BACKGROUND: Previous studies have reported that health literacy limitations are associated with poorer disease control for chronic conditions, but have not evaluated potential associations with medication adherence. OBJECTIVE: To determine whether health literacy limitations are associated with poorer antidepressant medication adherence. DESIGN: Observational new prescription cohort follow-up study. PARTICIPANTS: Adults with type 2 diabetes who completed a survey in 2006 and received a new antidepressant prescription during 2006-2010 (N = 1,366) at Kaiser Permanente Northern California. MAIN MEASURES: Validated three-item self-report scale measured health literacy. Discrete indices of adherence based on pharmacy dispensing data according to validated methods: primary non-adherence (medication never dispensed); early non-persistence (dispensed once, never refilled); non-persistence at 180 and 365 days; and new prescription medication gap (NPMG; proportion of time that the person is without medication during 12 months after the prescription date). KEY RESULTS: Seventy-two percent of patients were classified as having health literacy limitations. After adjusting for sociodemographic and clinical covariates, patients with health literacy limitations had significantly poorer adherence compared to patients with no limitations, whether measured as early non-persistence (46 % versus 38 %, p < 0.05), non-persistence at 180 days (55 % versus 46 %, p < 0.05), or NPMG (41 % versus 36%, p < 0.01). There were no significant associations with primary adherence or non-persistence at 365 days. CONCLUSIONS: Poorer antidepressant adherence among adults with diabetes and health literacy limitations may jeopardize the continuation and maintenance phases of depression pharmacotherapy. Findings underscore the importance of national efforts to address health literacy, simplify health communications regarding treatment options, improve public understanding of depression treatment, and monitor antidepressant adherence.
BACKGROUND: Previous studies have reported that health literacy limitations are associated with poorer disease control for chronic conditions, but have not evaluated potential associations with medication adherence. OBJECTIVE: To determine whether health literacy limitations are associated with poorer antidepressant medication adherence. DESIGN: Observational new prescription cohort follow-up study. PARTICIPANTS: Adults with type 2 diabetes who completed a survey in 2006 and received a new antidepressant prescription during 2006-2010 (N = 1,366) at Kaiser Permanente Northern California. MAIN MEASURES: Validated three-item self-report scale measured health literacy. Discrete indices of adherence based on pharmacy dispensing data according to validated methods: primary non-adherence (medication never dispensed); early non-persistence (dispensed once, never refilled); non-persistence at 180 and 365 days; and new prescription medication gap (NPMG; proportion of time that the person is without medication during 12 months after the prescription date). KEY RESULTS: Seventy-two percent of patients were classified as having health literacy limitations. After adjusting for sociodemographic and clinical covariates, patients with health literacy limitations had significantly poorer adherence compared to patients with no limitations, whether measured as early non-persistence (46 % versus 38 %, p < 0.05), non-persistence at 180 days (55 % versus 46 %, p < 0.05), or NPMG (41 % versus 36%, p < 0.01). There were no significant associations with primary adherence or non-persistence at 365 days. CONCLUSIONS: Poorer antidepressant adherence among adults with diabetes and health literacy limitations may jeopardize the continuation and maintenance phases of depression pharmacotherapy. Findings underscore the importance of national efforts to address health literacy, simplify health communications regarding treatment options, improve public understanding of depression treatment, and monitor antidepressant adherence.
Authors: Lisa A Cooper; Junius J Gonzales; Joseph J Gallo; Kathryn M Rost; Lisa S Meredith; Lisa V Rubenstein; Nae-Yuh Wang; Daniel E Ford Journal: Med Care Date: 2003-04 Impact factor: 2.983
Authors: Andrew J Karter; Assiamira Ferrara; Jennifer Y Liu; Howard H Moffet; Lynn M Ackerson; Joe V Selby Journal: JAMA Date: 2002-05-15 Impact factor: 56.272
Authors: Elizabeth H B Lin; Wayne Katon; Michael Von Korff; Carolyn Rutter; Greg E Simon; Malia Oliver; Paul Ciechanowski; Evette J Ludman; Terry Bush; Bessie Young Journal: Diabetes Care Date: 2004-09 Impact factor: 19.112
Authors: Wayne J Katon; Michael Von Korff; Elizabeth H B Lin; Greg Simon; Evette Ludman; Joan Russo; Paul Ciechanowski; Edward Walker; Terry Bush Journal: Arch Gen Psychiatry Date: 2004-10
Authors: Mark D Sullivan; Patrick O'Connor; Patricia Feeney; Don Hire; Debra L Simmons; Dennis W Raisch; Lawrence J Fine; K M Venkat Narayan; Mohammad K Ali; Wayne J Katon Journal: Diabetes Care Date: 2012-05-22 Impact factor: 19.112
Authors: Alyce S Adams; Stephen B Soumerai; Fang Zhang; Daniel Gilden; Marguerite Burns; Haiden A Huskamp; Connie Trinacty; Margarita Alegria; Robert F LeCates; Jennifer J Griggs; Dennis Ross-Degnan; Jeanne M Madden Journal: Clin Ther Date: 2015-01-22 Impact factor: 3.393
Authors: Andrew J Karter; Melissa M Parker; Matthew D Solomon; Courtney R Lyles; Alyce S Adams; Howard H Moffet; Mary E Reed Journal: Health Serv Res Date: 2017-05-05 Impact factor: 3.402
Authors: Melody S Goodman; Richard T Griffey; Christopher R Carpenter; Melvin Blanchard; Kimberly A Kaphingst Journal: J Am Board Fam Med Date: 2015 Sep-Oct Impact factor: 2.657
Authors: Amy M Bauer; Tessa Rue; Gina A Keppel; Allison M Cole; Laura-Mae Baldwin; Wayne Katon Journal: J Am Board Fam Med Date: 2014 Nov-Dec Impact factor: 2.657
Authors: R J Fredericksen; L Gibbons; S Brown; T C Edwards; F M Yang; E Fitzsimmons; K Alperovitz-Bichell; M Godfrey; A Wang; A Church; C Gutierrez; E Paez; L Dant; S Loo; M Walcott; M J Mugavero; K Mayer; W C Mathews; D L Patrick; P K Crane; H M Crane Journal: Res Social Adm Pharm Date: 2017-06-20
Authors: Joule J Li; Sarah L Appleton; Gary A Wittert; Andrew Vakulin; R Douglas McEvoy; Nick A Antic; Robert J Adams Journal: Sleep Date: 2014-03-01 Impact factor: 5.849