Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

Ingebrigtsen, Truls Sylvan; Marott, Jacob Louis; Nordestgaard, Børge G.; Lange, Peter; Hallas, Jesper; Dahl, Morten; Vestbo, Jørgen

doi:10.1007/s11606-014-3029-0

Cited by 58 publications

(77 citation statements)

References 24 publications

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“…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). Among individuals who use COPD medications, adherence is low, which poses difficulties in medication management (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Original Researchsupporting

confidence: 83%

“…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). Among individuals who use COPD medications, adherence is low, which poses difficulties in medication management (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In this study, we found that only 22% of the sample achieved adherence of at least 80%, regardless of depression status.…”

Section: Original Researchmentioning

confidence: 99%

“…Maintenance medications, including inhaled corticosteroids, long-acting b-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)(6)(7). 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)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

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confidence: 99%

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

et al. 2016

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Rationale: Among individuals with chronic obstructive pulmonary disease (COPD), depression is one of the most common yet underrecognized and undertreated comorbidities. 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.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. Methods:We used a 5% random sample of Medicare administrative claims data to identify beneficiaries diagnosed with COPD between 2006 and 2010. 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. We searched for prescription fills for inhaled corticosteroids, long-acting b-agonists, and long-acting anticholinergics and calculated adherence starting at the first fill. We modeled adherence to COPD maintenance medications as a function of new episodes of depression, using generalized estimated equations.Measurements and Main Results: Our primary outcome was adherence to COPD maintenance medications, measured as proportion of days covered. The exposure measure was depression. Both COPD and depression were assessed using diagnostic codes in Part A and B data. Covariates included sociodemographics, as well as clinical markers, including comorbidities, COPD severity, and depression severity. Of 31,033 beneficiaries meeting inclusion criteria, 6,227 (20%) were diagnosed with depression after COPD diagnosis. 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. 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).Conclusions: New episodes of depression decreased adherence to maintenance medications used to manage COPD among older adults. 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.

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Section: Original Researchsupporting

confidence: 83%

Section: Original Researchmentioning

confidence: 99%

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confidence: 99%

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

et al. 2016

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“…14–21 Treatment of comorbid illness could impact adherence and outcomes among individuals with COPD; however, few studies have examined this question. Among Medicare beneficiaries diagnosed with both COPD and depression, antidepressant treatment was associated with reduced mortality; however, receipt of depression care was not associated with fewer COPD-related hospitalizations among a similarly diagnosed cohort of veterans.…”

Section: Introductionmentioning

confidence: 99%

Adherence and healthcare utilization among older adults with COPD and depression

Albrecht

Khokhar

Huang

et al. 2017

Respiratory Medicine

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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.

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“…I ngebrigsten, et al 1 conducted a population-based study of patients with chronic obstructive pulmonary disease (COPD) in Denmark. Participants (n=5,812) were stratified by COPD severity and maintenance respiratory medication use was examined for 1 year.…”

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confidence: 99%

Capsule Commentary on Ingebrigsten et al., Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

Shireman

2014

J GEN INTERN MED

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I ngebrigsten, et al. 1 conducted a population-based study of patients with chronic obstructive pulmonary disease (COPD) in Denmark. Participants (n=5,812) were stratified by COPD severity and maintenance respiratory medication use was examined for 1 year. Less than 10 % of the cohort used any maintenance respiratory medications and even among patients with more severe COPD, use of respiratory medications was less than 40 %. Exacerbating this problem was that even among those prescribed medications, adherence was low.These findings are not unique to suburban Copenhagen. A recent retrospective observational study of health insurance claims in the United States tracked patients after a COPD discharge and noted that only 56 % filled a prescription for a long-acting bronchodilator in the 180 days post-hospitalization, with higher filling rates in the first 90 days as compared to days 91-180. 2 This investigation provides a valuable perspective on the prevalence and management of one of the leading causes of death and morbidity in the world. True population-based epidemiological investigations are expensive as they require detailed clinical measurements of a large number of persons, yet they are essential for appropriate public health surveillance. The overall prevalence rate (∼10 %) is consistent with other reports. What is perhaps most startling is the low concordance with international practice guidelines for maintenance respiratory medications. Evidence-based practice guidelines are meant to ensure the appropriate use of resources to achieve maximal health outcomes; adherence to global initiative for chronic obstructive lung disease (GOLD) guidelines for respiratory medications have been associated with lower health costs. 3 Improvement will require direct patient engagement. A global patient study 4 documented the mismatch between patients' perceptions of COPD and the impact of the disease on their lives. Their delays to treatment for exacerbations and perhaps overconfidence in their ability to manage their disease likely also underlie poor long-term adherence to maintenance medications. Physicians and other health care professionals also must be mindful of their roles in appropriate diagnosis, management, and monitoring of these patients. Together, we have many opportunities to reduce the burden of COPD, locally, nationally, and internationally, as Ingebrigsten and colleagues have aptly demonstrated. Conflict of Interest:The author has no conflicts of interest with this manuscript.Corresponding Author: Theresa I. Shireman, PhD, RPh; University of Kansas School of Medicine, 3901 Rainbow Blvd., MSN 1008, Kansas City, KS 66160, USA (e-mail: tshireman@kumc.edu). REFERENCES1. Ingebrigsten TS, Marott JL, Nordestgaard BG, Lange P, Hallas J, et al.Low use and adherence to maintenance medication in chronic obstructive pulmonary disease in the general population. J Gen Intern Med.

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Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

Cited by 58 publications

References 24 publications

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

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

Adherence and healthcare utilization among older adults with COPD and depression

Capsule Commentary on Ingebrigsten et al., Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

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