Using primary care prescribing data to improve GP awareness of antidepressant adherence issues

Abstract

Background Adherence to antidepressant therapy remains a major issue worldwide. Most people with depression are treated in a general practice setting, but many stop taking antidepressants before completing a six-month course as recommended by guidelines. Objectives To determine antidepressant adherence rates as indicated in primary care prescribing data and pharmacy dispensing data; to demonstrate commonly occurring patterns related to non-adherence, using a prescription visualisation tool we have developed; and to determine whether prescribing data is a good predictor of dispensing based adherence. Methods We analysed general practice electronic prescribing data for the year ending 31 December 2006 and linked pharmacy dispensing records by National Health Index. We calculated medication adherence for patients starting antidepressants using a six-month evaluation period and a gap-based adherence measure. Patients with a gap of more than 15 days in antidepressant therapy were considered non-adherent. Using a prescription visualisation tool, we described common modes of non-adherence.

Non-adherence to antiretroviral therapy in Yaounde: Prevalence, determinants and the concordance of two screening criteria

“…The indirect assessment of adherence using self-administered questionnaires is subject to recall bias, may not be appropriate for individuals with memory disorders and tends to overestimate adherence relative to more objective methods such as pill count and automated pharmacy databases [10,31]. Other methods, such as the use of electronic data banks [32] or prescription data [33], are also more objective methods, but their implementation and use in countries with limited resources must be evaluated. In addition, drug provision does not automatically imply that patients will take the drugs as prescribed.…”

Discontinuation of antidepressant therapy among patients with major depressive disorder

“…A similar extent of discontinuation (37% -56%) was observed among those treated for a new episode of depression, but who were not necessarily new initiators of therapy [32][33][34].…”

SNOMED is coming, and more about using and interacting with technology in primary care

“…The Editorial says more... 1 The paper by Mabotuwana et al illustrates that there is a gap between prescribing and dispensing of antidepressant medications. 2 Poor adherence identified through prescribing data is nearly always correct; however, poor prescribing data only predicts around half of those who have poor adherence at the dispensing stage. Therefore, monitoring of prescribing adherence is important but this won't identify all the problems.…”