Effectiveness of antidepressant pharmacotherapy: The impact of medication compliance and patient education

This study was designed to investigate the impact of a time-phased patient education program (RHYTHMS(TM)) on medication compliance and treatment outc omes of primary care patients diagnosed with major depression and started o n antidepressant pharmacotherapy. Two hundred forty-six depressed patients, diagnosed and treated at one of t hree outpatient clinics affiliated with the Kaiser-Permanente Northwest Reg ion (KPNW) healthcare system, were randomly assigned to either receive or n ot receive (usual care) the educational materials by mail. Depression sever itiy and functional impairment affecting patients' quality of life were ass essed at baseline and 4, 12, and 30 weeks later. Self-reported impressions of improvement and patient satisfaction with treatment were also assessed a t follow-up. Clinical assessment data were obtained using an interactive vo ice response (IVR) system. Study subjects were compensated $5, $10, $15; an d $25 for completing each assessment (Baseline to Week 30, respectively). U pon study completion, prescription fill data of the subjects were extracted from the KPNW Pharmacy System for analysis of medication compliance. Most of the study subjects (63.5%) responded to the pharmacotherapy treatme nt by study end-point. Few statistically significant differences in either treatment outcomes or duration of medication compliance were found between the treatment groups, and significant differences found were of fairly smal l magnitude. Patients not receiving the educational materials initially exh ibited a more positive response to treatment (Week 4), but this difference did not persist at later follow-ups and was associated with si,significantl y higher relapse rates. A strong time-dose relationship was evident between the duration of the initial treatment episode and treatment outcomes at fo llow-up, but randomized treatment assignment did not influence the duration of initial medication compliance. Educational programs designed to encourage depressed patients to obtain ade quate pharmacotherapy likely provide medical benefits. Such benefits appear to be relatively subtle and methodological differences between studies con tribute to inconsistent conclusions concerning observed benefits. The inten t of providing time-phased educational materials to patients is to maximize the relevance of such information by synchronizing it with typical recover y processes and issues. This study suggests that additional efforts at enga ging patients earlier after the initiation of treatment might be of most be nefit. Depression and Anxiety 13:1-10, 2001. (C) 2001 Wiley-Liss, Inc.