Antidepressants are most effective when taken for at least six months, according to background information in the article. However, rates of adherence (taking medications as prescribed) are low and methods that effectively increase them are often prohibitively expensive and complex. Managed care organizations have used a number of approaches to increase adherence at a lower cost, the authors write. These include providing print and Internet-based educational materials and developing comprehensive opt-in depression management programs.
Kara Zivin Bambauer, Ph.D., Harvard Pilgrim Health Care and Harvard Medical School, Boston, and colleagues assessed one such antidepressant compliance program, which began in May 2003 and alerted physicians by fax when patients were not adherent during the first six months of antidepressant therapy. Physicians were sent faxes when patients did not refill their prescription for at least 10 days beyond the date that their previous prescription ran out. The researchers studied 13,128 members of one health plan (9,079 women and 4,049 men) who received antidepressant prescriptions between May 15, 2002, and May 14, 2004.
Slightly less than half (6,387) of the patients began taking antidepressants before the fax alert program began and slightly more than half (6,741) began afterward. Over the two-year period of the study, there was no significant change in prescription adherence rates; 1,159 (18 percent) of patients were adherent before the fax alert program began and 1,171 (17 percent) were adherent afterward. The proportion of nonadherent patients remained relatively constant at about 75 percent.
There are several reasons why such a program might not be effective on its own, the authors suggest. "Patient nonadherence to drug therapy is a complex phenomenon, and reasons for nonadherence to recommended therapy may vary depending on where patients are in the treatment process," they write. Programs that involve personal contact with patients by pharmacists, nurses or depression care managers may be more effective. In addition, physicians could become densensitized if they receive too many faxes regarding patients who are actually adherent, which could happen if prescriptions are filled on day 11, if information from the pharmacy is delayed or if patients stop therapy because of adverse effects, they explain.
"Given the high rates of nonadherence to long-term drug therapy in general, and to the use of antidepressants in particular, inexpensive interventions to improve adherence are needed," the authors conclude. "However, based on the results of this study, managed care organizations should be cautious about using this form of faxed reminder system as a singular approach for physicians to improve patient medication adherence."
(Arch Intern Med. 2006; 166: 498-504. Available pre-embargo to media at www.jamamedia.org.)
Editor's Note: This work was funded by a faculty grant from the HPHC Foundation. Dr. Soumerai is an investigator in the HMO Research Network Center for Education and Research in Therapeutics, supported by the Agency for Healthcare Research and Quality, Rockville, Md.
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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