Skip to main content
SpringerLink
Log in

On-Site Prescription Dispensing Improves Antidepressant Adherence among Uninsured Depressed Patients

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

The successful treatment of depressive disorders critically depends on adherence to prescribed treatment regimens. Despite increasing rates of antidepressant medication prescription, adherence to the full treatment course remains poor. Rates of antidepressant non-adherence are higher for uninsured patients and members of some marginalized racial and ethnic communities due to factors such as inequities in healthcare and access to insurance. Among patients treated in a free, student-run and faculty-supervised clinic serving uninsured patients in a majority Hispanic community in East Harlem, adherence rates are lower than those observed in patients with private or public New York State health insurance coverage. A prior study of adherence in these patients revealed that difficulty in obtaining medications from an off-site hospital pharmacy was a leading factor that patients cited for non-adherence. To alleviate this barrier to obtaining prescriptions, we tested the effectiveness of on-site, in-clinic medication dispensing for improving antidepressant medication adherence rates among uninsured patients. We found that dispensing medications directly to patients in clinic was associated with increased visits at which patients self-reported proper adherence and increased overall adherence rates. Furthermore, we found evidence that higher rates of antidepressant medication adherence were associated with more favorable treatment outcomes. All patients interviewed reported increased satisfaction with on-site dispensing. Overall, this study provides promising evidence that on-site antidepressant dispensing in a resource-limited setting improves medication adherence rates and leads to more favorable treatment outcomes with enhanced patient satisfaction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

Available from the corresponding author upon request.

References

  1. Solomon DA, Keller MB, Leon AC, et al. Multiple Recurrences of Major Depressive Disorder. Am J Psychiatry. 2000;157(2):229–33.

    Article  CAS  PubMed  Google Scholar 

  2. Mathers CD, Loncar D. Projections of Global Mortality and Burden of Disease from 2002 To 2030. PLoS Med. 2006;3(11):e442.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime Prevalence and Age-of-Onset Distributions of Dsm-Iv Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.

    Article  PubMed  Google Scholar 

  4. Greenberg PE, Fournier AA, Sisitsky T, Pike CT, Kessler RC. The Economic Burden of Adults with Major Depressive Disorder in the United States (2005 And 2010). J Clin Psychiatry. 2015;76(2):155–62.

    Article  PubMed  Google Scholar 

  5. Cipriani A, Barbui C, Butler R, Hatcher S, Geddes J. Depression in adults: drug and physical treatments. BMJ Clin Evid. 2011;2011:1003.

    PubMed  PubMed Central  Google Scholar 

  6. Olfson M, Marcus SC. National Patterns in Antidepressant Medication Treatment. Arch Gen Psychiatry. 2009;66(8):848–56.

    Article  PubMed  Google Scholar 

  7. Melfi CA, Chawla AJ, Croghan TW, Hanna MP, Kennedy S, Sredl K. The Effects of Adherence to Antidepressant Treatment Guidelines on Relapse and Recurrence of Depression. Arch Gen Psychiatry. 1998;55(12):1128–32.

    Article  CAS  PubMed  Google Scholar 

  8. Ho SC, Chong HY, Chaiyakunapruk N, Tangiisuran B, Jacob SA. Clinical and Economic Impact of Non-Adherence to Antidepressants in Major Depressive Disorder: A Systematic Review. J Affect Disord. 2016;193:1–10.

    Article  PubMed  Google Scholar 

  9. Zivin K, Ganoczy D, Pfeiffer PN, Miller EM, Valenstein M. Antidepressant Adherence after Psychiatric Hospitalization among VA Patients With Depression. Adm Policy Ment Health Ment Health Serv Res. 2009;36(6):406–15.

    Article  Google Scholar 

  10. Rivero-Santana A, Perestelo-Perez L, Pérez-Ramos J, Serrano-Aguilar P, De las Cuevas C. Sociodemographic and Clinical Predictors of Compliance with Antidepressants for Depressive Disorders: Systematic Review of Observational Studies. Patient Prefer Adherence. 2013;7:151.

    PubMed  PubMed Central  Google Scholar 

  11. Olfson M, Marcus SC, Tedeschi M, Wan GJ. Continuity of Antidepressant Treatment for Adults With Depression in the United States. Am J Psychiatry. 2006;163(1):101–8.

    Article  PubMed  Google Scholar 

  12. Hodgkin D, Volpe-Vartanian J, Alegría M. Discontinuation of Antidepressant Medication among Latinos in the USA. J Behav Health Serv Res. 2007;34(3):329–42.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Pugh M Jr, Perrin PB, Rybarczyk B, Tan J. Racism, mental health, healthcare provider trust, and medication adherence among Black patients in safety-net primary care. J Clin Psychol Med Settings. 2020. https://doi.org/10.1007/s10880-020-09702-y.

  14. Cuffee YL, Hargraves JL, Rosal M, Briesacher BA, Schoenthaler A, Person S, et al. Reported Racial Discrimination, Trust in Physicians, and Medication Adherence among Inner-City African Americans with Hypertension. Am J Public Health. 2013;103(11):e55–62.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Smith S, Thomas R, Cruz M, Griggs R, Moscato B, Ferrara A. Presence and Characteristics of Student-Run Free Clinics in Medical Schools. JAMA. 2014a;312(22):2407–10.

    Article  PubMed  Google Scholar 

  16. Zucker J, Gillen J, Ackrivo J, Schroeder R, Keller S. Hypertension Management in a Student-Run Free Clinic: Meeting National Standards? Acad Med. 2011;86(2):239–45.

