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Associations Between Antidepressant Adherence and Shared Decision-Making, Patient–Provider Trust, and Communication Among Adults with Diabetes: Diabetes Study of Northern California (DISTANCE)

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ABSTRACT

BACKGROUND

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.

OBJECTIVE

To determine whether shared decision-making, patient–provider trust, or communication are associated with early stage and ongoing antidepressant adherence.

DESIGN

Observational new prescription cohort study.

SETTING

Kaiser Permanente Northern California.

PATIENTS

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.

MEASUREMENTS

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).

RESULTS

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).

LIMITATIONS

All patients were insured and had consistent access to and quality of care.

CONCLUSIONS

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.

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Acknowledgements

This research was supported by funding from the National Institutes of Health (R01-DK080726, R01-DK081796, P30-DK092924, and NCATS Grant KL2 TR000421). The research reported in this manuscript was presented at the annual meeting of the Academy of Psychosomatic Medicine in Tuscon, AZ, November 2013.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560, USA

    Amy M. Bauer MD, MS & Wayne Katon MD

  2. Division of General Internal Medicine, University of California, San Francisco, CA, USA

    Dean Schillinger MD

  3. Center for Vulnerable Populations, San Francisco General Hospital and Trauma Center, San Francisco, CA, USA

    Dean Schillinger MD

  4. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Melissa M. Parker MS, Alyce S. Adams PhD, Howard H. Moffet MPH & Andrew J. Karter PhD

  5. Departments of Psychiatry and Pediatrics and Center for Health and Community, University of California, San Francisco, CA, USA

    Nancy Adler PhD

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  1. Amy M. Bauer MD, MS
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Correspondence to Amy M. Bauer MD, MS.

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Bauer, A.M., Parker, M.M., Schillinger, D. et al. Associations Between Antidepressant Adherence and Shared Decision-Making, Patient–Provider Trust, and Communication Among Adults with Diabetes: Diabetes Study of Northern California (DISTANCE). J GEN INTERN MED 29, 1139–1147 (2014). https://doi.org/10.1007/s11606-014-2845-6

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  • DOI: https://doi.org/10.1007/s11606-014-2845-6

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