Impact of the JIT-D clinic implementation on medication adherence among Major Depressive disorder outpatients in Maetha Hospital Lampang Province

Abstract

Background: Depression is an important psychiatric problem that is common both abroad and within the country. The patient's

non-compliance in taking medication is one of the problems affecting the treatment of depression. Maetha Hospital has an established outpatient care in its depression clinic, but determined that patients not adhering to their prescribed antidepressant medication are as high as 40%, resulting in patients that are unable to keep their symptoms in check and affecting their family as a consequence. Thusly, the importance of revamping the consultation processes of the original clinic became evident, this lead to the establishment of a pilot clinic called the JIT-D Clinic.

Objective: To study the impact of the JIT-D Clinic implementation on medication adherence among major depressive disorder outpatients and outcomes of their depression treatment in Maetha Hospital Lampang Province.

Methods: This study implemented a Pre-Post Intervention research methodology. The sample group comprised outpatients diagnosed with depression and receiving their health services at Maetha Hospital during December 2021 – May 2022, who were selected as a volunteer sample group to participate in the study. 156 patients from a total of 309 outpatients diagnosed with depression were enrolled into the study. Before involvement with the JIT-D Clinic, and a follow-up assessment at 6 weeks, the subjects were assessed the drug adherence using the medication adherence standard visual analog scale (VAS) and pill count, and a 9-question (9Q) for depression symptom assessment. The activity of JIT-D Clinic comprised a total of 4 relevant methodological activities: 1. Recommended pharmaceutical service activities. 2. Assessment of accuracy and cooperation in drug-use 3. Identifying problems in drug-use and discerning their solutions 4. Follow-up on adherence and any adverse reactions. Data were analyzed using descriptive statistics and compare the statistical differences by using paired -sample t-test with a statistical significance level of p-value<0.05.

RESULTS: This study found that after receiving services from the JIT-D Clinic, patients became cooperative in taking medication and treatment outcomes for depression significantly improved statistically. Whereby, the mean score of patient medication adherence using visual analog scale (VAS) before and after the pilot clinic implementation was 55.19±26.11 and 99.87±1.13 respectively (p< 0.001). While, the mean score using pill counting method was 58.83±28.60 and 99.95±0.45 respectively (p< 0.001). The mean score on treatment outcomes for depression was 8.21±2.18 and 4.62±1.22 respectively (p< 0.001).

Conclusion and recommendations: After participation in the JIT-D Clinic activities, the patients had a significant difference in cooperative behavior in medication adherence and improved outcomes in the treatment of depression. However, this study comprised only one study group and no comparison group; making it impossible to rule out interference from natural influences. Long-term follow-up and reassessment should be undertaken to monitor patient progress. As such, the model should be further developed as a counseling guideline for pharmacists to foster better cooperation in medication adherence in depressive patients, as well as find the feasibility in applying to other hospitals with similar patient problems.