Patient satisfaction with the quality of care received is associated with adherence to antidepressant medications

Abstract

Background: There is a paucity of evidence on the association between satisfaction with quality of care and adherence to antidepressants.

Objectives: To examine the association between patient satisfaction with healthcare and adherence to antidepressants.

Methods: A cohort study design was used to identify antidepressant users from the 2010-2016Medical Expenditure Panel Survey data, a national longitudinal complex survey study design on the cost and healthcare utilization of the noninstitutionalized population in the United States. The Consumer Assessment of Healthcare Providers and Systems were used to measure participants' satisfaction with access and quality of care, patient-provider communication and shared decision-making (SDM). Patients were considered satisfied if they ranked the quality of care at ≥9 (range: 0[worst]- 10[best]). Antidepressant adherence was measured based on medication refill and complete discontinuation. MEPS sampling survey-weighted multivariable-adjusted logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between satisfaction and adherence to antidepressants. We tested for the potential presence of reverse associations by restricting the analysis to new users of antidepressants. The roles of patient-provider communication and SDM on the satisfaction-adherence association were examined through structural equation models (SEM).

Results: Among 4,990 (weighted counts = 8,661,953) antidepressant users, 36% were adherent while 39% discontinued antidepressants therapy. Half of antidepressant users were satisfied with the healthcare received. Satisfied patients were 26% (OR = 1.26, 95%CI: 1.08, 1.47) more likely to adhere and 17% (OR = 0.83, 95%CI: 0.71, 0.96) less likely to discontinue, compared to unsatisfied antidepressant users. Patient satisfaction was also associated with higher odds (OR = 1.41, 95%CI: 1.06, 1.88) of adherence among a subgroup of new users of antidepressants. The SEM analysis revealed that satisfaction was a manifestation of patient-provider communication (β = 2.03, P-value<0.001) and SDM (β = 1.14, P-value<0.001).

Conclusions: Patient satisfaction is a potential predictor of antidepressant adherence. If our findings are confirmed through intervention studies, improving patient-provider communication and SDM could likely drive both patient satisfaction and adherence to antidepressants.

Fig 1. Directed acyclic graph (DAG).

We theorize that patient satisfaction with healthcare quality is a manifestation of patients’ interactions with providers and the healthcare system within which they receive healthcare. The direct path from patient satisfaction to antidepressant adherence/discontinuation was quantified, all other relationships (dashed arrows) were accounted for in the analysis as covariates. Potential reverse association is represented as a feedback loop from patient perceptions of the effectiveness of antidepressant to depression-related factors (red dashed line).

Fig 2. Study design.

In this illustration, data collected from rounds 1–3 in 2015 are used to define patient ratings of providers, patient-provider relationships, access to care, and all covariates. The 2016 survey data are used to define medication refill adherence (MRA) based on the days’ supply of filled drugs.

Fig 3. A structural equation model.

The role of patient-provider communication and shared decision-making on patient satisfaction with care and adherence to antidepressants are depicted in this figure. The patient-clinician communication construct was created from participant responses (never, sometimes, usually, always) to the questions: how often the care provider (1) listen carefully to the patient. (2) explain to the patient. (3) show respect to the patient. (4) spend enough time with the patient? The SDM construct was defined from the four CAHPS items described above plus three additional questions about patients’ satisfaction with their usual source of care provider: Does the usual source of care provider (1) usually ask about and show respect for medical, traditional, and alternative treatments that the person is happy with (never/sometimes/usually/always)?. (2) ask the person to help make decisions between a choice of treatments (never/sometimes/usually/always). (3) usually ask about prescription medications and treatments other doctors may give them (yes/no)?