COPD Treatment in Older Adults with Depression

描述（由申请人提供）：大多数老年人患有多种慢性病（MCC）：三分之二的医疗保险受益人拥有两种或更多种MCC，十分之一患有6种或更多种MCC。因此，老年人每年使用7种或更多种独特的慢性药物。因此，药物依从性，“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，因为他们更多地暴露于多种疾病和药物治疗。不良的药物依从性与临床上重要且在很大程度上可预防的健康结果有关，包括急诊室就诊和住院、死亡率和医疗费用。这项研究为了解老年人中两种高度流行和昂贵的疾病的管理奠定了基础：慢性阻塞性肺疾病（COPD）和抑郁症。我们关注这两种慢性高度共病的疾病，因为它们的高患病率，高成本，以及它们对药物使用和依从性的反应。本研究的目的是进行研究，使我们了解抑郁症和COPD之间的周期性关系，以及治疗这些疾病的相对有效性，对老年COPD和抑郁症患者的重要预后。使用2006-2011年慢性病数据仓库（CCW）数据，一个全国代表性的医疗保险管理数据集的住院病人，门诊病人和药品索赔，我们采用新的边际结构建模技术的纵向分析文件。我们将讨论以下三个研究目的：目的1）测试共病抑郁症是否影响用于治疗COPD的必要维持药物的使用和依从性; 2）在患有COPD和抑郁症的医疗保险受益人中，测试抗抑郁药物的使用和依从性是否影响COPD必要维持药物的使用和依从性;和3）在患有COPD和抑郁症共病的医疗保险受益人中，测试抗抑郁药和/或COPD药物依从性是否降低了住院、医疗费用和死亡率。这项研究将在诊断为COPD和抑郁症的老年人队列中首次对抑郁症发病率和治疗依从性进行纵向和全国代表性估计，并提高我们对抑郁症治疗如何影响COPD维持药物使用和依从性以及COPD和抑郁症治疗如何共同影响重要患者结局的理解。本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局所需的知识，评估抑郁症治疗对重要患者相关结局的有效性，并证明可转移到Medicare和其他可用二级数据库中其他MCC组合的观察性研究的合理方法。

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.