Poor COPD Medication Adherence Observed in Older Patients With Comorbid Depression

Patients with comorbid depression and chronic obstructive pulmonary disease (COPD) have low rates of adherence to their COPD management medications, resulting in higher risk of emergency department (ED) visits and hospitalizations.

In a study recently published in Respiratory Medicine, researchers examined rates of adherence to antidepressants and COPD maintenance medications among Medicare beneficiaries with both conditions.¹ They measured adherence by calculating the proportion of days covered per 30-day period, and looked for healthcare utilization outcomes of all-cause ED visits and hospitalizations.

Over 16,000 beneficiaries met the study criteria of having 2 or more prescription fills during a minimum 12-month follow-up period. Using a benchmark of 80% or greater to determine adherence, the researchers found that 21% of the sample were adherent to COPD maintenance medications, while 55% were adherent to antidepressants.

Better adherence was linked to lower health utilization. Controlling for antidepressant use and possible confounding variables, those who were adherent to COPD maintenance medications had lower risk of ED visits (hazard ratio [HR], 0.79) and hospitalizations (HR, 0.82). Likewise, being adherent to antidepressants was linked with decreased risk of ED visits (HR, 0.74) and hospitalizations (HR, 0.77).

According to the study authors, the findings indicate that unnecessary utilization of healthcare services could be prevented by a better understanding of how COPD and depression interact and influence medication regimens among older patients.

“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,” the researchers concluded.

Previously, some of the same authors had researched whether depression had any effect on adherence to COPD maintenance medications in a similar sample of Medicare beneficiaries. The findings of that study, published in the September 2016 issue of Annals of the American Thoracic Society, indicated that depression was in fact associated with lower adherence to COPD maintenance medications.²

“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,” the authors wrote.

References

1. Albrecht JS, Khokhar B, Huang TY, et al. Adherence and healthcare utilization among older adults with COPD and depression. Respir Med. In press. doi: 10.1016/j.rmed.2017.06.002.

2. Albrecht JS, Park Y, Hur P, et al. Adherence to maintenance medications among older adults with chronic obstructive pulmonary disease: the role of depression. Ann Am Thorac Soc. 2016;13(9):1497-1504. doi: 10.1513/AnnalsATS.201602-136OC.