An estimated 44% of individuals with major depressive disorder (MDD) stop using their medications within three months of initiation, and 50% discontinue by the end of the first year. Untreated depression results in costly hospitalizations and ER visits, and poor psychiatric and medical outcomes, including suicide attempts and even deaths. Community pharmacists are accessible yet underutilized members of the healthcare team who can help explore reasons for non-adherence and intervene to resolve adherence barriers. Community pharmacy–based adherence interventions historically are fixed approaches to delivering one type of intervention, and do not consider patient preferences and, therefore, lack sustainability in adherence improvement.
Research is greatly needed to determine how pharmacy-based tailoring of an adherence intervention program to fit patient needs and preferences can affect outcomes. Through group meetings and phone interviews, we will collect different perspectives (from patients with MDD, pharmacists, and prescribers) on the content and process of tailoring adherence intervention options, as well as how they can best be implemented to be of the greatest benefit to stakeholders. An advisory panel of patients and other stakeholders across the region will further inform project development. Our overall objective is to move toward creating a comparative effectiveness trial in New England, examining across multiple patient outcomes the value, over a standardized intervention approach, of community pharmacists tailoring adherence intervention options. Adherence is an issue in other chronic illnesses besides MDD (diabetes, hypertension, etc.). Our paradigm of tailoring adherence intervention delivery will be applicable in public health across many disease domains.