Depression Linked to Reduced COPD Medication Adherence

Bridget M. Kuehn

June 29, 2016

Adherence to medications for chronic obstructive pulmonary disease (COPD) falls after older adults receive a diagnosis of depression, according to a large study of Medicare beneficiaries.

Jennifer S. Albrecht, PhD, assistant professor, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, and colleagues report their findings in an article published online June 22 in the Annals of the American Thoracic Society.

"With a prevalence of 17 to 44 percent, depression remains one of the most common, yet least recognized and under-treated, co-morbidities among patients with COPD," coauthor Linda Simoni-Wastila, PhD, professor, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, said in an American Thoracic Society news release.

Previous studies have documented reduced medication adherence in individuals with chronic conditions, including COPD, who have comorbid depression, the authors write. This study strengthens the evidence by providing a longitudinal analysis of what happens to COPD medication adherence after a diagnosis of depression.

"Clinicians who treat older adults with COPD should be aware of the development of depression, especially during the first six months following COPD diagnosis, and monitor patients' adherence to prescribed COPD medications to ensure the best clinical outcomes," the authors note.

To assess the relationship between a new episode of depression and COPD medication adherence, the authors analyzed data from a random sample of 5% of Medicare claims between 2006 and 2012. They included 31,033 beneficiaries with COPD who filled their COPD prescriptions at least twice in the 24 months after diagnosis in their analysis. Of those patients, 20% received a diagnosis of depression within 24 months after a COPD diagnosis. The researchers excluded patients with a history of respiratory cancer, tuberculosis, asbestosis, or sarcoidosis because they may use different medication regimens than other patients with COPD.

Average monthly adherence to medications for COPD was low among all of the patients, peaking at 57% 1 month after the first prescription and dropping to 35% within 6 months. Only 20% of patients with depression and COPD fell into the highest adherence category during the 24-month follow-up period compared with 22% of patients with COPD who did not have depression.

After adjustment for potential confounders, a new depression episode was associated with lower odds of high adherence (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.89 - 0.98). Acute inhaler use (OR, 2.08; 95% CI, 2.02 - 2.15), supplemental oxygen use (OR, 1.43; 95% CI, 1.36 - 1.51), nursing home residence (OR, 1.20; 95% CI, 1.11 - 1.23), and low-income subsidy (OR, 1.31; 95% CI, 1.27 - 1.37) were linked to higher adherence to COPD maintenance medications.

The presence of comorbid conditions other than asthma also reduced COPD medication adherence in this population, the authors note, with those patients with three or more conditions having the highest risk for poor adherence. This suggests patients may prioritize filling certain medications or may struggle to maintain complex regimens, the researchers write.

"It is our long-term hope that this study will help policymakers, practitioners, and patients and their caregivers think of their health more holistically, and to consider how the presence of one treated or untreated medical condition may influence the progression and management of other medical conditions," Dr Simoni-Wastila said in the news release.

The study was funded by a grant from the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Ann Am Thorac Soc. Published online June 22, 2016. Abstract

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