TY - JOUR
T1 - Adherence and healthcare utilization among older adults with COPD and depression
AU - Albrecht, Jennifer S.
AU - Khokhar, Bilal
AU - Huang, Ting Ying
AU - Wei, Yu Jung
AU - Harris, Ilene
AU - Moyo, Patience
AU - Hur, Peter
AU - Lehmann, Susan W.
AU - Netzer, Giora
AU - Simoni-Wastila, Linda
N1 - Funding Information:
This work was supported by National Institute on Aging grant R21AG045573-02. JSA was supported by Agency for Healthcare Research and Quality grant K01HS024560-01. BK was supported by National Institute on Aging grant T32AG000262-14.
Publisher Copyright:
© 2017 Elsevier Ltd
PY - 2017/8
Y1 - 2017/8
N2 - Background and objective Adherence to chronic obstructive pulmonary disease (COPD) maintenance medications and antidepressants may reduce healthcare utilization among multimorbid individuals with COPD and depression. We quantified the independent effects of adherence to antidepressants and COPD maintenance medications on healthcare utilization among individuals co-diagnosed with COPD and depression. Procedures We conducted a retrospective cohort study using a 2006–2012 5% random sample of Medicare beneficiaries co-diagnosed with COPD and depression who had two or more prescription fills of both COPD maintenance medications and antidepressants. We measured adherence to medications using the proportion of days covered per 30-day period. The primary outcomes were all-cause emergency department (ED) visits and hospitalizations. Beneficiaries were followed over a minimum 12-month follow-up period. Results Of the 16,075 beneficiaries meeting inclusion criteria, 21% achieved adherence ≥80% to COPD maintenance medications and 55% achieved adherence ≥80% to antidepressants. Compared to no use and controlling for antidepressant adherence and potential confounders, higher (≥80%) levels of adherence to COPD maintenance medications were associated with decreased risk of ED visits (hazard ratio (HR) 0.79; 95% CI 0.74, 0.83) and hospitalizations (HR 0.82; 95% CI 0.78, 0.87). Similarly, higher levels (≥80%) of adherence to antidepressants resulted in decreased risk of ED visits (HR 0.74; 95% CI 0.70, 0.78) and hospitalizations (HR 0.77; 95% CI 0.73, 0.81) compared to no use. Conclusions Clinicians can assist in the improved management of their multimorbid patients’ health by treating depression among patients with COPD and monitoring and encouraging adherence to the regimens they prescribe.
AB - Background and objective Adherence to chronic obstructive pulmonary disease (COPD) maintenance medications and antidepressants may reduce healthcare utilization among multimorbid individuals with COPD and depression. We quantified the independent effects of adherence to antidepressants and COPD maintenance medications on healthcare utilization among individuals co-diagnosed with COPD and depression. Procedures We conducted a retrospective cohort study using a 2006–2012 5% random sample of Medicare beneficiaries co-diagnosed with COPD and depression who had two or more prescription fills of both COPD maintenance medications and antidepressants. We measured adherence to medications using the proportion of days covered per 30-day period. The primary outcomes were all-cause emergency department (ED) visits and hospitalizations. Beneficiaries were followed over a minimum 12-month follow-up period. Results Of the 16,075 beneficiaries meeting inclusion criteria, 21% achieved adherence ≥80% to COPD maintenance medications and 55% achieved adherence ≥80% to antidepressants. Compared to no use and controlling for antidepressant adherence and potential confounders, higher (≥80%) levels of adherence to COPD maintenance medications were associated with decreased risk of ED visits (hazard ratio (HR) 0.79; 95% CI 0.74, 0.83) and hospitalizations (HR 0.82; 95% CI 0.78, 0.87). Similarly, higher levels (≥80%) of adherence to antidepressants resulted in decreased risk of ED visits (HR 0.74; 95% CI 0.70, 0.78) and hospitalizations (HR 0.77; 95% CI 0.73, 0.81) compared to no use. Conclusions Clinicians can assist in the improved management of their multimorbid patients’ health by treating depression among patients with COPD and monitoring and encouraging adherence to the regimens they prescribe.
KW - Chronic obstructive pulmonary disease
KW - Depression
KW - Healthcare utilization
KW - Medication adherence
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U2 - 10.1016/j.rmed.2017.06.002
DO - 10.1016/j.rmed.2017.06.002
M3 - Article
C2 - 28732836
AN - SCOPUS:85020403393
SN - 0954-6111
VL - 129
SP - 53
EP - 58
JO - Respiratory Medicine
JF - Respiratory Medicine
ER -