Abstract
Purpose
Non-adherence to antidepressant medications is a significant barrier to the successful treatment of depression. The purpose of this study was to explore the perspectives of health care providers on antidepressant medication non-adherence in clinical practice.
Methods
Individual semi-structured interviews were conducted with a purposive sample of 31 health care providers from a range of disciplines and settings in the state of New South Wales, Australia. Interviews focused on medication adherence issues in depression and participants’ strategies in addressing them. Interviews were audio recorded, transcribed verbatim and thematically content analyzed using a constant comparison approach.
Results
Participants acknowledged medication non-adherence to be a complex problem in depression, and attributed this problem to patient, medication and environmental-specific issues. Five approaches in addressing non-adherence were reported: patient education, building partnerships with patients, pharmacological management, developing behavioural skills and building supportive networks. Challenges to the management of non-adherence were lack of time and skills, assessment of medication adherence, transition period immediately post-discharge and conflicts in views between providers.
Conclusion
Participants were able to identify issues and strategies in addressing antidepressant non-adherence; however, barriers were also identified that could impact on providers’ ability to address this issue effectively. More research is needed to develop effective multidisciplinary strategies that take into account providers’ perspectives in improving adherence to antidepressant medications.
Similar content being viewed by others
References
World Health Organization (2001) The world health report: 2001: Mental health: new understanding, new hope. World Health Organization, Geneva
Murray CJ, Lopez AD (1997) Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 349(9064):1498–1504
Greenberg PE, Kessler RC, Birnbaum HG, Leong SA, Lowe SW, Berglund PA, Corey-Lisle PK (2003) The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry 64(12):1465–1475
Begg SJ, Vos T, Barker B, Stanley L, Lopez AD (2008) Burden of disease and injury in Australia in the new millennium: measuring health loss from diseases, injuries and risk factors. Med J Aust 188(1):36–40
beyondblue: The National Depression Initiative (2004) beyondblue: The Way Forward 2005–2010. http://www.beyondblue.org.au/index.aspx?link_id=2.18&tmp=FileDownload&fid=372. Accessed 16 Sept 2011
World Health Organization (2003) Adherence to long-term therapies: evidence for action. World Health Organization, Geneva
Demyttenaere K (1997) Compliance during treatment with antidepressants. J Affect Disord 43(1):27–39
Anderson IM, Ferrier IN, Baldwin RC, Cowen PJ, Howard L, Lewis G, Matthews K, McAllister-Williams RH, Peveler RC, Scott J, Tylee A (2008) Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines. J Psychopharmacol 22(4):343–396
National Institute for Health and Clinical Excellence (2009) Depression: the treatment and management of depression in adults. http://www.nice.org.uk/CG90. Accessed 10 Sept 2011
American Psychiatric Association (2010) Practice guideline for the treatment of patients with major depressive disorder, 3rd edn. http://www.psychiatryonline.com/pracGuide/pracGuideTopic_7.aspx. Accessed 10 Sept 2011
Lin EH, Von Korff M, Katon W, Bush T, Simon GE, Walker E, Robinson P (1995) The role of the primary care physician in patients’ adherence to antidepressant therapy. Med Care 33(1):67–74
Geddes JR, Carney SM, Davies C, Furukawa TA, Kupfer DJ, Frank E, Goodwin GM (2003) Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet 361:653–661
Melfi CA, Chawla AJ, Croghan TW, Hanna MP, Kennedy S, Sredl K (1998) The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression. Arch Gen Psychiatry 55(12):1128–1132
Cantrell CR, Eaddy MT, Shah MB, Regan TS, Sokol MC (2006) Methods for evaluating patient adherence to antidepressant therapy: a real-world comparison of adherence and economic outcomes. Med Care 44(4):300–303
Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C (2002) Patient adherence in the treatment of depression. Br J Psychiatry 180:104–109
Vergouwen ACM, Bakker A, Katon WJ, Verheij TJ, Koerselman F (2003) Improving adherence to antidepressants: a systematic review of interventions. J Clin Psychiatry 64(12):1415–1420
Chong WW, Aslani P, Chen T (2011) Effectiveness of interventions to improve antidepressant medication adherence: a systematic review. Int J Clin Pract 65(9):954–975
Coombs T, Deane FP, Lambert G, Griffiths R (2003) What influences patients’ medication adherence? Mental health nurse perspectives and a need for education and training. Int J Ment Health Nurs 12(2):148–152
Gisev N, Bell JS, O’Reilly CL, Rosen A, Chen TF (2010) An expert panel assessment of comprehensive medication reviews for clients of community mental health teams. Soc Psychiatry Psychiatr Epidemiol 45(11):1071–1079
O’Reilly CL, Bell JS, Chen TF (2012) Mental health consumers and caregivers as instructors for health professional students: a qualitative study. Soc Psychiatry Psychiatr Epidemiol 47(4):607–613
Bland R, Clarke M, Elsom S, Epstein M, Farhall J, Fielding J, Fossey E, Leggatt M, Liaw S-T, Meadows G, Minas H, Olsen A, Roper C, Rosen A, Singh B (2007) The active participants in mental health services. In: Meadows G, Singh B, Grigg M (eds) Mental health in Australia: collaborative community practice, 2nd edn. Oxford University Press, South Melbourne, pp 190–226
