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Am J Manag Care. 2003 Jan;9(1):70-80.

Impact of an antidepressant management program on medication adherence.

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Clinical Pharmacy, Blue Cross and Blue Shield of Florida Inc, 4800 Deerwood Campus Parkway, DCC-300-3, Jacksonville, FL 32246, USA.



To evaluate the impact of mail-based physician and member educational interventions on patient adherence to antidepressant medications.


The randomized controlled prospective design included patients followed for 6 months after filling a new prescription for an antidepressant. A pharmacy claims database was used to identify patients and track medication adherence.


Patients receiving a new prescription for an antidepressant and their prescribers were included. Prescribers were randomly assigned to the intervention and control groups. Patient assignment was linked to their physician's assignment. The control group received no intervention. The educational intervention consisted of monthly letters to patients and prescribers regarding the Health Plan Employer Data and Information Set (HEDIS) standards or educational information regarding the importance of medication adherence. The primary outcome was adherence as measured by the medication possession ratio and measurement as specified by HEDIS. The Student's ttest, the chi2 test, and a logistic regression model were used to compare groups and the variables that affect adherence. Other secondary measurements of adherence were performed.


A total of 9564 patients were included. Patients in the intervention group demonstrated greater adherence compared with the control group at 90 and 180 days (P < .05). After adjusting for variables, the intervention variable stood alone in its significant impact on adherence (P <.01; confidence interval, 1.003-1.197). Adherence in the total population was significantly higher for selective serotonin reuptake inhibitors than for other agents (P < .001).


A monthly mail-based educational intervention program regarding antidepressant medications can positively influence patient adherence to therapy.

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