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Measuring Concurrent Oral Hypoglycemic and Antidepressant Adherence and Clinical Outcomes
Hillary R. Bogner, MD, MSCE; Heather F. de Vries, MSPH; Alison J. O'Donnell, BA; and Knashawn H. Morales, ScD
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Measuring Concurrent Oral Hypoglycemic and Antidepressant Adherence and Clinical Outcomes

Hillary R. Bogner, MD, MSCE; Heather F. de Vries, MSPH; Alison J. O'Donnell, BA; and Knashawn H. Morales, ScD
Self-reported adherence tended to overestimate medication adherence compared with electronic monitoring. Electronic monitoring of oral hypoglycemic agents but not self-reported adherence predicted glycemic control.
Poor adherence is a major obstacle to the benefit of medication regimens in the treatment of comorbid T2DM and depression. Regular monitoring and discussion of adherence is an important aspect of clinical encounters. Given a lack of identification of clear risk profiles for nonadherence, physicians may only be able to suspect nonadherence during the course of treatment for depression and diabetes. Our data demonstrated that over time self-reported adherence more closely approximated electronic monitoring. However, heavy reliance on self-reported adherence in practice could affect the quality of clinical care. If nonadherence is suspected, reasons for nonadherence should be examined and addressed to mitigate poor health prognoses and adverse clinical outcomes. Improved management of both T2DM and depression through improved adherence could have an important public health impact on patient functional status and mortality.55

Author Affiliations: From Department of Family Medicine and Community Health (HRB, HFD, AJO), Center for Clinical Epidemiology and Biostatistics (HRB, HFD, AJO, KHM), University of Pennsylvania, Philadelphia, PA.

Funding Source: This work was supported by American Diabetes Association Clinical Research Award 1-09-CR-07. Dr Bogner was supported by NIMH grant MH082799 and MH047447. Dr Morales was supported by an NIMH-mentored Career Development Award (MH073903).

Author Disclosures: The authors (HRB, HFD, AJO, KHM) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (HRB, KHM); acquisition of data (HRB, HFD, AJO); analysis and interpretation of data (HRB, KHM, HFD, AJO); drafting of the manuscript (HRB, KHM, HFD, AJO); critical revision of the manuscript for important intellectual content (HRB, KHM, HFD, AJO); statistical analysis (KHM); provision of study materials or patients (HRB); obtaining funding (HRB); administrative, technical, or logistic support (HFD, AJO); and supervision (HRB).

Address correspondence to: Hillary R. Bogner, MD, MSCE, Assistant Professor, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, The University of Pennsylvania, 9 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104. E-mail:
1. Sabate E. Adherence to long-term therapies: evidence for action. Geneva, Switzerland: World Health Organization; 2003. WHO/MNC/03.01.

2. Cramer JA, Rosenheck R. Compliance with medication regimens formental and physical disorders. Psychiatr Serv. 1998;49(2):196-201.

3. Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications. JAMA. 2002;288(22):2880-2883.

4. Stuart BC, Simoni-Wastila L, Zhao L, Lloyd JT, Doshi JA. Increased persistency in medication use by U.S. Medicare beneficiaries with diabetes is associated with lower hospitalization rates and cost savings. Diabetes Care. 2009;32(4):647-649.

5. Rasmussen JN, Chong A, Alter DA. Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. Jama. 2007;297(2):177-186.

6. Simon GE, Katon WJ, Lin EH, et al. Diabetes complications and depression as predictors of health service costs. Gen Hosp Psychiatry. 2005;27(5):344-351.

7. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497.

8. Rand CS. I took the medicine like you told me doctor: self-report of adherence to medical regimens. In: Stone AA, Bachrach CA, Jobe JB, Kurtzman JS, Cain VS, eds. The Science of Self-Report: Implications for Research and Practice. Mahwah, NJ: Lawrence Erlbaum Associates; 2000.

