared to be lower which implied that features intrinsic to CCM may account mostly for depression treatment effectiveness.