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


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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  1. 1.

    Solomon DA, Keller MB, Leon AC, et al. Multiple Recurrences of Major Depressive Disorder. Am J Psychiatry. 2000;157(2):229–33.

    CAS  Article  Google Scholar 

  2. 2.

    Mathers CD, Loncar D. Projections of Global Mortality and Burden of Disease from 2002 To 2030. PLoS Med. 2006;3(11):e442.

    Article  Google Scholar 

  3. 3.

    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime Prevalence and Age-of-Onset Distributions of Dsm-Iv Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.

    Article  Google Scholar 

  4. 4.

    Greenberg PE, Fournier AA, Sisitsky T, Pike CT, Kessler RC. The Economic Burden of Adults with Major Depressive Disorder in the United States (2005 And 2010). J Clin Psychiatry. 2015;76(2):155–62.

    Article  Google Scholar 

  5. 5.

    Cipriani A, Barbui C, Butler R, Hatcher S, Geddes J. Depression in adults: drug and physical treatments. BMJ Clin Evid. 2011;2011:1003.

    PubMed  PubMed Central  Google Scholar 

  6. 6.

    Olfson M, Marcus SC. National Patterns in Antidepressant Medication Treatment. Arch Gen Psychiatry. 2009;66(8):848–56.

    Article  Google Scholar 

  7. 7.

    Melfi CA, Chawla AJ, Croghan TW, Hanna MP, Kennedy S, Sredl K. The Effects of Adherence to Antidepressant Treatment Guidelines on Relapse and Recurrence of Depression. Arch Gen Psychiatry. 1998;55(12):1128–32.

    CAS  Article  Google Scholar 

  8. 8.

    Ho SC, Chong HY, Chaiyakunapruk N, Tangiisuran B, Jacob SA. Clinical and Economic Impact of Non-Adherence to Antidepressants in Major Depressive Disorder: A Systematic Review. J Affect Disord. 2016;193:1–10.

    Article  Google Scholar 

  9. 9.

    Zivin K, Ganoczy D, Pfeiffer PN, Miller EM, Valenstein M. Antidepressant Adherence after Psychiatric Hospitalization among VA Patients With Depression. Adm Policy Ment Health Ment Health Serv Res. 2009;36(6):406–15.

    Article  Google Scholar 

  10. 10.

    Rivero-Santana A, Perestelo-Perez L, Pérez-Ramos J, Serrano-Aguilar P, De las Cuevas C. Sociodemographic and Clinical Predictors of Compliance with Antidepressants for Depressive Disorders: Systematic Review of Observational Studies. Patient Prefer Adherence. 2013;7:151.

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Olfson M, Marcus SC, Tedeschi M, Wan GJ. Continuity of Antidepressant Treatment for Adults With Depression in the United States. Am J Psychiatry. 2006;163(1):101–8.

    Article  Google Scholar 

  12. 12.

    Hodgkin D, Volpe-Vartanian J, Alegría M. Discontinuation of Antidepressant Medication among Latinos in the USA. J Behav Health Serv Res. 2007;34(3):329–42.

    Article  Google Scholar 

  13. 13.

    Pugh M Jr, Perrin PB, Rybarczyk B, Tan J. Racism, mental health, healthcare provider trust, and medication adherence among Black patients in safety-net primary care. J Clin Psychol Med Settings. 2020. https://doi.org/10.1007/s10880-020-09702-y.

  14. 14.

    Cuffee YL, Hargraves JL, Rosal M, Briesacher BA, Schoenthaler A, Person S, et al. Reported Racial Discrimination, Trust in Physicians, and Medication Adherence among Inner-City African Americans with Hypertension. Am J Public Health. 2013;103(11):e55–62.

    Article  Google Scholar 

  15. 15.

    Smith S, Thomas R, Cruz M, Griggs R, Moscato B, Ferrara A. Presence and Characteristics of Student-Run Free Clinics in Medical Schools. JAMA. 2014a;312(22):2407–10.

