Primary-care patients' trade-off preferences with regard to antidepressants.

Autor:	Wouters H; Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science,Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University,Utrecht,The Netherlands., Van Dijk L; NIVEL, Netherlands Institute for Health Services Research,Utrecht,The Netherlands., Van Geffen EC; Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science,Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University,Utrecht,The Netherlands., Gardarsdottir H; Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science,Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University,Utrecht,The Netherlands., Stiggelbout AM; Department of Medical Decision Making,Leiden University Medical Centre,Leiden,The Netherlands., Bouvy ML; Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science,Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University,Utrecht,The Netherlands.
Jazyk:	angličtina
Zdroj:	Psychological medicine [Psychol Med] 2014 Aug; Vol. 44 (11), pp. 2301-8. Date of Electronic Publication: 2014 Jan 07.
DOI:	10.1017/S0033291713003103
Abstrakt:	Background: Antidepressants are frequently prescribed but results regarding their efficacy have been equivocal for different spectra of the severity continuum and their side-effects are often burdensome. Non-adherence is a likely consequence. The objective was therefore to examine patients' trade-offs between the efficacy, side-effects and other drawbacks of antidepressants and whether these trade-offs predicted non-adherence. Method: Trade-offs from 225 antidepressant users, recruited through community pharmacies, were assessed with an Adaptive Conjoint Analysis (ACA) choice task that was customized to each individual patient. From the estimated utilities, relative importance scores of treatment properties were calculated. Non-adherence was measured through self-report and pharmacy refill data. Results: Relapse prevention and symptom relief were on average equally important. Side-effects were as important and the side-effect stomach and intestine complaints was on average even slightly more important than relapse prevention and symptom relief. Additional treatment with psychotherapy was preferred by 61% of the patients. A benefit/drawback ratio revealed that 18% of the patients did not consider the efficacy to outweigh the drawbacks. A higher benefit/drawback ratio was associated with a decreased odds of intentional non-adherence [odds ratio (OR) 0.2, 95% confidence interval (CI) 0.07-0.7, Wald = 6.7, p = 0.01). Conclusions: For nearly one in five patients, the efficacy of antidepressants does not outweigh their drawbacks. Knowing patients' trade-offs is likely to aid both physicians and patients to identify important treatment preferences, to improve adherence and to make more deliberate decisions on whether or not to continue treatment.
Databáze:	MEDLINE
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