SAN FRANCISCO— A study comparing physician and patient perspectives for making shared treatment decisions regarding antidepressant use garnered some interesting results. “General practitioners attributed greater importance to cost and dosing schedules and patients gave more emphasis to uncommon/rare serious side effects and time in use,” reported David Gardner, PharmD, lead author of the study, which was presented at the 156th Annual Meeting of the American Psychiatric Association. “It appears that physicians overestimated the issue of cost for patients,” he noted.

IT TAKES TWO

According to previous research, poor treatment concordance with antidepressants results in less than half of patients with depression following a planned treatment course beyond three months, “which may double the risk of relapse,” Dr. Gardner said. “Shared treatment decisions can lead to improved patient satisfaction and long-term concordance with treatment plans,” he added. Dr. Gardner, who is an Associate Professor in the Department of Psychiatry and the College of Pharmacy at Dalhousie University, Halifax, Nova Scotia, and Harold Boudreau, BSc, a pharmacy student in the College of Pharmacy, Dalhousie University, developed two matching surveys for distribution to patients and general practitioners in an attempt to identify and compare the factors used by both groups in the selection of antidepressants.

The survey first asked participants to indicate the importance of each of 20 factors (see Figure 1) using a 5-point scale. The survey then required 12 factors to be ranked against one another according to importance. The survey was distributed to 193 consecutive patients at four separate practice sites in Nova Scotia and mailed to 247 randomly selected general practitioners. Survey response rates were 65% and 45% for patients and physicians, respectively.

FACTOR EVALUATION

The researchers found that mean scores concerning the importance of factors were significantly higher for 11 of the 20 factors in the patient group as opposed to the physician group. “This may indicate that patients were less capable of discerning differences in factor importance for choosing an antidepressant,” Dr. Gardner said. Only cost was scored significantly higher as influencing selection by the general practitioners, he noted.

For the second question, the ranking of importance of the factors differed between patients and physicians for six of 12 factors. “Common side effects” ranked first for both groups; beyond that, there was disagreement among the rankings of patients and physicians (see Figure 2). The researchers hope these findings will prove useful in constructing a decision-making tool for facilitating collaborative decisions regarding antidepressant therapy.

THE ANTIDEPRESSANT EXPERIENCE

Additionally, Dr. Gardner and colleagues reported on data comparing patients with antidepressant experience to those who were treatment naive. Patients in both subgroups scored all 20 selection factors similarly in the first question regarding importance of factors, with the same factors included in their top five and minor differences in order, Dr. Gardner said.

For the second question—degree of importance—distribution of ranks matched for all 12 differentiable factors, he added, noting that “the level of discordance remained substantial (five of 12) when comparing patients with and without antidepressant experience to general practitioner rankings.”

These findings suggest that “the factors important to treatment-naive patients in choosing an antidepressant tend to remain important with antidepressant experience, and that these factors are often attributed a different level of importance by general practitioners,” the researchers concluded.

—C. Justin Romano

Suggested Reading
Bultman DC, Svarstad BL. Effects of physician communication style on client medication beliefs and adherence with antidepressant treatment. Patient Educ Couns. 2000;40:173-185.
Hamann J, Leucht S, Kissling W. Shared decision making in psychiatry. Acta Psychiatr Scan. 2003;107:403-409.

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