Lingam R, Scott J (2002) Treatment non-adherence in affective disorders. Acta Psychiatr Scand 105(3):164–172
Keller MB, Hirschfeld RM, Demyttenaere K, Baldwin DS (2002) Optimizing outcomes in depression: focus on antidepressant compliance. Int Clin Psychopharmacol 17(6):265–271
Charles C, Gafni A, Whelan T (1997) Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 44(5):681–692
D’Amour D, Ferrada-Videla M, San Martin Rodriguez L, Beaulieu M-D (2005) The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks. J Interprof Care 19(Suppl 1):116–131
Boyatzis RE (1998) Transforming qualitative information: thematic analysis and code development. Sage Publications, Thousand Oaks
Silverman D (2000) Doing qualitative research. A practical handbook. The Cromwell Press Ltd, Wilshire
Urquhart J, Vrijens B (2005) New findings about patient adherence to prescribed drug dosing regimens: an introduction to pharmionics. Eur J Hosp Pharm Sci 11(5):103–106
Bulloch AGM, Patten SB (2010) Non-adherence with psychotropic medications in the general population. Soc Psychiatry Psychiatr Epidemiol 45(1):47–56
Bollini P, Tibaldi G, Testa C, Munizza C (2004) Understanding treatment adherence in affective disorders: a qualitative study. J Psychiatr Ment Health Nurs 11(6):668–674
van Geffen ECG, Hermsen JHCM, Heerdink ER, Egberts ACG, Verbeek-Heida PM, van Hulten R (2011) The decision to continue or discontinue treatment: experiences and beliefs of users of selective serotonin-reuptake inhibitors in the initial months—a qualitative study. Res Social Adm Pharm 7(2):134–150
Haslam C, Brown S, Atkinson S, Haslam R (2004) Patients’ experiences of medication for anxiety and depression: effects on working life. Fam Pract 21(2):204–212
Givens JL, Datto CJ, Ruckdeschel K, Knott K, Zubritsky C, Oslin DW, Nyshadham S, Vanguri P, Barg FK (2006) Older patients’ aversion to antidepressants. A qualitative study. J Gen Intern Med 21(2):146–151
Grime J, Pollock K (2003) Patients’ ambivalence about taking antidepressants: a qualitative study. Pharm J 271(7270):516–519
Badger F, Nolan P (2006) Concordance with antidepressant medication in primary care. Nurs Stand 20(52):35–40
Slingsby BT, Plotnikoff GA, Mizuno T, Akabayashi A (2007) Physician strategies for addressing patient adherence to prescribed psychotropic medications in Japan: a qualitative study. J Clin Pharm Ther 32(3):241–245
Garfield S, Francis S-A, Smith FJ (2004) Building concordant relationships with patients starting antidepressant medication. Patient Educ Couns 55(2):241–246
Chakraborty K, Avasthi A, Kumar S, Grover S (2009) Attitudes and beliefs of patients of first episode depression towards antidepressants and their adherence to treatment. Soc Psychiatry Psychiatr Epidemiol 44(6):482–488
Clever SL, Ford DE, Rubenstein LV, Rost KM, Meredith LS, Sherbourne CD, Wang N-Y, Arbelaez JJ, Cooper LA (2006) Primary care patients’ involvement in decision-making is associated with improvement in depression. Med Care 44(5):398–405
Loh A, Leonhart R, Wills CE, Simon D, Harter M (2007) The impact of patient participation on adherence and clinical outcome in primary care of depression. Patient Educ Couns 65(1):69–78
Cooper-Patrick L, Crum RM, Ford DE (1994) Characteristics of patients with major depression who received care in general medical and specialty mental health settings. Med Care 32(1):15–24
Fisher WA, Fisher JD, Harman J (2003) The Information–Motivation–Behavioral skills model: a general social psychological approach to understanding and promoting health behavior. In: Suls J, Wallston K (eds) Social psychological foundations of health and illness. Blackwell, London, pp 87–106
Fisher JD, Fisher WA, Amico KR, Harman JJ (2006) An information–motivation–behavioral skills model of adherence to antiretroviral therapy. Health Psychol 25(4):462–473
Byrne MK, Deane FP, Lambert G, Coombs T (2004) Enhancing medication adherence: clinician outcomes from the Medication Alliance training program. Aust N Z J Psychiatry 38(4):246–253
Byrne MK, Willis A, Deane FP, Hawkins B, Quinn R (2010) Training inpatient mental health staff how to enhance patient engagement with medications: Medication Alliance training and dissemination outcomes in a large US mental health hospital. J Eval Clin Pract 16(1):114–120
Feros DL, Byrne MK, Deane FP, Lambert G, Meadows G, Favilla A, Gray J (2010) Allied health clinicians’ beliefs and attitudes about medication adherence in depressive disorders. J Eval Clin Pract 16(6):1361–1363
Fickel JJ, Parker LE, Yano EM, Kirchner JE (2007) Primary care—mental health collaboration: an example of assessing usual practice and potential barriers. J Interprof Care 21(2):207–216
Ellitt GR, Brien JA, Aslani P, Chen TF (2009) Quality patient care and pharmacists’ role in its continuity—a systematic review. Ann Pharmacother 43(4):677–691
Acknowledgments
The authors thank the health care providers who gave their time to be interviewed for the study.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chong, W.W., Aslani, P. & Chen, T.F. Health care providers’ perspectives of medication adherence in the treatment of depression: a qualitative study. Soc Psychiatry Psychiatr Epidemiol 48, 1657–1666 (2013). https://doi.org/10.1007/s00127-012-0625-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-012-0625-3