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Adults With Diabetes And Limited Health Literacy Less Likely To Adhere To Prescribed Antidepressants

OAKLAND, Calif., March 25, 2013 /PRNewswire/ -- Adult patients with diabetes who don't understand basic health information are significantly less likely to take newly prescribed antidepressant medication, according to a new Kaiser Permanente study in The Journal of General Internal Medicine.

In this study conducted by the Kaiser Permanente Division of Research and the University of Washington School of Medicine, 72 percent of the 1,366 study participants had limited health literacy and had significantly poorer adherence to newly prescribed antidepressants, compared to patients with no limitations.

"Research shows that those with health literacy limitations are more likely to have poor control of their chronic medical conditions such as diabetes, congestive heart failure and HIV," said Andrew Karter, PhD, research scientist at Kaiser Permanente and senior author on the study. "However, this is the first study to examine the association between health literacy and antidepressant adherence among patients with diabetes. This type of research gives our health care systems important feedback because, as providers, we often remain unsure whether the critical health information we convey to our patients is fully understood."

The Institute of Medicine defines health literacy as the capacity for patients to "obtain, process, and understand basic health information and services needed to make appropriate health decisions." Because nearly 90 percent of Americans have some difficulty using routine health information, the U.S. Surgeon General has identified the improvement of health literacy as a national priority.

Adequate adherence for antidepressants is particularly important for patients with diabetes and other chronic medical conditions.  Depression occurs twice as frequently among adults with diabetes compared to adults without diabetes and has been associated with an increased risk of the serious diabetic complications, dementia and mortality.

In the study, health literacy was based on a self-reported scale in which participants with type 2 diabetes responded to three questions:
  • How often do you have problems learning about your medical condition because of difficulty understanding written information?
  • How confident are you filling out medical forms by yourself?
  • How often do you have someone like a family member, friend, hospital or clinic worker or caregiver, help you read health plan materials?

The study examined medication nonadherence during the 12 months after the initial antidepressant prescription, and researchers found that many patients failed to adhere to their treatment. Although most patients filled the prescription at least once, 43 percent failed to fill the prescription a second time, and nearly two-thirds had discontinued the antidepressant by the end of the 12-month period.

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