How to Improve Your Patient's Antidepressant Adherence

Depression is one of the most common conditions in behavioral health, and it has a significant impact on both mental and physical well-being.

Primary care settings are often the first line of identification for behavioral health issues such as Depression. In order to confirm or rule out a diagnosis, PCPs should use screening tools (e.g., PHQ-9 for Depression) which are available for many behavioral health conditions. For more information regarding the PHQ-9 and to obtain the screening tool in additional languages, please refer to PHQ screener website.

After an initial diagnosis of depression is made, a primary care provider may consider starting a patient on an antidepressant medication for treatment of his/her illness. It is critical that the primary care provider also discuss the side effects of these medications, the length of time it may take for a patient to begin to see the effects of the medication, as well as the need for regular follow-up visits with either the primary care provider or a behavioral health provider. These follow-up visits provide the opportunity for the patient to discuss any side effects, address possible concerns around worsening symptoms, and allow for adjustments to the medications to be made.

Through feedback from forums involving members who have a diagnosis of Depression, NHP has learned that non-adherence to antidepressant medications is often a result of either not feeling better (without an adequate trial and/or dose of medication) or side effects experienced.

To address the findings referenced above, NHP in collaboration with its Behavioral Health vendor, Beacon Health Options, has been working on a variety of initiatives to raise awareness about the objectives of National Committee for Quality Assurance (NCQA) HEDIS® Antidepressant Medication Management (AMM) measures, which guide our efforts in measuring the quality and effectiveness of the care provided. The AMM measure specifically focuses on follow-up care for those prescribed antidepressant medication.

What is the HEDIS AMM Measure?

After an initial diagnosis of depression and prescription of an antidepressant medication, regular follow-up visits are recommended to support patients with treating their illness to:

• Remain on antidepressant medication for at least 84 days (Effective Acute Phase)
• Continue taking antidepressant medication for at least 180 days (Effective Continuation Phase)

Please refer to the HEDIS Tip Sheet (page 12) for further information about the AMM measure.

How to Improve Your Patient's Antidepressant Adherence

What can you do to improve your patients' adherence to their treatment plans? First and foremost, develop rapport and engage the patient collaboratively in the development of their treatment plan.

Use your rapport to educate the patient on important issues that impact adherence, such as:

• When will the medication start working and how will your patient know it is working?
• What it will feel like to be on the medication?
• How long will it take for the medication to work?
• How long should the patient expect to take the medication?
• Why is it important to continue the medication?
• What should the patient do if they have any questions, possible side effects or concerns?
• Reiterate the importance of attending follow-up visits

Patients also benefit from information about common side effects, how long the side effects may last, and how to manage those side effects. This information should be simple and specific.

Sometimes patients benefit from referral to a behavioral health specialist. If you do refer your patient, be sure to coordinate care with the specialist, and follow up with the patient about his/her treatment, particularly regarding medications. As the primary care provider, you are in a powerful position to promote your patient's adherence to treatment.