The objective of this study was to assess the impact of depression on COPD maintenance medication adherence among a nationally representative sample of Medicare beneficiaries newly diagnosed with COPD. Few studies have assessed the association between depression and adherence to COPD medications, and these were limited by a cross-sectional study design ( 30, 31). Depression has been associated with decreased adherence to maintenance medications used in chronic conditions such as diabetes ( 28, 29). Nonetheless, use of and adherence to COPD maintenance medications remain low, ranging from 29 to 56%, and contribute to increased hospitalization, health care costs, and mortality ( 8– 20).Īmong patients with COPD, depression remains one of the most common, yet least recognized and undertreated, comorbidities, with a prevalence of 17–44% ( 21– 27). Maintenance medications, including inhaled corticosteroids, long-acting β-agonists, and long-acting anticholinergics, have been shown to reduce exacerbations and improve lung function and health-related quality of life among patients with moderate to severe disease ( 5– 7). In 2010, medical costs of COPD in the United States were estimated at $36 billion and projected to reach $49 billion by 2020 ( 4).Ĭlinicians select pharmacologic strategies used for the management of COPD based on COPD severity to reduce symptoms and prevent COPD exacerbations ( 1). Although smoking is the most common risk factor for the development of COPD in the United States, environmental exposures and genetics also play a role ( 1, 3). COPD is a leading cause of morbidity and mortality worldwide, and the third leading cause of death in the United States ( 1, 2). Clinicians who treat older adults with COPD should be aware of the development of depression, especially during the first 6 months after COPD diagnosis, and monitor patients’ adherence to prescribed COPD medications to ensure best clinical outcomes.Ĭhronic obstructive pulmonary disease (COPD) is a chronic lower respiratory disease characterized by obstruction of airflow. In our adjusted regression model, depression was associated with decreased adherence to COPD maintenance medications (odds ratio, 0.93 95% confidence interval, 0.89–0.98).Ĭonclusions: New episodes of depression decreased adherence to maintenance medications used to manage COPD among older adults. Average monthly adherence to COPD maintenance medications was low, peaking at 57% in the month after first fill and decreasing to 35% within 6 months. Of 31,033 beneficiaries meeting inclusion criteria, 6,227 (20%) were diagnosed with depression after COPD diagnosis. Covariates included sociodemographics, as well as clinical markers, including comorbidities, COPD severity, and depression severity. Both COPD and depression were assessed using diagnostic codes in Part A and B data. Measurements and Main Results: Our primary outcome was adherence to COPD maintenance medications, measured as proportion of days covered. We modeled adherence to COPD maintenance medications as a function of new episodes of depression, using generalized estimated equations. We searched for prescription fills for inhaled corticosteroids, long-acting β-agonists, and long-acting anticholinergics and calculated adherence starting at the first fill.
We included beneficiaries with 2 years of continuous Medicare Parts A, B, and D coverage and at least two prescription fills for COPD maintenance medications after COPD diagnosis. Methods: We used a 5% random sample of Medicare administrative claims data to identify beneficiaries diagnosed with COPD between 20. Objectives: The objective of this study was to assess the impact of depression on COPD maintenance medication adherence among a nationally representative sample of Medicare beneficiaries newly diagnosed with COPD. Although depression has been associated with reduced adherence to maintenance medications used in other conditions, such as diabetes, little research has assessed the role of depression in COPD medication use and adherence. Rationale: Among individuals with chronic obstructive pulmonary disease (COPD), depression is one of the most common yet underrecognized and undertreated comorbidities.
0 kommentar(er)
