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Health Literacy and Antidepressant Medication Adherence Among Adults with Diabetes: The Diabetes Study of Northern California (DISTANCE)

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ABSTRACT

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.

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REFERENCES

  1. Nielsen-Bohlman L, Panzer AM, Kindig DA, eds. Health Literacy: A Prescription to End Confusion. Washington: National Academies Press; 2004.

    Google Scholar 

  2. Kutner M, Greenberg E, Jin Y, Paulsen C. The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy. Washington, DC: U.S. Department of Education. National Center for Education Statistics; 2006.

  3. Benjamin R. Health literacy improvement as a national priority. J Health Commun. 2010;15(Suppl 2):1–3.

    Article  PubMed  Google Scholar 

  4. Macabasco-O’Connell A, DeWalt DA, Broucksou KA, et al. Relationship between literacy, knowledge, self-care behaviors, and heart failure-related quality of life among patients with heart failure. J Gen Intern Med. 2011;26(9):979–86.

    Article  PubMed  Google Scholar 

  5. Osborn CY, Paasche-Orlow MK, Davis TC, Wolf MS. Health literacy: an overlooked factor in understanding HIV health disparities. Am J Prev Med. 2007;33(5):374–8.

    Article  PubMed  Google Scholar 

  6. Osborn CY, Cavanaugh K, Wallston KA, et al. Health literacy explains racial disparities in diabetes medication adherence. J Health Commun. 2011;16(Suppl 3):268–78.

    Article  PubMed  Google Scholar 

  7. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24(6):1069–78.

    Article  PubMed  CAS  Google Scholar 

  8. de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001;63(4):619–30.

    PubMed  Google Scholar 

  9. Lin EH, Katon W, Von Korff M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27(9):2154–60.

    Article  PubMed  Google Scholar 

  10. Katon WJ, Rutter C, Simon G, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care. 2005;28(11):2668–72.

    Article  PubMed  Google Scholar 

  11. Katon W, Lyles CR, Parker MM, Karter AJ, Huang ES, Whitmer RA. Association of depression with increased risk of dementia in patients with type 2 diabetes: the diabetes and aging study. Arch Gen Psychiatry. 2012;69(4):410–7.

    Article  PubMed  Google Scholar 

  12. Sullivan MD, O’Connor P, Feeney P, et al. Depression predicts all-cause mortality: epidemiological evaluation from the ACCORD HRQL substudy. Diabetes Care. 2012;35(8):1708–15.

    Google Scholar 

  13. Katon WJ, Simon G, Russo J, et al. Quality of depression care in a population-based sample of patients with diabetes and major depression. Med Care. 2004;42(12):1222–9.

    Article  PubMed  Google Scholar 

  14. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.

    Article  PubMed  Google Scholar 

  15. Carter JS, Pugh JA, Monterrosa A. Non-insulin-dependent diabetes mellitus in minorities in the United States. Ann Intern Med. 1996;125(3):221–32.

    Article  PubMed  CAS  Google Scholar 

  16. Zhang Q, Wang Y, Huang ES. Changes in racial/ethnic disparities in the prevalence of type 2 diabetes by obesity level among US adults. Ethn Health. 2009;14(5):439–57.

    Article  PubMed  Google Scholar 

  17. Duru OK, Gerzoff RB, Selby JV, et al. Identifying risk factors for racial disparities in diabetes outcomes: the translating research into action for diabetes study. Med Care. 2009;47(6):700–6.

    Article  PubMed  Google Scholar 

  18. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder. 3rd ed. Washington: American Psychiatric Association; 2010.

    Google Scholar 

  19. Karter AJ, Ferrara A, Liu JY, Moffet HH, Ackerson LM, Selby JV. Ethnic disparities in diabetic complications in an insured population. JAMA. 2002;287(19):2519–27.

    Article  PubMed  Google Scholar 

  20. Moffet HH, Adler N, Schillinger D, et al. Cohort profile: The Diabetes Study of Northern California (DISTANCE)—objectives and design of a survey follow-up study of social health disparities in a managed care population. Int J Epidemiol. 2009;38(1):38–47.

    Article  PubMed  Google Scholar 

  21. Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36(8):588–94.

    PubMed  Google Scholar 

  22. Chew LD, Griffin JM, Partin MR, et al. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med. 2008;23(5):561–6.

    Article  PubMed  Google Scholar 

  23. Sarkar U, Schillinger D, Lopez A, Sudore R. Validation of self-reported health literacy questions among diverse English and Spanish-speaking populations. J Gen Intern Med. 2011;26(3):265–71.

