COPD Treatment in Older Adults with Depression

描述(申请人提供)：大多数老年人患有多发性慢性病(MCC)：三分之二的医疗保险受益人患有两种或两种以上MCC，十分之一的人患有六种或更多MCC。因此，老年人每年使用7种或更多独特的慢性药物。因此，服药依从性，即一个人的行为与医疗或健康建议相一致的程度，在患有MCC的老年人中变得特别成问题，因为他们更容易接触多种疾病和药物治疗。服药依从性差与临床上重要且基本上可以预防的健康后果有关，包括急诊科就诊和住院、死亡率和医疗费用。这项研究奠定了理解两种在老年人中高度流行和代价高昂的疾病的管理所需的基础：慢性阻塞性肺疾病(COPD)和抑郁症。我们将重点放在这两种慢性、高度并存的疾病上，因为它们的患病率高、费用高，以及它们对药物使用和依从性的反应。这项研究的目的是进行研究，让我们了解抑郁症和COPD之间的循环关系-以及治疗这些疾病的比较有效性-对患有COPD和抑郁症的老年人的重要患者结局。使用2006-2011年慢性疾病数据仓库(CCW)数据，这是一个具有全国代表性的住院、门诊和药物索赔的医疗保险管理数据集，我们将新的边缘结构建模技术应用于纵向分析文件。我们将致力于以下三个研究目标：目的1)测试并发抑郁是否影响用于治疗COPD的必要的维持药物的使用和坚持；2)在患有COPD和抑郁症的联邦医疗保险受益人中，测试抗抑郁药物的使用和坚持是否影响COPD的必要维持药物的使用和坚持；以及3)在患有COPD并同时患有抑郁症的联邦医疗保险受益人中，测试抗抑郁药物和/或COPD药物的坚持是否减少住院、医疗成本和死亡率。这项研究将首次对被诊断为COPD和抑郁症的老年人队列中的抑郁症发病率和治疗依从性进行纵向和具有全国代表性的估计，并加深我们对抑郁症治疗如何影响COPD维持用药和依从性，以及COPD和抑郁症治疗如何共同影响重要患者结局的理解。这项研究的预期结果是多方面的，包括提供减少可预防的不良结果所需的知识，评估抑郁症治疗对与患者相关的重要结果的有效性，并展示可转移到Medicare和其他可用的二级数据库中的其他MCC组合的观察性研究的可靠的方法学方法。

DESCRIPTION (provided by applicant): The majority of older adults suffer multiple chronic conditions (MCCs): two-thirds of Medicare beneficiaries possess two or more MCCs, and 1 in 10 suffer 6 or more MCCs. As a result, older adults utilize 7 or more unique chronic medications annually. Thus, medication adherence, "the extent to which a person's behavior coincides with medical or health advice", becomes particularly problematic in older adults with MCCs due to their greater exposure to multiple diseases and pharmacologic treatments. Poor medication adherence is implicated in clinically important and largely preventable health outcomes, including emergency department visits and hospitalizations, mortality, and medical costs. This study establishes the foundation needed to understand the management of two highly prevalent and costly conditions in older adults: chronic obstructive pulmonary disease (COPD) and depression. We focus on these two chronic, highly comorbid conditions because of their high prevalence, high costs, and their responsiveness to pharmacologic medication use and adherence. The objective of this study is to conduct research that informs our understanding of the cyclical relationships between depression and COPD-and the comparative effectiveness of treating each of these conditions-on important patient outcomes in older adults with COPD and depression. Using 2006-2011 Chronic Condition Data Warehouse (CCW) data, a nationally-representative Medicare administrative dataset of inpatient, outpatient, and pharmaceutical claims, we apply novel marginal structural modeling techniques to longitudinal analytic files. We will address the following three study aims: Aim 1) Test whether comorbid depression influences use of and adherence to necessary maintenance medications used to treat COPD; 2) Among Medicare beneficiaries with COPD and depression, test whether use of and adherence to antidepressant medications influences use of and adherence to necessary maintenance medications for COPD; and 3) Among Medicare beneficiaries with COPD and comorbid depression treated for depression, test whether antidepressant and/or COPD medication adherence reduces hospitalization, medical costs, and mortality. This study will produce the first longitudinal and nationally-representative estimates of depression incidence and treatment adherence in an older adult cohort diagnosed with COPD and depression, as well as improve our understanding of how depression treatment influences COPD maintenance medication use and adherence, and how COPD and depression treatment jointly influence important patient outcomes. The expected outcomes of this research are multiple, and include providing the knowledge needed to reduce preventable adverse outcomes, evaluate the effectiveness of depression treatment on important patient-relevant outcomes, and to demonstrate a sound methodological approach transferable to observational studies of other MCC combinations in Medicare and other available secondary databases.