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Faxed pharmacy alerts to doctors when patients miss their antidepressant prescription refill does not improve compliance

Only about one-fourth of patients diagnosed with depression take antidepressant medication for the 6 months recommended by the National Committee on Quality Assurance and others, concludes a new study. Over a 6-month period, researchers found that 75 percent of patients with depression delayed refilling their antidepressant prescription 10 days beyond when their last prescription should have been completed. Many of these patients did not refill their prescription within 30 days. This suggests that those with 10-day refill gaps are quite likely to drop the medication altogether.

The researchers also found that a pilot program did not improve compliance with antidepressant therapy. The antidepressant compliance program (ACP) used pharmacy faxes to alert physicians when their patients had gaps of more than 10 days in refilling antidepressant prescriptions during the first 6 months of treatment. Following the beginning of the ACP, there was an immediate, but insignificant, 2 percent decrease in medication noncompliance. Thus, faxed pharmacy feedback to physicians should be carefully evaluated before widespread implementation. It is insufficient as a stand-alone tool, conclude researchers at the HMO Research Network Center for Education and Research in Therapeutics (CERTS), which is supported by the Agency for Healthcare Research and Quality (HS10391).

The researchers used pharmacy claims data between May 2002 and May 2004 to examine the impact of the ACP, begun in May 2003, on antidepressant compliance among 13,128 members diagnosed with depression in a managed care plan in 3 States. They examined compliance rates before and after program inception. Rates of nonadherence among the adults who started antidepressant treatment remained relatively constant, averaging about 75 percent over the 2-year study period. Rates were the same whether patients were treated by psychiatrists or internal medicine physicians.

See "Physician alerts to increase antidepressant adherence: Fax or fiction?" by Kara Zivin Bambauer, Ph.D., Alyce S. Adams, Ph.D., Fang Zhang, Ph.D., and others in the March 13, 2006, Archives of Internal Medicine 166, pp. 498-504.

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