Albrecht Jennifer S, Khokhar Bilal, Huang Ting-Ying, Wei Yu-Jung, Harris Ilene, Moyo Patience, Hur Peter, Lehmann Susan W, Netzer Giora, Simoni-Wastila Linda
Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States.
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, United States.
Respir Med. 2017 Aug;129:53-58. doi: 10.1016/j.rmed.2017.06.002. Epub 2017 Jun 3.
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.
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.
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.
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.
坚持使用慢性阻塞性肺疾病（COPD）维持药物和抗抑郁药可能会降低同时患有COPD和抑郁症的多病个体的医疗保健利用率。我们量化了坚持使用抗抑郁药和COPD维持药物对同时诊断为COPD和抑郁症的个体医疗保健利用率的独立影响。
我们进行了一项回顾性队列研究，使用2006 - 2012年5%的医疗保险受益人的随机样本，这些受益人同时被诊断为COPD和抑郁症，并且有两种或更多的COPD维持药物和抗抑郁药的处方配药记录。我们使用每30天的覆盖天数比例来衡量药物依从性。主要结局是全因急诊科（ED）就诊和住院情况。对受益人进行了至少12个月的随访。
在符合纳入标准的16,075名受益人中，21%的人对COPD维持药物的依从性≥80%，55%的人对抗抑郁药的依从性≥80%。与不使用药物并控制抗抑郁药依从性和潜在混杂因素相比，较高（≥80%）水平的COPD维持药物依从性与ED就诊风险降低（风险比（HR）0.79；95%置信区间0.74，0.83）和住院风险降低（HR 0.82；95%置信区间0.78，0.87）相关。同样，与不使用药物相比，较高水平（≥80%）的抗抑郁药依从性导致ED就诊风险降低（HR 0.74；95%置信区间0.70，0.78）和住院风险降低（HR 0.77；95%置信区间0.73，0.81）。
临床医生可以通过治疗COPD患者的抑郁症以及监测和鼓励患者坚持他们所开的治疗方案，来帮助改善其多病患者的健康管理。
