Jingjing Qian

Association of chronic obstructive pulmonary disease maintenance medication adherence with all-cause hospitalization and spending in a Medicare population.

BACKGROUND Although maintenance medications are a cornerstone of chronic obstructive pulmonary disease (COPD) management, adherence remains suboptimal. Poor medication adherence is implicated in poor outcomes with other chronic conditions; however, little is understood regarding links between adherence and outcomes in COPD patients. OBJECTIVE This study investigates the association of COPD maintenance medication adherence with hospitalization and health care spending. METHODS Using the 2006 to 2007 Chronic Condition Warehouse administrative data, this retrospective cross-sectional study included 33,816 Medicare beneficiaries diagnosed with COPD who received at least 2 prescriptions for ≥1 COPD maintenance medications. After a 6-month baseline period (January 1, 2006 to June 30, 2006), beneficiaries were followed through to December 31, 2007 or death. Two medication adherence measures were assessed: medication continuity and proportion of days covered (PDC). PDC values ranged from 0 to 1 and were calculated as the number of days with any COPD maintenance medication divided by duration of therapy with these agents. The association of adherence with all-cause hospital events and Medicare spending were estimated using negative binomial and γ generalized linear models, respectively, adjusting for sociodemographics, Social Security disability insurance status, low-income subsidy status, comorbidities, and proxy measures of disease severity. RESULTS Improved adherence using both measures was significantly associated with reduced rate of all-cause hospitalization and lower Medicare spending. Patients who continued with their medications had lower hospitalization rates (relative rate [RR] = 0.88) and lower Medicare spending (-

Prevalence of depressive symptoms and predictors of treatment among U.S. adults from 2005 to 2010

3764), compared with patients who discontinued medications. Similarly, patients with PDC ≥0.80 exhibited lower hospitalization rates (RR = 0.90) and decreased spending (-

Effects of Depression Diagnosis and Antidepressant Treatment on Mortality in Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease

2185), compared with patients with PDC <0.80. CONCLUSIONS COPD patients with higher adherence to prescribed regimens experienced fewer hospitalizations and lower Medicare costs than those who exhibited lower adherence behaviors. Findings suggested the clinical and economic importance of medication adherence in the management of COPD patients in the Medicare population.

Association between depression and maintenance medication adherence among Medicare beneficiaries with chronic obstructive pulmonary disease

OBJECTIVES To determine nationally representative estimates of the prevalence of depressive symptoms and factors associated with treatment among those with moderate to severe symptoms. METHODS A cross-sectional, retrospective analysis of adults age≥18 years in the 2005-2010 National Health and Nutrition Examination Survey data who responded to the Patient Health Questionnaire (PHQ-9) was conducted (n=13,320). Depressive symptoms and severity were defined by PHQ-9 scores. Depression treatment was defined as either receiving antidepressants or seeing a mental health professional. Multivariable logistic regression analyses using population weights identified factors associated with having depressive symptoms and receipt of any treatment. RESULTS The prevalence of depressive symptoms increased from 20.92% to 25.66% over 6 years. Among patients with moderate to severe depression, 38.66% received treatment. Multivariable analyses found that being female, other Hispanic, younger age, having certain chronic comorbidities or previous hospitalization, no health insurance and in poverty status were associated with having depressive symptoms (P<.05). Among patients with moderate to severe depression, being female, white, younger age, having comorbidities (arthritis and hypertension) or previous hospitalization were associated with receipt of treatment (P<.05). CONCLUSIONS The prevalence of depressive symptoms is high, and only a small portion of patients with moderate to severe depression received treatments. Treatment disparities exist and need improvement.

Influence of prescription monitoring programs on analgesic utilization by an insured retiree population.

To estimate the effects of depression diagnosis and antidepressant treatment on 2‐year all‐cause mortality in Medicare beneficiaries with chronic obstructive pulmonary disease (COPD) and determine whether Social Security Disability Insurance (SSDI) eligibility modifies these relationships.

Association between Depression and Maintenance Medication Adherence among Medicare Beneficiaries with COPD

Depression is a significant comorbidity in patients with chronic obstructive pulmonary disease (COPD). Although comorbid depression is associated with low use and poor adherence to medications treating other chronic conditions, evidence of the relationship between depression and COPD management is limited. This study estimated the association between depression and COPD maintenance medication (MM) adherence among patients with COPD.

