title: Medication and health care service utilization related to depressive symptoms in older adults with psoriasis.
abstract: OBJECTIVE
  This study examined the relationship between depressive symptoms and related medication adherence and health care costs in older adults (age > or = 65 years) with psoriasis.
  
  
  METHODS
  Prospective longitudinal cohort study over a 2-year post enrollment period in a population of older adults with psoriasis enrolled in managed care.
  
  
  METHODS
  A Medicare Health Maintenance Organization (HMO) in southeastern United States with prescription benefits.
  
  
  METHODS
  Sixty-three older adults with psoriasis using topical corticosteroids therapy and enrolled in a Medicare HMO for a 2-year continuous period.
  
  
  METHODS
  Upon enrollment, each enrollee was mailed a comprehensive health status assessment battery, which included the Center for Epidemiologic Studies Depression (CES-D) scale. Information on medication adherence (using medication possession ratio) and total health care utilization/costs following enrollment were retrieved from the Medicare HMO database.
  
  
  RESULTS
  Nearly one-fifth of the patient population had depressive symptoms. Patients with psoriasis who had depressive symptoms at the time of enrollment were less likely to be adherent to topical corticosteroid medication (r= -0.29, p<0.01) and less likely to utilize health care resources as evidenced by lower health care costs (r= -0.27, p<0.05), after confounder adjustment.
  
  
  CONCLUSIONS
  The prevalence of depressive symptoms in older adults with psoriasis is commonplace, with strong, yet unexplained correlations between presence of depressive symptoms and lower rates of medication and health care service use among these patients.
authors.affiliation: Division of Management, Policy, and Community Health, University of Texas School of Public Health, Houston, 77030, USA.
authors.forename: Amit S
authors.initials: AS
authors.lastname: Kulkarni
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
authors.forename: Fabian T
authors.initials: FT
authors.lastname: Camacho
authors.forename: Roger T
authors.initials: RT
authors.lastname: Anderson
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007641:Keratolytic Agents / Q000600:supply & distribution; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D006278:Medicare; D010349:Patient Compliance; D015995:Prevalence; D011446:Prospective Studies; D011565:Psoriasis / Q000191:economics / Q000473:pathology / Q000523:psychology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013781:Texas / Q000453:epidemiology
chemical_list: D007641:Keratolytic Agents