Effects of gender and depression on oral medication adherence in persons with type 2 diabetes mellitus.

BACKGROUND: In a range of chronic conditions including diabetes, it has been observed that depressive symptoms may be associated with nonadherence to medications. OBJECTIVE: The objective of the study was to determine the main effects, and interactive effect, of depression and gender on patients adherence to oral diabetes medications. METHODS: A cross-sectional design was employed, in which persons with type 2 diabetes mellitus completed a questionnaire regarding medication use behaviors, depressive symptoms (measured by the 8-item Patient Health Questionnaire [PHQ-8]), health beliefs, and demographics. A 2x2 factorial analysis of variance was used to determine the effects of gender and depression on medication adherence after adjusting for age, education, self efficacy, social support, and number of doses of diabetes medications. RESULTS: Of the 391 respondents who completed the questionnaire, 73 (18.7%) were categorized as having depression (ie, PHQ-8 score>0). Overall, women (n=196) had a mean (SD) score of 6.10 (6.19) on the PHQ-8, and men (n=195) had a lower score of 4.62 (5.28) (t=2.75; P<0.01). There was a significant main effect of depression, but not gender, on patients' adherence to diabetes medications in that those who were categorized as depressed had significantly worse adherence to diabetes medications (F=4.82; P=0.03). Additionally, there was a significant "gender x depression" interaction effect on adherence (F=5.93; P=0.01). Men with depression had mean adherence scores that indicated more nonadherence than did men without depression (9.44 [3.45] vs 7.47 [2.50], respectively), but adherence varied little between women with depression and women without depression (7.83 [2.69] vs 7.55 [2.58], respectively). CONCLUSIONS: The association between depression and medication adherence appears to be stronger in men than in women. Clinicians should be cognizant of the potential effect of depression on self-care for diabetes, particularly in men with depressive symptoms.

Impact of pharmacy care services on patients' perceptions of health care quality for diabetes.

OBJECTIVES: To (1) construct and evaluate a measure of patients' perceptions of the quality of diabetes care and (2) determine the impact of pharmacy care services (PCSs) on patients' perceptions of the quality of their diabetes care while controlling for patient-related factors. DESIGN: Two-phased study using a single-group, pretest-posttest design. SETTING: Community pharmacies that provided PCSs to diabetic patients as part of the Patient Self-Management Program for Diabetes in North Carolina, Georgia, Ohio, and Wisconsin. PARTICIPANTS: 218 patients with diabetes covered by self-insured employers' health plans. INTERVENTIONS: Pharmacist-provided care services using scheduled consultations, clinical goal setting, monitoring, and collaborative drug therapy management with physicians and referrals to diabetes educators. MAIN OUTCOMES MEASURES: Changes in patients' perceptions of quality measured by a self-administered questionnaire that included a six-item scale of information quality, a five-item scale of provider quality, and a one-item overall rating of care. RESULTS: The assessment of the baseline data (Phase I) demonstrated that the measures of perceived quality possessed acceptable psychometric properties. After PCSs were implemented (Phase II), the scores for the information scale improved significantly (paired t = 7.64, P < 0.01), as did the scores for the provider scale (paired t = 6.30, P < 0.01) and the overall rating (paired t = 5.54, P < 0.01). In multivariate analyses, the improvement in perceived quality was not explained by the change in glycosylated hemoglobin when controlling for age, gender, race/ethnicity, and baseline quality perceptions. CONCLUSION: PCSs enhanced patients' perceived quality of their diabetes care. The improvement in perceived quality was not explained by the change in glycemic control, which suggests that nonclinical factors in care are important to patients' evaluations of quality.