title: Depressive symptomatology, medication persistence, and associated healthcare costs in older adults with glaucoma.
abstract: OBJECTIVE
  Depressive symptoms may impact patients' medication use behavior and utilization of healthcare services. This study examined association between depressive symptoms and Glaucoma medication-related persistence and predictors of associated healthcare charges in older adults with primary open angle Glaucoma.
  
  
  METHODS
  This study used a retrospective cohort of older adults with primary open angle Glaucoma who completed health status assessment, used Glaucoma medications, and were enrolled in a Medicare Health Maintenance Organization. Baseline assessment surveyed patients on demographics, healthcare service utilization in year before enrollment, lifestyle, and quality of life. Demographic, clinical, and utilization-related economic variables were retrieved from administrative claims database of patients' Health Maintenance Organization. Survival techniques were used to measure time to discontinuation (persistence) and Center for Epidemiologic Studies Depression Scale a 20-item self-reporting scale assessed depressive symptomatology on a range of 0 to 60. Associations were examined using mixed-model regression approach. Sensitivity analysis that considered log-transformed and untransformed specifications of cost variable tested model appropriateness.
  
  
  RESULTS
  In total 268 patients were followed for 2 years (N=536). After controlling for potential confounders and temporal effects, depressive symptomatology was associated with decreased Glaucoma medication-related persistence (P<0.005). Patients who lived alone and had cardiovascular disease showed higher odds of experiencing depressive symptoms (P<0.005). Healthcare charges increased with number of comorbidities and prescriptions (P<0.005).
  
  
  CONCLUSIONS
  Presence of depressive symptoms in patients lead to poor Glaucoma medication use behavior. Healthcare expenditures increased for patients with increase in comorbidities. Plan enrollees' risk assessment offers advantage of improving health outcomes and reduces healthcare utilization.
authors.affiliation: Department of Pharmacy Practice and Administration, Ohio State University, Columbus, OH 43210, USA.
authors.forename: Sujata S
authors.initials: SS
authors.lastname: Jayawant
authors.forename: Monali J
authors.initials: MJ
authors.lastname: Bhosle
authors.forename: Roger T
authors.initials: RT
authors.lastname: Anderson
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D003866:Depressive Disorder / Q000150:complications*; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000191:economics*; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents