On-Site Prescription Dispensing Improves Antidepressant Adherence among Uninsured Depressed Patients

Abstract

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.

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Data Availability

Available from the corresponding author upon request.

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Funding

No direct funding was provided to conduct this research. The Mental Health Clinic of the East Harlem Health Outreach Partnership is supported by private grants and donations from the Atran Foundation and Ira W. DeCamp Foundation.

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Authors

Contributions

CLG, EN, YSM, CLK originated the conception and design of the study. SKP, CLG, EN, and IO collected data. SKP and CLG analyzed the data. SKP created the figures. SKP and CLG wrote the manuscript. All authors reviewed the manuscript and revised it for quality of content.

Corresponding author

Correspondence to Samuel K. Powell.

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The authors declare that they have no conflicts of interest.

Informed Consent

The Institutional Review Board of the Icahn School of Medicine at Mount Sinai granted a waiver of consent for the retrospective chart review component of this study. Informed consent was obtained for all patients interviewed in this study. This study was approved by the Institutional Review Board at the Icahn School of Medicine at Mount Sinai, IRB #18–00914.

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Powell, S.K., Gibson, C.L., Okoroafor, I. et al. On-Site Prescription Dispensing Improves Antidepressant Adherence among Uninsured Depressed Patients. Psychiatr Q (2021). https://doi.org/10.1007/s11126-021-09885-z

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Keywords

  • Major depressive disorder
  • Medication adherence
  • Outpatient psychiatry
  • Immigrant mental health
  • Antidepressants
  • Student-run clinic