Building concordant relationships with patients starting antidepressant medication

https://doi.org/10.1016/j.pec.2003.09.011Get rights and content

Abstract

Fifty one patients beginning courses of antidepressant medication were recruited from general practice surgeries in two health authorities in London and interviewed on two occasions. Respondents were asked about their experiences of using antidepressant medication, including their information needs and the level of involvement which they had had in making decisions about their medication. Analysis was carried out using qualitative procedures. The study identified information needs which were unmet at the start of treatment, including the impact of adverse drug reactions on patients’ lives, the very gradual process of recovery and information regarding dosage prescribed in the context of minimum and maximum dosages. Respondents also had a broad view of the term dependancy that needed to be addressed. However, some respondents reported that they experienced difficulty in absorbing information given during the initial consultation. Therefore developing strategies for reinforcement of information would be advantageous. Patients involvement in decision making varied between respondents and at different points in therapy.

Introduction

Development of mental health services has been identified as a priority for the British Government [1], [2]. The national service framework for mental health [2] set out national standards for the promotion of mental health and treatment of mental illness and recommended that assessment and management protocols for the treatment of depression are implemented throughout primary care. The document recognises that many patients feel that they do not receive adequate information about their antidepressant treatment.

Compliance with antidepressant medication has been shown to be between 48 [3] and 56% [4] at 3 months whereas as the recommended minimum treatment time is 4–6 months [5]. In the past, interventions to improve compliance have focussed on educational programmes [6]. Research has shown that patients who had received key messages from healthcare professionals were liable to be more compliant with their treatment [4], [7]. This is in line with a medical model of compliance, in which patients are expected to follow the doctor’s instructions rather than make their own judgements. However, the medical psychological approach identifies non-compliance as a patient response to his/her circumstances which may be very meaningful rather than needing to be corrected. Various models of health behaviour have been proposed [8], [9], [10], [11]. Further to the development of the understanding that patients are actively involved in making decisions about their medication, medication-taking behaviour has been increasingly viewed as a partnership between patients and healthcare professionals. This is referred to as a concordant approach [12]. Patients’ insight into chronic illnesses can inform the development of services sensitive to patients’ needs and wishes and will provide valuable information to promote a concordant approach in decision making [13]. Previous work has not focussed on presenting an in depth view of the information needs of patients beginning courses of antidepressant medication and their preferences for involvement in decision making regarding treatment. The current study aimed to identify information needs and the level of involvement in decision making desired by patients beginning courses of antidepressant medication, in order to inform the development of a concordant approach responsive to patients’ needs.

Section snippets

Recruitment

Patients beginning courses of antidepressant medication were recruited through general practice surgeries. Every practice from three health authorities in north London was invited to take part in the study. General practitioners (GPs) were given a screening tool to identify all eligible patients from computerised databases. Patients were invited to participate if they were between 18 and 65 years of age, had begun a new course of antidepressant medication in the previous 3 months and had a

Characteristics of respondents

One hundred and seventy-one patients were approached from six practices. Fifty one patients (30%) took part in a first interview, 44 also taking part in a second interview. Twenty two respondents were male and 29 were female. The age of respondents ranged from 19 to 61, the mean age being 41 and the median, 42. All social classes were represented amongst the respondents. Forty seven of the respondents had been prescribed licensed antidepressant medication in the 3 months prior to the first

Conclusion and discussion

The current study found that a large amount of information was required to support patients beginning courses of antidepressant medication including the impact of adverse drug reactions on patients’ lives, the very gradual process of recovery and information regarding dosage prescribed in the context of minimum and maximum dosages. Patients also had a broad view of the term dependancy to which they needed healthcare professionals to be responsive. Current healthcare services did not provide

Acknowledgements

We are grateful to the School of Pharmacy, University of London and the Royal Pharmaceutical Society of Great Britain’s Galen award and Sir Hugh Linstead Fellowship for funding the research. We would also like to pay special thanks to all the practices and patients who participated in the research.

References (25)

  • K. Demyttenaere

    Compliance during treatment with antidepressants

    J. Affect. Disord

    (1997)
  • C. Charles et al.

    Decision-making in the physician–patient encounter: revisiting the shared decision-making model

    Soc. Sci. Med

    (1999)
  • Department of Health. Saving lives: our healthier nation. London: The Stationary Office;...
  • Department of Health. National service framework for mental health: modern standards and service models. London: The...
  • J.C. Maddox et al.

    The compliance with antidepressants in general practice

    J. Psychopharmacol

    (1994)
  • E.H.B. Lin et al.

    The role of the primary care physician in patients’ adherence to antidepressant therapy

    Med. Care

    (1995)
  • E.S. Paykel et al.

    Recognition and management of depression in general practice: consensus statement

    Br. Med. J

    (1992)
  • P. Ley et al.

    A method for decreasing patients’ educational errors

    Psychol. Med

    (1976)
  • S.A. Bull et al.

    Discontinuation of use and switching of antidepressants. Influence of patient–physician communication

    J. Am. Med. Assoc

    (2002)
  • M.H. Becker et al.

    Selected psychological models and correlates of individual help seeking behaviours

    Med. Care

    (1977)
  • K.A. Wallston et al.

    Development of multidimensional health locus of control

    Heal. Ed. Mon

    (1978)
  • Ajzen, I, Fishbein M. Understanding attitudes and predicting social behaviour. Englewood Cliffs, NJ: Prentice-Hall;...
  • Cited by (60)

    • Depression Screening, Diagnosis, and Treatment Across the Lifespan

      2016, Primary Care - Clinics in Office Practice
    • Patient experiences of taking antidepressants for depression: A secondary qualitative analysis

      2013, Research in Social and Administrative Pharmacy
      Citation Excerpt :

      Grime and Pollock describe a “stoical attitude” to temporary side effects that do not interfere with daily activities.44 Unexpected severe side effects lead to experimentation with dosage46 questioning of the GP's knowledge and expertise, use of self-help and stopping treatment.25,45 Moreover, unwelcome, severe side effects are often the trigger for patients taking either proactive or aggressive role in decisions about treatment, with or without their GP's input.46

    • Unmet depression information needs in the community

      2013, Journal of Affective Disorders
      Citation Excerpt :

      Powell and Clarke (2006) in a qualitative study found that service users with mild to moderate mental health problems reported a lack of information about diagnosis and treatment options including side effects of medication. Similarly, other studies have reported consumer dissatisfaction with the information that health professionals provide about mental illness including its nature, course and treatment (Fossey et al., 2012) and about antidepressants and other psychotropic medications (Bell et al., 2006; Bowskill et al., 2007; Fossey et al., 2012; Garfield et al., 2004; Happell et al., 2004; Pollock et al., 2004). With the advent of the Internet and a proliferation of information about the common mental disorders in books, brochures, and newspapers, consumers are not solely reliant on health professionals to satisfy their mental health information needs (Pohjanoksa-Mäntylä et al., 2011; Tanenbaum, 2008).

    View all citing articles on Scopus
    View full text