A method that dramatically improves patient adherence to depression treatment
Use of a flow sheet, coupled with patient education and diligent follow-up, improves medication adherence.
Another study showed that a strong alliance between physicians and patients that involves discussions about adverse drug effects may alleviate patients’ concerns and help them continue treatment.1
Moreover, intolerance to one antidepressant is not necessarily indicative of intolerance to another, even within the same drug class. Therefore, patients who respond poorly to one drug or who experience adverse effects may benefit by switching to another antidepressant medication.1 This medication shift, however, necessitates good communication between patients and clinicians about treatment experiences.1
Adherence can be improved. This study showed that patient adherence to a prescribed medical regimen significantly improved over the life of the study. The 9-month medication adherence rate of 66% dramatically exceeds the 33% rate chronicled in the literature. Over time, the use of the process outlined was associated with significant reductions in the severity of depressive symptoms.
A few caveats. One limitation of this study is its small number of subjects, and the deficiency of data for subjects who had died, transferred out of the practice, or were otherwise lost to contact.
The lack of a control group is also acknowledged. However, comparisons were made between this study and the adherence rates documented in other studies.
Though the PHQ-9 diagnostic tool is reliable and valid, it is self-administered. Likewise, data collection—ie, whether they discontinued medications, and, if so, for what reason—depended on patients’ responses.
Even though the project stressed patient adherence, the use of the flow sheet may very well have contributed to increased physician awareness and physician education, which therefore, in itself, may have resulted in improved patient compliance.
The results of this project can be generalized only to practices similar to its setting. Other practices with different methods or types of information systems may not achieve the same results when using a flow sheet. Further research in a wider area using a larger number of subjects with broader demographics is necessary to corroborate these findings.
TABLE 3
Reasons for discontinuing medications
| Drug-related adverse effects |
| Short-term relief from depression, or, conversely, the lack of relief |
| Reluctance to take pills |
| Depression itself as a factor for nonadherence to medical treatment |
| Lack of physician/patient communication |
| Social stigma |
| Poor commitment to treatment |
| Lack of patient education |
| Spousal separation, death of a spouse, or divorce |
| Lack of social support |
| Complexity and behavioral demands of concurrent restrictions such as weight loss or smoking cessation |
| Exacerbation of a comorbid condition |
TABLE 4
Factors conducive to regimen compliance
| Good physician/patient communication |
| A strong treatment alliance between patients and clinicians, and discussions about adverse effects throughout treatment |
| A full disclosure of the need for the patient to continue medications for the expected duration of antidepressant therapy—in other words, taking antidepressants chronically to prevent future recurrence |
| Keeping the regimen as simple as possible—patients who participate in concurrent non-drug therapy are less likely to discontinue the antidepressant |
| Frequent physician-patient contact |
| Prior use of antidepressants may reduce the discontinuance of medication, probably because of a recurrent episode of depression |
| Switching medication has been related to a favorable outcome |
CORRESPONDING AUTHOR
Gary Ruoff, MD, Westside Family Medical Center, 6565 West Main Street, Kalamazooo, MI 49009. E-mail: gryruof@aol.com
