Neil Jordan1, Todd A Lee2, Marcia Valenstein3, Paul A Pirraglia4, Kevin B Weiss5. 1. Center for Management of Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL. Electronic address: neil-jordan@northwestern.edu. 2. Center for Management of Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL. 3. Serious Mental Illness Treatment Research and Evaluation Center, VA Center for Practice Management & Outcomes Research, Ann Arbor VA Hospital, Ann Arbor, MI. 4. Providence VA Medical Center, Providence, RI. 5. Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Abstract
BACKGROUND: Although depression among COPD patients is a common problem with important consequences for the management of COPD and overall outcomes, the proportion of those who receive guideline-concordant depression care is low. Guideline-concordant depression care is associated with fewer depressive symptoms and lower risk for psychiatric hospitalization; however, it is unknown whether guideline-concordant depression care favorably impacts COPD-related outcomes for patients with both conditions. METHODS: This retrospective cohort study investigated 5,517 veterans with COPD who experienced a new treatment episode for depression. Guideline-concordant depression care was defined as having an adequate supply of antidepressant medication and sufficient follow-up care. Multivariate methods were used to examine the relationship between the receipt of guideline-concordant depression care and (1) COPD-related hospitalization and (2) all-cause mortality 2 years after the depression episode, while controlling for care setting and other covariates. RESULTS: There was no association between the receipt of guideline-concordant depression care and COPD-related hospitalization (odds ratio [OR], 0.98) or all-cause mortality (OR, 0.95). However, patients seen in mental health settings during their depressive episode had 30% lower odds of 2-year mortality than patients seen in primary care. CONCLUSIONS: For patients with COPD and depression, interacting with a mental health professional may be an important intervention. However, receiving guideline-concordant depression care, as outlined in common quality monitors, was not significantly associated with decreased hospitalization or mortality. These findings suggest that more referrals to specialty care or better care coordination with mental health specialty care may lead to a significant reduction in mortality risk for these patients.
BACKGROUND: Although depression among COPDpatients is a common problem with important consequences for the management of COPD and overall outcomes, the proportion of those who receive guideline-concordant depression care is low. Guideline-concordant depression care is associated with fewer depressive symptoms and lower risk for psychiatric hospitalization; however, it is unknown whether guideline-concordant depression care favorably impacts COPD-related outcomes for patients with both conditions. METHODS: This retrospective cohort study investigated 5,517 veterans with COPD who experienced a new treatment episode for depression. Guideline-concordant depression care was defined as having an adequate supply of antidepressant medication and sufficient follow-up care. Multivariate methods were used to examine the relationship between the receipt of guideline-concordant depression care and (1) COPD-related hospitalization and (2) all-cause mortality 2 years after the depression episode, while controlling for care setting and other covariates. RESULTS: There was no association between the receipt of guideline-concordant depression care and COPD-related hospitalization (odds ratio [OR], 0.98) or all-cause mortality (OR, 0.95). However, patients seen in mental health settings during their depressive episode had 30% lower odds of 2-year mortality than patients seen in primary care. CONCLUSIONS: For patients with COPD and depression, interacting with a mental health professional may be an important intervention. However, receiving guideline-concordant depression care, as outlined in common quality monitors, was not significantly associated with decreased hospitalization or mortality. These findings suggest that more referrals to specialty care or better care coordination with mental health specialty care may lead to a significant reduction in mortality risk for these patients.
Authors: Jennifer S Albrecht; Bilal Khokhar; Ting-Ying Huang; Yu-Jung Wei; Ilene Harris; Patience Moyo; Peter Hur; Susan W Lehmann; Giora Netzer; Linda Simoni-Wastila Journal: Respir Med Date: 2017-06-03 Impact factor: 3.415
Authors: Jingjing Qian; Linda Simoni-Wastila; Patricia Langenberg; Gail B Rattinger; Ilene H Zuckerman; Susan Lehmann; Michael Terrin Journal: J Am Geriatr Soc Date: 2013-04-25 Impact factor: 5.562
Authors: George S Alexopoulos; Jo Anne Sirey; Samprit Banerjee; Danielle S Jackson; Dimitris N Kiosses; Cristina Pollari; Richard S Novitch; Amanda Artis; Patrick J Raue Journal: Am J Geriatr Psychiatry Date: 2017-10-10 Impact factor: 4.105