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Rate of non-adherence prior to upward dose titration in previously stable antidepressant users.
MedLine Citation:
PMID:  20950862     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Non-adherence to antidepressant medications is a contributing factor to disease relapse and may result in needless increases in antidepressant dosing.
METHODS: We analyzed de-identified patient claims data from Medco Health Solutions, Inc.'s information database and measured adherence as the medication possession ratio (MPR), with adequate adherence as MPR ≥80%. Adherence was calculated for patients in whom antidepressants were dose escalated and who were on the same antidepressant medication for at least 180days before the upward dosage titration. Statistical analysis was performed on subgroups comparing adherence with mail vs. retail channels, differences in age and gender, generic prescription vs. brand only, and prescription by psychiatrist vs. non-psychiatrist.
RESULTS: 29.7% of patients were non-adherent to their antidepressant medication during the 6months prior to a prescribed increase in dosage. Non-adherence was significantly lower among patients using the Medco Therapeutic Resource Centers® mail order vs. retail channel. Younger age correlated with poorer adherence. Rates of non-adherence were also significantly greater among women, those receiving generic medications, and among patients with overall lower disease comorbidity. Adherence was not significantly impacted by prescription from a psychiatrist or a non-psychiatrist.
LIMITATIONS: Retrospective design and use of an administrative patient claims database.
CONCLUSIONS: Suboptimal medication adherence commonly precedes an upward dosage titration of antidepressant medications. Utilization of a mail order channel may improve adherence. Clinicians prescribing antidepressants should explore adherence issues carefully prior to recommending an increase in dosage.
Authors:
David J Muzina; Donald A Malone; Inderpal Bhandari; Rocco Lulic; Rich Baudisch; Matthew Keene
Publication Detail:
Type:  Journal Article     Date:  2010-10-14
Journal Detail:
Title:  Journal of affective disorders     Volume:  130     ISSN:  1573-2517     ISO Abbreviation:  J Affect Disord     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-03-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7906073     Medline TA:  J Affect Disord     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  46-52     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier B.V. All rights reserved.
Affiliation:
Medco Health Solutions, Inc., Franklin Lakes, NJ, USA; Cleveland Clinic Neurological Institute, Department of Psychiatry and Psychology, Cleveland, OH, USA.
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