Associations between antidepressant adherence and shared decision-making, patient-provider trust, and communication among adults with diabetes: diabetes study of Northern California (DISTANCE).
BACKGROUND
Depression and adherence to antidepressant treatment are important clinical concerns in diabetes care. While patient-provider communication patterns have been associated with adherence for cardiometabolic medications, it is unknown whether interpersonal aspects of care impact antidepressant medication adherence.


OBJECTIVE
To determine whether shared decision-making, patient-provider trust, or communication are associated with early stage and ongoing antidepressant adherence.


METHODS
Observational new prescription cohort study.


METHODS
Kaiser Permanente Northern California.


METHODS
One thousand five hundred twenty-three adults with type 2 diabetes who completed a survey in 2006 and received a new antidepressant prescription during 2006-2010.


METHODS
Exposures included items based on the Trust in Physicians and Interpersonal Processes of Care instruments and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) communication scale. Measures of adherence were estimated using validated methods with physician prescribing and pharmacy dispensing data: primary non-adherence (medication never dispensed), early non-persistence (dispensed once, never refilled), and new prescription medication gap (NPMG; proportion of time without medication during 12 months after initial prescription).


RESULTS
After adjusting for potential confounders, patients' perceived lack of shared decision-making was significantly associated with primary non-adherence (RR = 2.42, p < 0.05), early non-persistence (RR = 1.34, p < 0.01) and NPMG (estimated 5% greater gap in medication supply, p < 0.01). Less trust in provider was significantly associated with early non-persistence (RRs 1.22-1.25, ps < 0.05) and NPMG (estimated NPMG differences 5-8%, ps < 0.01).


CONCLUSIONS
All patients were insured and had consistent access to and quality of care.


CONCLUSIONS
Patients' perceptions of their relationships with providers, including lack of shared decision-making or trust, demonstrated strong associations with antidepressant non-adherence. Further research should explore whether interventions for healthcare providers and systems that foster shared decision-making and trust might also improve medication adherence.
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560, USA, abauer1@uw.edu.
Amy M
AM
Bauer
Melissa M
MM
Parker
Dean
D
Schillinger
Wayne
W
Katon
Nancy
N
Adler
Alyce S
AS
Adams
Howard H
HH
Moffet
Andrew J
AJ
Karter
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D003142:Communication; D003625:Data Collection / Q000379:methods; D003657:Decision Making; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D006282:Health Personnel / Q000523:psychology; D055118:Medication Adherence / Q000523:psychology; D011369:Professional-Patient Relations; D035502:Trust / Q000523:psychology
D000928:Antidepressive Agents