FROM THE ANNALS OF THE AMERICAN THORACIC SOCIETY
Chronic obstructive pulmonary disease (COPD) patients with depression are less likely to take their maintenance medications, according to a review of Medicare claims by the University of Maryland, Baltimore.
“Clinicians who treat older adults newly diagnosed with COPD should be aware of the development of depression, especially during the first 6 months. As such, clinicians should consider the need to monitor their patients with COPD for … depression [treatment], as well as use of and adherence to prescribed COPD medications. Close management of these and other aspects of newly diagnosed older adults with COPD will help to ensure optimal clinical outcomes,” said the investigators, led by Jennifer Albrecht, PhD, of the department of epidemiology and public health at the University of Maryland.
Depression is common but underrecognized in COPD, with a prevalence of 17%–44%. Depression is also well known to decrease drug adherence in diabetes and other chronic conditions, but few studies have analyzed its effect on drug adherence in COPD (Ann Am Thorac Soc. 2016 Sep;13[9]:1497-504. doi: 10.1513/AnnalsATS.201602-136OC).
The researchers ran a random sampling of Medicare data and identified 31,033 beneficiaries diagnosed with COPD between 2006 and 2010; 6,227 patients (20% of the study sample) were diagnosed with depression within 2 years of being diagnosed with COPD.
The investigators found that depression reduced the likelihood of chronic obstructive pulmonary disease patients filling their prescriptions. Maintenance medication adherence was low overall, peaking at 57% in the month after the first fill and decreasing every month for the next 9 months for both the patients with depression and those patients who had not been diagnosed with the condition. Depression made things worse; 20% of depressed patients filled 80% or more of their medications at the pharmacy, vs. 22% of nondepressed patients. Patients with newly diagnosed depression were about 7% less likely to have good adherence (odds ratio, 0.93; 95% confidence interval, 0.89-0.98). Women – 65% of the study sample and 75% of those with depression – were less likely than men to fill their scripts.
Meanwhile, adherence to COPD maintenance medication was more likely among patients on short-term inhalers and supplemental oxygen, as well as among nursing home patients and those with low-income subsidies.
Patients were 83% white. Those diagnosed with depression were slightly younger on average than those who were not (67 vs. 69 years old) and were more likely to have more than three comorbid conditions (33% vs. 23%). With the exception of asthma, comorbid conditions made adherence worse. Depressed patients also had more severe COPD symptoms, based on their higher rates of oxygen use (10% vs. 8%).
Dr. Albrecht reported receiving grants from the National Institutes of Health during the conduct of the study.