Associations of depression diagnosis and antidepressant treatment with mortality among young and disabled Medicare beneficiaries with COPD.

To estimate the association between prescription drug monitoring programs (PDMP) and the probability of analgesic use, overall and by analgesic type.

Cardiotoxicity in targeted therapy for breast cancer: A study of the FDA adverse event reporting system (FAERS).

Depression is a significant comorbidity in patients with chronic obstructive pulmonary disease (COPD). Although comorbid depression is associated with low use and poor adherence to medications treating other chronic conditions, evidence of the relationship between depression and COPD management is limited. This study estimated the association between depression and COPD maintenance medication (MM) adherence among patients with COPD.

Antidepressant Medication Use and Its Association With Cardiovascular Disease and All-Cause Mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study:

OBJECTIVE Depression is prevalent in chronic obstructive pulmonary disease (COPD) patients and a risk factor for COPD exacerbation and death. The objective of this study was to determine the associations of depression diagnosis and antidepressant treatment with mortality among Social Security Disability Insurance (SSDI)-eligible (age <65 years who had permanent physical or mental disabilities) Medicare beneficiaries with COPD. METHOD This retrospective cohort study used a 5% random sample of SSDI-eligible Medicare beneficiaries with COPD in stand-alone Part D plans during 2006-2008 (n=17,320). COPD and depression diagnoses were assessed during 2006. Evidence of antidepressant treatment was measured in 2006-2008. All-cause mortality was measured in 2007-2008. Cox proportional hazards models were used to examine the associations of depression diagnosis with mortality and, among depressed beneficiaries, antidepressant treatment (time dependent) with mortality after controlling for covariates. RESULTS More than one third (37.3%) of SSDI-eligible beneficiaries with COPD had a baseline depression diagnosis; of those, 86.8% had evidence of antidepressant treatment. Baseline depression diagnosis was an independent risk factor for 2-year mortality [hazard ratio (HR)=1.21; 99% confidence interval (CI)=1.07-1.37]. Among depressed beneficiaries, receiving antidepressant treatment was associated with significantly lower mortality (HR=0.55; 99% CI=0.44-0.68). CONCLUSION Proactive antidepressant treatment should be considered as an intervention to reduce mortality for this young and disabled Medicare population.

Comparison of Outcomes Following a Switch From a Brand to an Authorized Versus Independent Generic Drug

Purpose Cancer chemotherapy-induced cardiotoxicity is concerning. Certain anthracyclines and targeted therapies are known to have potential for cardiotoxicity, but existing trial evidence is inadequate to understand real-world patterns of cardiotoxicity with newer targeted therapies and their common combinations with older agents. This study evaluated chemotherapy-related cardiotoxicity reports for targeted therapies and their combinations in breast cancer patients. Methods The US Food and Drug Administration Adverse Event Reporting System (FAERS) database from January 2004 through September 2012 was used to summarize characteristics of reported cardiotoxicity events and their health outcomes. Disproportionality analyses with reporting odds ratios (ROR) and 95% confidence intervals (95% CI) were conducted to detect event signals using a case/non-case method for each targeted therapy and combination. Results A total of 59,739 cases of cardiotoxicity reports were identified; 937 cases identified targeted therapy as the suspect drug. Trastuzumab had the highest number of reports followed by bevacizumab and lapatinib. Proportions of reports of death and disability outcomes for each targeted therapy were approximately 20–25% of the total reports of serious events. Trastuzumab had the highest ROR as a single agent (ROR = 5.74; 95% CI = 5.29–6.23) or combination use of cyclophosphamide (ROR = 16.83; 95% CI = 13.32–21.26) or doxorubicin (ROR = 17.84; 95% CI = 13.77–23.11). Relatively low cardiotoxicity reporting rates were found with lapatinib, regardless of use with combination therapy. Conclusions Analysis of FAERS data identified signals for adverse cardiotoxicity events with targeted therapies and their combinations. Practitioners should consider factors that may increase the likelihood of cardiotoxicity when assessing treatment. Findings support continued surveillance, risk factor identification, and comparative studies.