Patterns of Early Adherence to the Antidepressant Citalopram among Older Primary Care Patients: The Prospect Study

Bogner, Hillary R.; Lin, Julia; Morales, Knashawn H.

doi:10.2190/djh3-y4r0-r3kg-jycc

Cited by 30 publications

(20 citation statements)

References 59 publications

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“…However, the methodology of this study, which included both depressed and non-depressed subjects did not allow the investigators to determine whether the differences in adherence rates by race were due to 1) lower diagnosis or prescription rates by providers, or 2) lower rates of initiation and adherence by African-American subjects. Another study using data from a collaborative care intervention (PROSPECT) found that non-White race was the factor most strongly associated with non-adherence to citalopram [52]. Finally, in a study comparing African-American (n=49) to Latino (n=52) subjects over the age of 55 who had been prescribed antidepressants in the prior year, Ayalon et al found that 52.6% of African-American subjects were non-adherent, similar to the number found in our study [53].…”

Section: Discussionmentioning

confidence: 99%

Racial Differences in Adherence to Antidepressant Treatment in Later Life

Kales

Nease

Sirey

et al. 2013

The American Journal of Geriatric Psychiatry

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Objective Although antidepressants are an effective treatment for later-life depression, older patients often choose not to initiate or to discontinue medication treatment prematurely. While racial differences in depression treatment preferences have been reported, little is known about racial differences in antidepressant medication adherence among older patients. Design Prospective, observational study comparing antidepressant adherence for older African-American and white primary care patients. Participants One hundred and eighty-eight subjects aged 60 and older, diagnosed with clinically significant depression with a new recommendation for antidepressant treatment by their primary care physician. Measurement Study participants were assessed at study entry and at four-month follow-up (encompassing the acute treatment phase). Depression medication adherence was based on a well-validated self-report measure. Results At four-month follow-up, 61.2% of subjects reported that they were adherent to their antidepressant medication. In unadjusted and two of the three adjusted analyses, African-American subjects (n=82) had significantly lower rates of four-month antidepressant adherence than white subjects (n=106). African-American females had the lowest adherence rates (44.4%) followed by African-American males (56.8%), white males (65.3%) and white females (73.7%). In logistic regression models controlling for demographic, illness, and functional status variables, significant differences persisted between African-American women and white women in reported four-month antidepressant adherence (OR 3.58, 95% CI 1.27-10.07, Wald Chi-square =2.42, df=1, p<0.02). Conclusions The results demonstrate racial and gender differences in antidepressant adherence in older adults. Depression treatment interventions for the older adults should take into account the potential impact of race and gender on adherence to prescribed medications.

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Section: Discussionmentioning

confidence: 99%

Racial Differences in Adherence to Antidepressant Treatment in Later Life

Kales

Nease

Sirey

et al. 2013

The American Journal of Geriatric Psychiatry

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“…15,16 Our conceptual framework, adapted from Cooper and colleagues, 17 is practical in its approach and provided a framework that allowed for fl exible, tailored interventions ( Figure 1). Our intervention addressed each factor resulting in nonadherence in the conceptual model by means of a multifaceted, individualized approach in which participants worked with the integrated care manager to develop strategies to overcome barriers to adherence to medications.…”

Section: Introductionmentioning

confidence: 99%

Integration of Depression and Hypertension Treatment: A Pilot, Randomized Controlled Trial

