Treatment Adequacy and Adherence as Predictors of Depression Response in Primary Care |
| |
| Affiliation: | 1. Department of Psychiatry, Weill Cornell Medical College (JAS, AW, NS, PZ, GA);2. Department of Healthcare Policy & Research, Weill Cornell Medicine (LE, SB);3. Department of Psychiatry and Behavioral Sciences, University of California at Davis (HCK);1. Yale School of Medicine (KMW, MLC, PDK, RHP), New Haven, CT;2. VA Connecticut Healthcare System (KMW, MLC, RHP), West Haven, CT;3. VA Greater Los Angeles Healthcare System (BCY), Los Angeles, CA;4. University of California (BCY), Los Angeles, CA;5. McLean Hospital, Harvard Medical School (BPF), Boston, MA;6. Tulane University School of Medicine (PDK), New Orleans, LA;7. Southeast Louisiana Veterans Healthcare System (PDK), New Orleans, LA;1. Department of Psychiatry (KJM), University of Connecticut Health Center, Farmington, CT;2. Department of Psychiatry and Behavioral Sciences (WDT), Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, TN;3. Geriatric Research, Education, and Clinical Center (WDT), Veterans Affairs Tennessee Valley Health System, Nashville, TN;1. Global Brain Health Institute, University of California San Francisco (FEW, GSW, WDD), San Francisco, CA;2. Global Brain Health Institute, Trinity College (FEW, GSW, WDD), Dublin, Ireland;3. DDS Architects Ltd (Dementia Design Specialist Architects) (FEW, GSW), UK;4. Royal Institute of British Architects (FEW), London, United Kingdom;5. Royal Institute of the Architects of Ireland (FEW), Dublin, Ireland;6. Department of Psychiatry, University of Melbourne (HAE), Melbourne, Victoria, Australia;7. School of Medicine, The University of Queensland (HAE), Brisbane, Queensland, Australia;8. Deakin University, IMPACT SRC, School of Medicine (HAE), Geelong, Victoria, Australia;9. Department of Psychiatry, Brainstorm Laboratory for Mental Health Innovation, Stanford University School of Medicine (HAE), Palo Alto, CA;10. Discipline of Psychiatry, School of Medicine, The University of Adelaide (HAE), Adelaide, South Australia, Australia;11. Department of Neurology, School of Medicine, Oregon Health and Science University (WDD), Portland, OR;12. Institute on Aging, College of Urban and Public Affairs, Portland State University (WDD), Portland, OR |
| |
| Abstract: | ObjectivePrimary care is the de facto mental health system in the United States where physicians treat large numbers of depressed older adults with antidepressant medication. This study aimed to examine whether antidepressant dosage adequacy and patient adherence are associated with depression response among middle-aged and older adults prescribed with antidepressants by their primary care provider.DesignA secondary analysis was conducted on a sample drawn from a randomized controlled trial comparing Treatment as Usual to Treatment Initiation Program, an adherence intervention. Treatment Initiation Program improved adherence but not depression compared to Treatment as Usual (Sirey et al., 2017). For this analysis, we examined dosing adequacy and adherence at 6 and 12 weeks as predictors of depression response in both groups at 12 and 24 weeks.SettingPrimary care practices.ParticipantsOne hundred eighty-seven older adults with depression prescribed an antidepressant for depression by their primary care provider.MeasurementsDepression response was defined as 50% reduction on the Hamilton Rating Scale for Depression. Adherence was defined as taking 80% of doses at follow-up interviews (6 and 12 weeks). Patient-reported dosage and duration of antidepressant therapy was collected using the Composite Antidepressant Score (adequacy score of >3) at follow-up.ResultsGreater adherence, but not receipt of adequate dosage, was associated with higher likelihood of treatment response at both 12 (Odds ratio (OR) = 2.63; 95% Confidence Interval (CI), 1.19–5.84) and 24 weeks (OR = 3.09; 95% CI, 1.46–6.55).ConclusionAs physicians prescribe antidepressants to the diverse group of adults seen in primary care, special attention to patients’ views and approach to adherence may improve depression outcomes. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
