Antidepressant Medication Management and Health Plan Employer Data Information Set (HEDIS) Criteria: Reasons for Nonadherence
J Clin Psychiatry 2002;63:727-732
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: While nationwide data
have found that many patients do not meet the
National Committee for Quality Assurance uniform
standards for successful antidepressant treatment, reasons for this failure are not well
understood. We examined the reasons for this failure
through a systematic chart review.
Method: A chart review was conducted on
a random sample of 249 health maintenance organization patients who failed 1 or more of the
3 Health Plan Employer Data Information Set criteria (i.e., 3 follow-up visits or adequate duration
of acute or continuation phase treatment).
Results: The most common reason for
visits failure (N=192) was that the patient restarted
a previously prescribed successful antidepressant (N=30, 16%). In 23 patients (12%), the
patient had a visit with the prescribing provider, but
mental health was not coded or documented in the case notes. Twenty-one percent (N=40)
were misclassified as not having 3 visits. The
most common reasons for misclassification were mental health was discussed but not coded
(N=16, 8%) and wrong start dates due to use of
medication samples (N=10, 5%). Patient
nonadherence was the most common reason for failure to
meet adequate acute (N=109) and continuation (N=99) phase duration of treatment (13%
and 24%, respectively); only 9% stopped taking
medication in the acute phase due to side effects. Twenty-five percent of patients had told
their doctor they were taking their medication
while the pharmacy database found they were not.
Conclusion: A large discrepancy between
patients' actual and reported compliance was found and may in part account for physicians'
inability to detect and thus address this issue.
Patients' restarting a previous medication is common
and warrants discussion regarding differential
need for visit frequency.