Effect of information leaflets and counselling on antidepressant adherence: open randomised controlled trial in a psychiatric hospital in Kuwait

Objective To assess the acceptability and effectiveness of two educational initiatives on patterns of antidepressant medication use in depressed Kuwaiti patients. Setting Patients were interviewed on three occasions at the Psychological Medicine Hospital, Kuwait. Method Two-hundred and seventy-eight patients attending a hospital outpatient clinic in Kuwait and receiving a single antidepressant for mild or moderate depression were randomised into a control and two treatment groups. Medication was dispensed from the pharmacy as normal. However, members of the treatment groups additionally received a patient information leaflet (PIL) written in Arabic with or without counselling from a clinical pharmacist. Medication adherence was monitored 2 months and 5 months later by self-report and tablet counting. Patient knowledge of medication and the acceptability of the educational interventions were assessed after 2 months using questionnaires. Key findings Patients in each of the treatment groups had an improved knowledge of the rationale behind their therapy. Clinic attendance was more likely when patients had received a PIL (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.3-3.2) or a PIL plus counselling (OR 3.2, CI 2.14.9). Good medication adherence at 2 and 5 months was more common in patients who were given a PIL (OR 3.0, CI 1.7-5.3) or a PIL plus counselling (OR 5.5, CI 3.2-9.6). Certain pre-existing patient attitudes to therapy and the occurrence of side-effects were not determinants of adherence. Conclusions Patient responses to each of these educational interventions were very positive. After 5 months, patients receiving a PIL were more likely to be adhering to their medication regimen, particularly when they had also received counselling from a clinical pharmacist.