    Article  PubMed  Google Scholar 

  24. Sarkar U, Karter AJ, Liu JY, et al. The literacy divide: health literacy and the use of an internet-based patient portal in an integrated health system—results from the diabetes study of northern California (DISTANCE). J Health Commun. 2010;15(Suppl 2):183–96.

    Article  PubMed  Google Scholar 

  25. Karter AJ, Parker MM, Moffet HH, Ahmed AT, Schmittdiel JA, Selby JV. New prescription medication gaps: a comprehensive measure of adherence to new prescriptions. Health Serv Res. 2009;44(5 Pt 1):1640–61.

    Article  PubMed  Google Scholar 

  26. Zou GY. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6.

    Article  PubMed  Google Scholar 

  27. Cheung YB. A modified least-squares regression approach to the estimation of risk difference. Am J Epidemiol. 2007;166(11):1337–44.

    Article  PubMed  Google Scholar 

  28. Horvitz DG, Thompson DJ. A generalization of sampling without replacement from a finite universe. J Am Stat Assoc. 1952;47(260):663–85.

    Article  Google Scholar 

  29. Olfson M, Marcus SC, Tedeschi M, Wan GJ. Continuity of antidepressant treatment for adults with depression in the United States. Am J Psychiatry. 2006;163(1):101–8.

    Article  PubMed  Google Scholar 

  30. Wu CH, Erickson SR, Piette JD, Balkrishnan R. The association of race, comorbid anxiety, and antidepressant adherence among Medicaid enrollees with major depressive disorder. Res Soc Adm Pharm. 2012;8(3):193–205.

    Article  Google Scholar 

  31. Katon WJ, Von Korff M, Lin EHB, et al. The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry. 2004;61(10):1042–9.

    Article  PubMed  Google Scholar 

  32. Katon WJ, Lin EH, Von Korff M, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med. 2010;363(27):2611–20.

    Article  PubMed  CAS  Google Scholar 

  33. Schillinger D, Bindman A, Wang F, Stewart A, Piette J. Functional health literacy and the quality of physician–patient communication among diabetes patients. Patient Educ Couns. 2004;52(3):315–23.

    Article  PubMed  Google Scholar 

  34. Swenson SL, Rose M, Vittinghoff E, Stewart A, Schillinger D. The influence of depressive symptoms on clinician–patient communication among patients with type 2 diabetes. Med Care. 2008;46(3):257–65.

    Article  PubMed  Google Scholar 

  35. Lin EH, Von Korff M, Ciechanowski P, et al. Treatment adjustment and medication adherence for complex patients with diabetes, heart disease, and depression: a randomized controlled trial. Ann Fam Med. 2012;10(1):6–14.

    Article  PubMed  Google Scholar 

  36. Cooper LA, Gonzales JJ, Gallo JJ, et al. The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients. Med Care. 2003;41(4):479–89.

    PubMed  Google Scholar 

  37. Givens JL, Houston TK, Van Voorhees BW, Ford DE, Cooper LA. Ethnicity and preferences for depression treatment. Gen Hosp Psychiatry. 2007;29(3):182–91.

    Article  PubMed  Google Scholar 

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Acknowledgements

This research was supported by funding from the National Institutes of Health (R01-DK080726, R01-DK081796, P30-DK092924, and NCATS Grant KL2 TR000421). This research reported in this manuscript was presented at the annual meeting of the Academy of Psychosomatic Medicine in Atlanta GA, November 2012.

Conflict of Interest

Dr. Katon has received honoraria for CME lectures from Pfizer, Forest, and Eli Lilly and is on the advisory board for Eli Lilly. The authors report no other potential conflicts of interest.

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Correspondence to Amy M. Bauer MD, MS.

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ESM 1

Sensitivity analyses demonstrating the associations between health literacy limitations, race/ethnicity, and antidepressant medication adherence (DOCX 31 kb)

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Bauer, A.M., Schillinger, D., Parker, M.M. et al. Health Literacy and Antidepressant Medication Adherence Among Adults with Diabetes: The Diabetes Study of Northern California (DISTANCE). J GEN INTERN MED 28, 1181–1187 (2013). https://doi.org/10.1007/s11606-013-2402-8

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  • DOI: https://doi.org/10.1007/s11606-013-2402-8

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