Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Psychiatr Q. 2021 Sep;92(3):1093-1107. doi: 10.1007/s11126-021-09885-z. Epub 2021 Feb 15.
The successful treatment of depressive disorders critically depends on adherence to prescribed treatment regimens. Despite increasing rates of antidepressant medication prescription, adherence to the full treatment course remains poor. Rates of antidepressant non-adherence are higher for uninsured patients and members of some marginalized racial and ethnic communities due to factors such as inequities in healthcare and access to insurance. Among patients treated in a free, student-run and faculty-supervised clinic serving uninsured patients in a majority Hispanic community in East Harlem, adherence rates are lower than those observed in patients with private or public New York State health insurance coverage. A prior study of adherence in these patients revealed that difficulty in obtaining medications from an off-site hospital pharmacy was a leading factor that patients cited for non-adherence. To alleviate this barrier to obtaining prescriptions, we tested the effectiveness of on-site, in-clinic medication dispensing for improving antidepressant medication adherence rates among uninsured patients. We found that dispensing medications directly to patients in clinic was associated with increased visits at which patients self-reported proper adherence and increased overall adherence rates. Furthermore, we found evidence that higher rates of antidepressant medication adherence were associated with more favorable treatment outcomes. All patients interviewed reported increased satisfaction with on-site dispensing. Overall, this study provides promising evidence that on-site antidepressant dispensing in a resource-limited setting improves medication adherence rates and leads to more favorable treatment outcomes with enhanced patient satisfaction.
抑郁障碍的成功治疗关键取决于是否遵循规定的治疗方案。尽管抗抑郁药物的处方率不断上升，但仍有很多患者不能全程遵医嘱治疗。由于医疗保健和保险获取方面的不平等，未参保患者和某些边缘化种族和族裔群体的成员的抗抑郁药不依从率更高。在一家免费的、由学生运营和教师监管的诊所中，为东哈莱姆区以西班牙裔为主的未参保患者提供治疗，这些患者的遵医嘱率低于拥有私人或纽约州公共医疗保险的患者。先前对这些患者的遵医嘱情况进行的一项研究显示，从医院外的药房获取药物有困难是导致患者不遵医嘱的主要因素。为了缓解获得处方的这一障碍，我们测试了在诊所内直接为患者配药以提高未参保患者的抗抑郁药遵医嘱率的效果。我们发现，直接向诊所内的患者配药与增加患者自述遵医嘱情况的就诊次数以及整体遵医嘱率的提高有关。此外，我们有证据表明，更高的抗抑郁药遵医嘱率与更有利的治疗结果相关。所有接受采访的患者都报告说对现场配药的满意度提高了。总体而言，这项研究提供了有希望的证据，表明在资源有限的环境中现场配抗抑郁药可提高药物遵医嘱率，并通过提高患者满意度带来更有利的治疗结果。
