Effect of depression care on outcomes in COPD patients with depression.
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.
Jordan
Neil
N
Center for Management of Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL. Electronic address: neil-jordan@northwestern.edu.
Lee
Todd A
TA
Center for Management of Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL.
Valenstein
Marcia
M
Serious Mental Illness Treatment Research and Evaluation Center, VA Center for Practice Management & Outcomes Research, Ann Arbor VA Hospital, Ann Arbor, MI.
Pirraglia
Paul A
PA
Providence VA Medical Center, Providence, RI.
Weiss
Kevin B
KB
Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.
D000368:Aged; D002423:Cause of Death; D003863:Depression / Q000150:complications / Q000188:drug therapy*; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000523:psychology* / Q000628:therapy