Clinical depression affects more than 19 million Americans each year. Most depression cases in the United States are diagnosed by primary-care physicians with antidepressants being the most commonly prescribed treatment. The medications usually take six to eight weeks to have an effect, making it important for physicians to follow up with patients during the first three months to ensure that they are staying on the drugs and to check for the side effects that are more likely to occur early on in the treatment.

Richard Hansen, Phd Assistant Professor Division of Pharmaceutical Outcomes and Policy Research Interests Dr. Hansen's research focuses on health outcomes as a function of clinical intervention. He is especially interested in understanding real-world parameters (e.g., access, adherence, cost, patient preferences, and promotion) that influence treatment decisions and subsequent health outcomes.

That’s the way treatment with antidepressants is supposed to work, says Richard Hansen, PhD, an assistant professor at the UNC School of Pharmacy. However, he says, that is often not the case. For a variety of reasons, many patients fail to stay on their medicine long enough to see an effect.

“There’s evidence that about fifty percent of patients stop taking the drug by three months, and in most cases, the physician doesn’t know the patient has stopped taking it,” Hansen says. “It’s a really bad system for tracking patients, and untreated depression brings people into the hospital, decreases work time, and causes all kinds of family and social problems.”

Hansen says one reason for the lack of follow-ups is that depression is often a “straggler” in primary-care settings where more attention is given to physical conditions than to mental-health issues. Another reason is the limited time a primary-care doctor has with each patient.

“Primary-care physicians’ time with patients is very short: it’s patient after patient after patient,” Hansen says. “There is a poor system in place to actually flag the follow-up. So a physician may have the right intention in saying as the patient leaves, ‘Schedule an appointment and see me again in two weeks,’ but there is no system in place from that time if a patient doesn’t schedule an appointment or come back for that appointment.”

Hansen, who joined the School’s Division of Pharmaceutical Outcomes and Policy in 2003, is looking for ways to remedy the problem. His work is supported by a five-year Career Development Award from the National Institutes of Health, which he received in 2006.

One of the solutions he is working on is the creation of a system to intervene through community pharmacies.

“If community pharmacies can identify people that are taking an antidepressant and stop coming back, we can intervene by calling them and seeing what’s going on,” he says. “We can try to get them to either stay on the drug or find a better drug for them by working with their physicians or simply educate them about the fact that the drug may not work for the first few weeks and to just stay with it for a little while.”

Hansen is also developing a pilot-and-feasibility grant for an online system to help patients and doctors track adherence. Patients would be entered into the system when they receive a prescription. The system provides tools for patients to track their drug use, report problems, learn about the medication, and communicate with physicians.

“We are trying to improve the efficiency of monitoring patients and prevent people from stopping the drugs early,” Hansen says. “The Web-based monitoring system would be based on the patient interacting with the Web and the physician being alerted whenever the system detects that there are problems.”

Part of the challenge, he says, is finding ways to get patients to actually use the system.

“Not only is it hard enough to get your everyday patients to log on to a Web site to interact about their health, but now we are talking about depressed patients, who are probably not very motivated to act on their own behalf,” Hansen says. “So we are trying to use various gaming mechanisms to make this an interesting thing. We’ve played around with accumulating points every time you interact with the system or climbing to the top of the tower, things like that, some way to try to excite the patient.”

Click on the links below to read about Hansen's other research work.

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