Does Patient Adherence to Antidepressant Medication Actually Vary Between Physicians?

Area of Science:

• Health Services Research
• Clinical Pharmacy
• Psychiatry

Background:

• Physician quality of care is often presumed to influence patient nonadherence to antidepressant medications.
• Previous improvement efforts have focused on individual physician performance to address adherence issues.

Purpose of the Study:

• To examine the variation in antidepressant medication adherence among prescribing physicians.
• To determine if patient nonadherence is a valid measure of individual physician performance.

Main Methods:

• Utilized electronic health records and insurance claims data from 150,318 adults initiating antidepressant treatment.
• Defined early adherence as any antidepressant refill within 180 days of the initial prescription.
• Controlled for patient-level demographic and clinical characteristics.

Main Results:

• Adjusted early adherence rates varied minimally among physicians (psychiatrists: 72%-78%; primary care physicians: 64%-69%).
• Raw adherence rates showed wider ranges, highlighting the impact of case-mix differences.
• Average early adherence was 82% for psychiatrists and 74% for primary care physicians.

Conclusions:

• Early adherence to antidepressant medication varies minimally among prescribing physicians after accounting for patient factors.
• Early discontinuation of antidepressant treatment should not be used to assess individual physician performance.
• System-level interventions are recommended to improve antidepressant adherence rather than focusing on individual physician accountability.