Limitations of this study
Our findings are limited to primary care patients from 3 types of primary care settings—private offices, university-based clinics, and VA clinics. These findings may not generalize to other types of family practice or primary care settings such as large managed care organizations, publicly funded primary care settings, and so on.
Also, it’s important to note that we did not assess what physicians actually told patients; we only inquired about those messages that patients recalled. However, the information actually recalled seems more likely to influence their behavior.
In addition, because we did not perform direct observation of the physician-patient interaction, we were unable to control for other possible confounders. For example, physicians who communicate more effectively may have a positive effect on adherence through some other aspect of communication than the specific messages measured.11
Finally, we did not assess patient-related factors such as health literacy. Patients with low functional health literacy may have lower recall of information provided during the visit and may have lower levels of adherence.
Keeping our sights on patient education
Future studies are needed to assess patient’s literacy and record physicians’ actual communications and patients’ self-reports of such information in order to determine the impact of such factors. Nevertheless, our findings provide useful information about educational messages that physicians—as well as nurses—can provide to improve antidepressant adherence.
Acknowledgments
This research was supported by a grant from the National Institute of Mental Health (R01 MH60763) to Charlotte Brown, PhD. The authors thank the physicians and medical staff of Renaissance Family Practice, University of Pittsburgh–St. Margaret’s Family Practice Residency Program, and the Veteran’s Health Administration Primary Care Clinics for their assistance in the recruitment of study participants. Special thanks goes out to Sarah Stephenson, MSW, LSW, Nicole Ryan, BA, and Janine Smith, BS, for their technical assistance.
Correspondence
Charlotte Brown, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, Pa, 15213 brownc@upmc.edu