Bogner¹,

Vries²

2008

The Annals of Family Medicine

117

122

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PURPOSE We wanted to examine whether integrating depression treatment into care for hypertension improved adherence to antidepressant and antihypertensive medications, depression outcomes, and blood pressure control among older primary care patients. METHODSOlder adults prescribed pharmacotherapy for depression and hypertension from physicians at a large primary care practice in West Philadelphia were randomly assigned to an integrated care intervention or usual care. Outcomes were assessed at baseline, 2, 4, and 6 weeks using the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depression, an electronic monitor to measure blood pressure, and the Medication Event Monitoring System to assess adherence. RESULTSIn all, 64 participants aged 50 to 80 years participated. Participants in the integrated care intervention had fewer depressive symptoms (CES-D mean scores, intervention 9.9 vs usual care 19.3; P <.01), lower systolic blood pressure (intervention 127.3 mm Hg vs usual care 141.3 mm Hg; P <.01), and lower diastolic blood pressure (intervention 75.8 mm Hg vs usual care 85.0 mm Hg; P <.01) compared with participants in the usual care group at 6 weeks. Compared with the usual care group, the proportion of participants in the intervention group who had 80% or greater adherence to an antidepressant medication (intervention 71.9% vs usual care 31.3%; P <.01) and to an antihypertensive medication (intervention 78.1% vs usual care 31.3%; P <.001) was greater at 6 weeks.CONCLUSION A pilot, randomized controlled trial integrating depression and hypertension treatment was successful in improving patient outcomes. Integrated interventions may be more feasible and effective in real-world practices, where there are competing demands for limited resources. Ann Fam Med 2008;6:295-301. DOI: 10.1370/afm.843. INTRODUCTIONP rimary care occupies a strategic position in the evaluation and treatment of depression among older adults, 1 and enhancing depression management in primary care appears to be a promising use of health care resources.2 To have an impact on public health, advances in the treatment of depression must be realized in primary care. Although recent studies have shown that a variety of primary care interventions can improve depression outcomes among older adults, 3,4 these interventions are not being widely implemented in practice. Some evidence indicates that addressing medical comorbidity, especially cardiovascular disease (CVD), may be essential in managing depression. [5][6][7] In addition, managing depression in the context of medical comorbidity may be more acceptable to patients than managing depression alone. DEPR ES SION A ND HY PER T ENSION T R E AT MEN Tmanagement of depression with management of medical comorbidity.In this trial, we focused on integrating depression management into care for hypertension. Hypertension affects between 20% to 50% of adults in most countries 9 and is a major risk factor for cardiovascular morbidity and mortality, 10 representing two-thirds of all s...

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“…In elderly adults, Bogner et al (2006) found that even after controlling for education, ethnic minority status predicted adherence as measured by pill counts, such that Whites were more likely to be adherent to taking their antidepressant. After controlling for a host of confounding variables, Diaz et al (2005) found that monolingual Hispanic and AfricanAmerican patients had lower medication adherence rates than did NonHispanic Whites.…”

Section: S Department Of Health and Human Services 2001; Freedenthanmentioning

confidence: 99%

Treatment of Culturally Diverse Children and Adolescents with Depression

Stewart

Simmons²,

Habibpour

2012

Journal of Child and Adolescent Psychopharmacology

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This article is written for the practitioners treating depression in ethnic minority youth. It will review the context in which services are delivered to these youth: Researchers have recognized persistent ethnic differences in terms of utilization of services and unmet need. Furthermore, when ethnic minority youth do receive pediatric mental health care, the services that they receive may differ from those given to White patients. The reasons for these discrepancies have been examined in numerous studies, and have included contextual variables (economics, availability, and accessibility of services), patient variables (differences in prevalence or manifestation of the disorder, cultural beliefs and attitudes, preferential use of alternative or informal services, health literacy, and adherence), and provider variables (referral bias and patient-provider communication). Information about the differences between White and minority youth in the pharmacodynamics and pharmacokinetics of the antidepressant response is still limited. There are significant challenges for developing evidence-based guidelines that inform practice with these youth, hinging on both the underrepresentation of ethnic minority groups in clinical trials, and the great variability in biological and cultural characteristics of individuals in ethnic minority categories. Awareness on the part of the practitioner of the cultural variables that influence help-seeking and ongoing utilization of mental health services may aid in the engagement, effective treatment, and retention of ethnic minority children and adolescents with depression. However, given the great heterogeneity that exists within any cultural grouping, clinicians will need to integrate information about cultural patterns with that obtained from the individual patient and family to inform optimal practices for each patient. This article is written to enhance awareness on the part of the practitioner as to the variables that influence psychiatric care for depression in culturally diverse youth. The mental health needs of minority youth are not well served: They are treated less frequently, and when they are treated, the services they receive are less frequently adequate. The reasons that have been proposed for the disparities in their care, particularly with regard to diagnosis and treatment for depression, will be reviewed. They include contextual factors (such as economics, insurance, and other variables affecting the availability of services) patient and family factors (such as prevalence, symptom presentation, and values and beliefs that influence whether patients are referred to and avail themselves of services), and provider factors (such as referral bias and patient-provider communication, which affect whether patients engage and stay in treatment). The implications for the practitioner treating ethnic minority youth with depression will be discussed. Culture, as used in this article, refers to the common values, beliefs, and social behaviors of individuals with a shared heritage. S...

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Patterns of Early Adherence to the Antidepressant Citalopram among Older Primary Care Patients: The Prospect Study

Cited by 30 publications

References 59 publications

Racial Differences in Adherence to Antidepressant Treatment in Later Life

Racial Differences in Adherence to Antidepressant Treatment in Later Life

Integration of Depression and Hypertension Treatment: A Pilot, Randomized Controlled Trial

Treatment of Culturally Diverse Children and Adolescents with Depression

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