Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

Therapietrouw onder depressieve ouderen in de eerste lijn; gevolg van gebrek aan tijd in de spreekkamer?

(2019) Galama, H. (Hiske)

Introduction The project “Consequences of polypharmacy and comorbidity on adherence of older depressed patients in general practice’1-3 shows a prevalence of depression among people over 55 years in the primary care setting of 13,7% in The Netherlands. Medication adherence of depressive elderly is not optimal. Considering different stages of adherence according to the ABC-model, adherence to antidepressants and cardiovascular medication is especially altered in the long term. In this study attention has been paid to interventions for adherence improvement at each stage of adherence according to the ABC-model. Goal of the project was to communicate project results to general practitioners, general practitioners trainees and pharmacists and discuss possible interventions for adherence. The ultimate goal is to improve the treatment and quality of life of depressed elderly in the primary care setting.
Methods Literature study focused on depressive elderly and interventions to improve adherence. In focus groups including general practitioners (n=7), general practitioners trainees (n=9) and pharmacists (n=2) daily experiences with depressive elderly and possible interventions for adherence were explored. Atlas.ti 8 was used to encode the data. Themes and subthemes were analysed.
Results All the respondents turned out to have experience with depressive elderly. Non-adherence appeared to be attributed to lack of time of the doctor or pharmacist, side-effects and declining cognition. For the different stages of adherence interventions were suggested. In the initiation phase shared decision making could be important. In the implementation phase there should be frequent attention for medication use, effect and side effects. In the continuation phase attention to adherence rates and more control appointments should be the main focus.
Conclusion From the literature as well as from the focus groups adherence of depressive elderly turned out as a complex problem for the future. Different phases of adherence need different interventions. For all phases more time for a consult, deployment of a practice assistant of the general practitioner who is specialized in older people, more tools for medication use and more simple information about medication and disease could improve adherence to antidepressants and cardiovascular medication in depressive elderly and could prevent relapse of depression and increasing risks of cardiovascular morbidity and mortality.

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