    Article  Google Scholar 

  16. 16.

    Zucker J, Gillen J, Ackrivo J, Schroeder R, Keller S. Hypertension Management in a Student-Run Free Clinic: Meeting National Standards? Acad Med. 2011;86(2):239–45.

    Article  Google Scholar 

  17. 17.

    Liberman KM, Meah YS, Chow A, Tornheim J, Rolon O, Thomas DC. Quality of Mental Health Care at a Student-Run Clinic: Care for the Uninsured Exceeds that of Publicly and Privately Insured Populations. J Community Health. 2011;36(5):733–40.

    Article  Google Scholar 

  18. 18.

    Smith SD, Marrone L, Gomez A. Clinical Outcomes of Diabetic Patients at a Student-Run Free Clinic Project. Fam Med. 2014b;46(3):198.

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Mann CL, Rifkin RA, Nabel EM, Thomas DC, Meah YS, Katz CL. Exploring Antidepressant Adherence at a Student-Run Free Mental Health Clinic. Community Ment Health J. 2019;55(1):57–62.

    Article  Google Scholar 

  20. 20.

    Finley PR, Rens HR, Pont JT, Gess SL, Louie C, Bull SA, et al. Impact of a Collaborative Care Model on Depression in a Primary Care Setting: A Randomized Controlled Trial. Pharmacotherapy. 2003;23(9):1175–85.

    Article  Google Scholar 

  21. 21.

    GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, Regional, and National Incidence, Prevalence, and Years Lived With Disability for 310 Diseases and Injuries, 1990–2015: A Systematic Analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545–602.

    Article  Google Scholar 

  22. 22.

    NYCHealth. Manhattan Community District 11: EAST HARLEM. New York City 2015.

  23. 23.

    Osterberg L, Blaschke T. Adherence to Medication. N Engl J Med. 2005;353(5):487–97.

    CAS  Article  Google Scholar 

  24. 24.

    Sansone RA, Sansone LA. Antidepressant Adherence: Are Patients Taking Their Medications? Innov Clin Neurosci. 2012;9(5–6):41–6.

    PubMed  PubMed Central  Google Scholar 

  25. 25.

    Keller MD, Berndt ER. Depression Treatment: A Lifelong Commitment? Psychopharmacol Bull. 2002;36(Suppl 2):133–41 Review.

    PubMed  Google Scholar 

  26. 26.

    McQuaid EL, Landier W. Cultural Issues in Medication Adherence: Disparities and Directions. J Gen Intern Med. 2018;33(2):200–6.

    Article  Google Scholar 

  27. 27.

    Lin EH, Von Korff M, Ludman EJ, et al. Enhancing adherence to prevent depression relapse in primary care. Gen Hosp Psychiatry. 2003;25(5):303–10.

    Article  Google Scholar 

  28. 28.

    Liu X, Tepper PG, Able SL. Adherence and Persistence with Duloxetine and Hospital Utilization in Patients with Major Depressive Disorder. Int Clin Psychopharmacol. 2011;26(3):173–80.

    CAS  Article  Google Scholar 

  29. 29.

    Readdean KC, Heuer AJ, Scott Parror J. Effect of Pharmacist Intervention on Improving Antidepressant Medication Adherence and Depression Symptomology: A Systematic Review and Meta-Analysis. Res Soc Adm Pharm. 2018;14(4):321–31.

    Article  Google Scholar 

  30. 30.

    Hunot VM, Horne R, Leese MN, Churchill RC. A Cohort Study of Adherence to Antidepressants in Primary Care: The Influence of Antidepressant Concerns and Treatment Preferences. Prim Care Companion J Clin Psychiatry. 2007;9(2):91–9.

    Article  Google Scholar 

  31. 31.

    Chong WW, Aslani P, Chen TF. Effectiveness of Interventions to Improve Antidepressant Medication Adherence: A Systematic Review. Int J Clin Pract. 2011;65(9):954–75.

    CAS  Article  Google Scholar 

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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.

Author information




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.

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