Building concordant relationships with patients starting antidepressant medication
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)
Compliance during treatment with antidepressants
J. Affect. Disord
(1997)- 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...
- et al.
The compliance with antidepressants in general practice
J. Psychopharmacol
(1994) - et al.
The role of the primary care physician in patients’ adherence to antidepressant therapy
Med. Care
(1995) - et al.
Recognition and management of depression in general practice: consensus statement
Br. Med. J
(1992) - et al.
A method for decreasing patients’ educational errors
Psychol. Med
(1976) - et al.
Discontinuation of use and switching of antidepressants. Influence of patient–physician communication
J. Am. Med. Assoc
(2002) - et al.
Selected psychological models and correlates of individual help seeking behaviours
Med. Care
(1977)
Development of multidimensional health locus of control
Heal. Ed. Mon
Cited by (60)
Depression Screening, Diagnosis, and Treatment Across the Lifespan
2016, Primary Care - Clinics in Office Practice"My dirty little habit": Patient constructions of antidepressant use and the 'crisis' of legitimacy
2015, Social Science and MedicinePerspective of community pharmacists on their practice with patients who have an antidepressant drug treatment: Findings from a focus group study
2015, Research in Social and Administrative PharmacyPatient experiences of taking antidepressants for depression: A secondary qualitative analysis
2013, Research in Social and Administrative PharmacyCitation 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 DisordersCitation 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).
New Zealand community pharmacists' views of their roles in meeting medicine-related needs for people with mental illness
2011, Research in Social and Administrative Pharmacy