SOP Students Take the Lead, Present at Annual Gerontology Meeting

Student-led teams are unraveling Medicare data to learn factors influencing whether patients with multiple medical conditions adhere to their medications, and are proposing methods for improvements.

By Steve Berberich
November 29, 2010

The youngest pharmacy researchers at the University of Maryland School of Pharmacy are working to help protect the oldest of the baby boomers.

Four of the freshest faces in pharmacy research today reported results of their innovative studies designed to help elderly patients deal with multiple medical conditions, stay on their medications, and out of the hospital.

The four students, each near or at the end of their graduate studies, are representing the School’s Department of Pharmaceutical Health Services Research (PHSR) and the Peter Lamy Center on Drug Therapy and Aging at the annual meeting of the Gerontological Society of America in New Orleans.

Using administrative records of Medicare patients, fifth-year PhD student Jingjing Qian said patients with chronic obstructive pulmonary disease [COPD] are less likely to use or continue to use antidepressant drugs. “To our knowledge, this study is among the first to use a population-based sample of older adults with depression diagnoses to examine the association of COPD with their use of antidepressants,” she said.

Physicians who collaborated with the study said they consider COPD to be more serious than the patients’ depression and tend to treat it first. “From this study, we suggest prescribers consider co-morbidities when treating patients with chronic diseases,” said Qian.

Doctoral student Jennifer Lloyd, MA, of the University of Maryland’s Doctoral Program in Gerontology, said that if Medicare provided drug cost incentives for patients with congestive heart failure (CHF), the program would potentially spend less on expensive hospitalizations for heart failure patients who consistently use recommended medications. “A significant proportion of these patients remain untreated,” said Lloyd, who found that higher adherence to most CHF medications was linked with lower Medicare spending over three years.

More than 5 million adults have heart failure in the United States and the incidence is increasing, said Sarah Dutcher, a PHSR graduate student. Her study of drug use patterns among Medicare beneficiaries with heart failure revealed that those with dementia get fewer medications for heart failure compared to those without dementia. However, those with heart failure and dementia who receive and adhere to drugs for heart failure benefit to the same extent as those who have heart failure but no dementia through a reduction in the number of hospitalizations.

And pharmacist H. Keri Yang, PhD, MPH, BSPharm, who is a postdoctoral fellow at the School, found that 12.4 percent of Medicare beneficiaries with depression also have dementia. Depressed beneficiaries with co-morbid dementia were significantly older, had more co-morbidities, and used more chronic disease medications than those without dementia. However, Medicare beneficiaries with co-morbid depression and dementia had higher risks of hospitalization and were less likely to use any antidepressant and for a shorter duration than non-demented beneficiaries.

Ilene Zuckerman, PharmD, PhD, professor and chairperson of PHSR said, “This [GSA] is a major conference bringing together many different disciplines. We wanted to highlight our students and focus on their work on medical adherence. They worked together on the four studies and each is first author on a paper or poster they are presenting. ” The four young researchers are fully aware, she said, that they are at the forefront of an expanding research field in determining methods to solve highly complicated drug adherence problems of an expanding baby boom generation of elderly, most of which have or will have more than one chronic medical condition.

Gail Rattinger, PharmD, PhD, research assistant professor in PHSR and co-author, noted that much of the research in the field is “from the 30,000-foot level first. We look for patterns to adherence and medical outcomes and eventually we hope to design interventions to improve medical outcomes.”

Yang reflected on her study, “Unlike physical ailments, dementia patients may be unable to express their depression. I am concerned about the vulnerability of these patients. Our research is trying to bring more awareness among health care providers.”

Yang was a pharmacist in Taiwan prior to being admitted to the PHSR graduate program in the School of Pharmacy and has always been interested in how the prescriptions she was filling met the medical outcomes of the patients. Of her current postdoctoral studies, she added, “My pharmacy background allows me to pursue clinically relevant research questions that can help improve health outcomes for patients.”

Dutcher said her focus is on finding new methods that can apply to a number of combinations of medical conditions. “There is not a disease that I am not interested in measuring adherence and outcomes. What has surprised me is learning how complicated they can get and that is why they are challenging.”

Lloyd, who worked for the Lamy Center before being admitted to the gerontology program, said, “This is a growing field. I am very interested in this because you can study the entire lifespan of patients as it pertains to their health and well-being.” She wants to continue to apply such work to helping caregivers of the elderly, “to find ways to make their life easier because it can be terribly stressful.”

Zuckerman said the four students “are representative of the high goals of our students working in cooperation with their faculty advisors. Part of the successful outcomes of therapy is that people adhere to their prescriptions, so this work being presented by our students is important.”

Linda Simoni-Wastila, RPh, PhD, a professor in PHSR and student advisor, said, “One reason for these students’ successes was the close teamwork in thinking through the important clinical and policy questions, designing the analysis, and interpreting the findings. ”