9. Sackett DL, Haynes RB. Compliance with therapeutic regimens. Baltimore, MD: Johns Hopkins University Press; 1976.

10. Nakonezny PA, Byerly MJ, Rush AJ. Electronic monitoring of antipsychotic medication adherence in outpatients with schizophrenia or schizoaffective disorder: an empirical evaluation of its reliability and predictive validity. Psychiatry Res. 2008;157(1-3):259-263.

11. Bogner HR, Cahill EC, Frauenhoffer C, Barg FK. Older primary care patients views regarding antidepressants: a mixed methods approach. J Ment Health. 2009;18(1):57-64.

12. Bogner HR, Dahlberg B, de Vries HF, Cahill EC, Barg FK. Older patients’ views on the relationship between depression and heart disease. Fam Medicine. 2008;40(9):652-657.

13. Gonzalez JS, Peyrot M, McCarl LA, et al. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care. 2008;31(12): 2398-2403.

14. Grenard JL, Munjas BA, Adams JL, et al. Depression and Medication adherence in the treatment of chronic diseases in the United States: a meta-analysis [published online May 1, 2011]. J Gen Intern Med. 2011;26(10):1175-1182.

15. Kilbourne AM, Good CB, Sereika SM, Justice AC, Fine MJ. Algorithm for assessing patients’ adherence to oral hypoglycemic medication. Am J Health Syst Pharm. 2005;62(2):198-204.

16. Lee MS, Lee HY, Kang SG, et al. Variables influencing antidepressant medication adherence for treating outpatients with depressive disorders. J Affect Disord. 2010;123(1-3):216-221.

17. Choudhry NK, Shrank WH, Levin RL, et al. Measuring concurrent adherence to multiple related medications. Am J Manag Care. 2009; 15(7):457-464.

18. van Dijk L, Heerdink ER, Somai D, et al. Patient risk profiles and practice variation in nonadherence to antidepressants, antihypertensives and oral hypoglycemics. BMC Health Serv Res. 2007;7:51-62.

19. Bogner HR, Morales KH, de Vries HF, Cappola AR. Integrated management of type 2 diabetes mellitus and depression treatment to improve medication adherence: a randomized controlled trial. Ann Fam Med. 2012;10(1):15-22.

20. Lau DT, Nau DP. Oral antihyperglycemic medication nonadherence and subsequent hospitalization among individuals with type 2 diabetes. Diabetes Care. 2004;27(9):2149-2153.

21. George CF, Peveler RC, Heiliger S, Thompson C. Compliance with tricyclic antidepressants: the value of four different methods of assessment. Br J Clin Pharmacol. 2000;50(2):166-171.

22. Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA. 1993;269(18):2386-2391.

23. Stewart AL, Hays RD, Ware JE. The MOS Short-form General Health Survey: reliability and validity in a patient population. Med Care. 1988;26(7):724-735.

24. Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198.

25. Svarstad BL, Chewning BA, Sleath BL, Claesson C. The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999;37(2):113-124.

26. Odegard PS, Gray SL. Barriers to medication adherence in poorly
controlled diabetes mellitus. Diabetes Educ. 2008;34(4):692-697.

27. Heckman BD, Catz SL, Heckman TG, Miller JG, Kalichman SC. Adherence to antiretroviral therapy in rural persons living with HIV disease in the United States. AIDS Care. 2004;16(2):219-230.

28. Hashmi SK, Afridi MB, Abbas K, et al. Factors associated with adherence to anti-hypertensive treatment in Pakistan. PLoS One. 2007; 2(3):e280.

29. Rickles NM, Svarstad BL. Relationships between multiple selfreported nonadherence measures and pharmacy records. Res Social Adm Pharm. 2007;3(4):363-377.

30. American Diabetes Association. Clinical Practice Recommendations. Diabetes Care. 2011;34(suppl 1):S1-S100.

31. Moridani MY, Verjee Z, Allen LC. Analytical evaluation of hemoglobin A(1c) dual kit assay on Bio-Rad Variant II: an automated HPLC hemoglobin analyzer for the management of diabetic patients. Clin Biochem. 2003;36(4):317-320.

32. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.

33. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a selfreport version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282(18):1737-1744.

34. Angst J. Clinical course of affective disorders. In: Helgason T, Daly R, eds. Depression Illness: Prediction of Course and Outcome. Berlin, Germany: Springer-Verlag; 1988:1-47.

35. Thompson C, Peveler RC, Stephenson D, McKendrick J. Compliance with antidepressant medication in the treatment of major depressive disorder in primary care: a randomized comparison of fluoxetine and a tricyclic antidepressant. Am J Psychiatry. 2000;157(3):338-343.

36. Odegard PS, Capoccia K. Medication taking and diabetes: a systematic review of the literature. Diabetes Educ. 2007;33(6):1014-1029; discussion 1030-1011.

37. Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther. 1999;21(6):1074-1090; discussion 1073.

38. Campbell JP, Maxey VA, Watson WA. Hawthorne effect: implications for prehospital research. Ann Emerg Med. 1995;26(5):590-594.

39. Tedlow JR, Fava M, Uebelacker LA, Alpert JE, Nierenberg AA, Rosenbaum JF. Are study dropouts different from completers? Biol Psychiatry. 1996;40(7):668-670.

40. 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):1128-1132.

41. Croghan TW, Lair TJ, Engelhart L, et al. Effect of antidepressant therapy on health care utilization and costs in primary care. Psychiatr Serv. 1997;48(11):1420-1426.

42. Williams JW, Katon W, Lin EHB, et al. The effectiveness of depression care management on diabetes-related outcomes in older patients. Ann Intern Med. 2004;140(12):1015-1024.

43. Shi L, Liu J, Koleva Y, Fonseca V, Kalsekar A, Pawaskar M. Concordance of adherence measurement using self-reported adherence questionnaires and medication monitoring devices. Pharmacoeconomics. 2010;28(12):1097-1107.

44. Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86(4):304-314.

45. Neath I. Distinctiveness and serial position effects in recognition. Mem Cognit. 1993;21(5):689-698.

46. Marlowe D, Crowne D. Social desirability and responses to perceived situational demands. J Consult Clin Psychol. 1961;25:109-115.

47. Stone AS, Turkann JS, Brachrach CA, Jobe JB, Kurtzman HS, Cain VS. The Science of Self-Report: Implications for Research and Practice. Mahwah, NJ: Lawrence Erlbaum Associates, Inc; 2000.

48. Mason BJ, Matsuyama JR, Jue SG. Assessment of sulfonylurea adherence and metabolic control. Diabetes Educator. 1995;21(1):52-57.

49. Stewart JW, McGrath PJ, Quitkin FM. Can mildly depressed outpatients with atypical depression benefit from antidepressants? Am J Psychiatry. 1992;149(5):615-619.

50. Rapaport MH, Judd LL. Minor depressive disorder and subsyndromal depressive symptoms: functional impairment and response to treatment. J Affect Disord. 1998;48(2-3):227-232.

51. Barbui C, Cipriani A, Patel V, Ayuso-Mateos JL, van Ommeren M. Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis. Br J Psychiatry. 2011;198(1):11- 16, sup 11.

52. Sirey JA, Bruce ML, Alexopoulos GS, Perlick DA, Friedman SJ, Meyers BS. Stigma as a barrier to recovery: perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatr Serv. 2001;52(12):1615-1620.

53. Bambauer KZ, Safran DG, Ross-Degnan D, et al. Depression and cost-related medication nonadherence in Medicare beneficiaries. Arch Gen Psychiatry. 2007;64(5):602-608.

54. Bogner HR, Ford DE, Gallo JJ. The role of cardiovascular disease in the identification and management of depression by primary care physicians. Am J Geriatr Psychiatry. 2006;14(1):71-78.

55. Bogner HR, Morales KH, Post EP, Bruce ML. Diabetes, depression, and death: a randomized controlled trial of a depression treatment program for older adults based in primary care (PROSPECT). Diabetes Care. 2007;30(12):3005-3010.
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