Association between depression and maintenance medication adherence among Medicare beneficiaries with chronic obstructive pulmonary disease

Abstract

Objective Depression is a significant comorbidity in patients with chronic obstructive pulmonary disease (COPD). Although comorbid depression is associated with low use and poor adherence to medications treating other chronic conditions, evidence of the relationship between depression and COPD management is limited. This study estimated the association between depression and COPD maintenance medication (MM) adherence among patients with COPD. Methods This cross-sectional study used a 5% random sample of 2006–2007 Chronic Condition Warehouse data. Medicare beneficiaries enrolled in Parts A, B, and D plans with diagnosed COPD who survived through 2006 were included (n=74,863). COPD MM adherence was measured as medication discontinuation and Proportion of Days Covered (PDC). Depression was identified through ICD-9-CM diagnosis codes. Multivariable models with modified generalized estimating equations were used to estimate adjusted association between depression diagnosis and medication adherence, controlling for sociodemographics, comorbidities, and disease severity. Results Among the sample, about one-third (33.6%) had diagnosed depression. More than half (61.8%) of beneficiaries with COPD filled at least one COPD MM prescription. Depressed beneficiaries had a higher likelihood of using COPD MM than non-depressed beneficiaries (adjusted prevalence ratios (PR)=1.02; 95% confidence intervals (CI)=1.01, 1.03). Among COPD MM users, depressed beneficiaries were more likely to discontinue medications (PR=1.09; 95% CI=1.04, 1.14) and less likely to exhibit PDC≥0.80 (PR=0.89; 95% CI=0.86, 0.92) than non-depressed beneficiaries. Conclusions Depression is prevalent in Medicare beneficiaries with COPD and independently associated with lower COPD MM adherence. Interventions to improve medication adherence for COPD patients may consider management of comorbidities such as depression.

Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression

“…Our results suggest that individuals with more than three chronic conditions are at highest risk of poor adherence. This effect was mitigated by increased severity of COPD symptoms, evidenced by acute inhaler use, oxygen use, and COPD-related hospitalizations, and is consistent with a prior report (30). Historically, use of and adherence to COPD maintenance medications has been suboptimal, with many individuals with COPD not receiving any maintenance medications (14,15,17).…”

“…Qian and colleagues analyzed maintenance medication adherence, using a crosssectional study design, among Medicare beneficiaries with COPD and reported that individuals with depression were 11% less likely to have high adherence (30). Our study overcame the limitations of the crosssectional study design by examining the longitudinal association between depression and medication adherence, yet reported results consistent with those of the study by Qian and colleagues (9% less likely to have greater adherence).…”

“…Characteristics suggestive of COPD severity included supplemental oxygen use, COPD-related hospitalization (dichotomized at >1 COPD hospital days/mo), and monthly COPD-related emergency department visits (dichotomized at >1 emergency department visit/mo) (30,41,42). We searched carrier and durable medical equipment claims for the following preventive health services use measures: influenza vaccination, colorectal cancer screening, prostate cancer screening, and mammography and Papanicolaou smears (43).…”

“…Depression has been associated with decreased adherence to maintenance medications used in chronic conditions such as diabetes (28,29). 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). 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.…”

Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…Previous studies have linked psychological comorbidities with increased risk of mortality in patients with COPD, although data about readmissions are less definitive (38,41). Coventry and colleagues prospectively examined psychosocial risk factors, including depressive symptoms and social support, and readmissions in a small cohort of patients with COPD in the United Kingdom and found a modest correlation with readmission risk in 1 year (26).…”