    Article  PubMed  Google Scholar 

  17. Liberman KM, Meah YS, Chow A, Tornheim J, Rolon O, Thomas DC. Quality of Mental Health Care at a Student-Run Clinic: Care for the Uninsured Exceeds that of Publicly and Privately Insured Populations. J Community Health. 2011;36(5):733–40.

    Article  PubMed  Google Scholar 

  18. Smith SD, Marrone L, Gomez A. Clinical Outcomes of Diabetic Patients at a Student-Run Free Clinic Project. Fam Med. 2014b;46(3):198.

    PubMed  PubMed Central  Google Scholar 

  19. Mann CL, Rifkin RA, Nabel EM, Thomas DC, Meah YS, Katz CL. Exploring Antidepressant Adherence at a Student-Run Free Mental Health Clinic. Community Ment Health J. 2019;55(1):57–62.

    Article  PubMed  Google Scholar 

  20. Finley PR, Rens HR, Pont JT, Gess SL, Louie C, Bull SA, et al. Impact of a Collaborative Care Model on Depression in a Primary Care Setting: A Randomized Controlled Trial. Pharmacotherapy. 2003;23(9):1175–85.

    Article  PubMed  Google Scholar 

  21. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, Regional, and National Incidence, Prevalence, and Years Lived With Disability for 310 Diseases and Injuries, 1990–2015: A Systematic Analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545–602.

    Article  Google Scholar 

  22. NYCHealth. Manhattan Community District 11: EAST HARLEM. New York City 2015.

  23. Osterberg L, Blaschke T. Adherence to Medication. N Engl J Med. 2005;353(5):487–97.

    Article  CAS  PubMed  Google Scholar 

  24. Sansone RA, Sansone LA. Antidepressant Adherence: Are Patients Taking Their Medications? Innov Clin Neurosci. 2012;9(5–6):41–6.

    PubMed  PubMed Central  Google Scholar 

  25. Keller MD, Berndt ER. Depression Treatment: A Lifelong Commitment? Psychopharmacol Bull. 2002;36(Suppl 2):133–41 Review.

    PubMed  Google Scholar 

  26. McQuaid EL, Landier W. Cultural Issues in Medication Adherence: Disparities and Directions. J Gen Intern Med. 2018;33(2):200–6.

    Article  PubMed  Google Scholar 

  27. Lin EH, Von Korff M, Ludman EJ, et al. Enhancing adherence to prevent depression relapse in primary care. Gen Hosp Psychiatry. 2003;25(5):303–10.

    Article  PubMed  Google Scholar 

  28. Liu X, Tepper PG, Able SL. Adherence and Persistence with Duloxetine and Hospital Utilization in Patients with Major Depressive Disorder. Int Clin Psychopharmacol. 2011;26(3):173–80.

    Article  CAS  PubMed  Google Scholar 

  29. Readdean KC, Heuer AJ, Scott Parror J. Effect of Pharmacist Intervention on Improving Antidepressant Medication Adherence and Depression Symptomology: A Systematic Review and Meta-Analysis. Res Soc Adm Pharm. 2018;14(4):321–31.

    Article  Google Scholar 

  30. Hunot VM, Horne R, Leese MN, Churchill RC. A Cohort Study of Adherence to Antidepressants in Primary Care: The Influence of Antidepressant Concerns and Treatment Preferences. Prim Care Companion J Clin Psychiatry. 2007;9(2):91–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Chong WW, Aslani P, Chen TF. Effectiveness of Interventions to Improve Antidepressant Medication Adherence: A Systematic Review. Int J Clin Pract. 2011;65(9):954–75.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No direct funding was provided to conduct this research. The Mental Health Clinic of the East Harlem Health Outreach Partnership is supported by private grants and donations from the Atran Foundation and Ira W. DeCamp Foundation.

Author information

Author notes

  1. Samuel K. Powell and Claire L. Gibson contributed equally to this work.

Authors and Affiliations

  1. Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Samuel K. Powell & Elisa M. Nabel

  2. Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Samuel K. Powell & Elisa M. Nabel

  3. Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Samuel K. Powell

  4. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Samuel K. Powell & Craig L. Katz

  5. Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Samuel K. Powell

  6. Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Claire L. Gibson, Ibeawuchi Okoroafor, Josimar Hernandez-Antonio & Craig L. Katz

  7. Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Yasmin S. Meah

  8. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Yasmin S. Meah

  9. Department of Geriatric and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Yasmin S. Meah

  10. Global Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Craig L. Katz

Authors
  1. Samuel K. Powell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claire L. Gibson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ibeawuchi Okoroafor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Josimar Hernandez-Antonio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elisa M. Nabel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yasmin S. Meah
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Craig L. Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CLG, EN, YSM, CLK originated the conception and design of the study. SKP, CLG, EN, and IO collected data. SKP and CLG analyzed the data. SKP created the figures. SKP and CLG wrote the manuscript. All authors reviewed the manuscript and revised it for quality of content.

Corresponding author

Correspondence to Samuel K. Powell.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Informed Consent

The Institutional Review Board of the Icahn School of Medicine at Mount Sinai granted a waiver of consent for the retrospective chart review component of this study. Informed consent was obtained for all patients interviewed in this study. This study was approved by the Institutional Review Board at the Icahn School of Medicine at Mount Sinai, IRB #18–00914.

Code Availability

Available from the corresponding author upon request.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 18.4 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Powell, S.K., Gibson, C.L., Okoroafor, I. et al. On-Site Prescription Dispensing Improves Antidepressant Adherence among Uninsured Depressed Patients. Psychiatr Q 92, 1093–1107 (2021). https://doi.org/10.1007/s11126-021-09885-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-021-09885-z

Keywords

Search

Navigation