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Factors Influencing Glaucoma Treatment Adherence

Published Online: June 21st 2012 US Ophthalmic Review, 2012;5(2):88-90 DOI: http://doi.org/10.17925/USOR.2012.05.02.88
Authors: Anand Mantravadi, Leslie Jay Katz
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Abstract:
Overview

Despite the availability of effective medical therapies, poor adherence to glaucoma medications is a significant challenge in the management of the disease. The basis for non-adherence is probably a complex interplay of many potential causes that can vary between different patient populations. Studies vary in the way adherence is measured, in the root causes of non-adherence, and in the possible ways to improve it. However, the overarching commonalities of these studies is the underlying reality that poor adherence is a major problem affecting the quality of glaucoma care. Awareness and detection of non-adherence by clinicians is also problematic. Adherence is often inaccurately thought of as a responsibility that rests entirely with the patient. However, identifying potential barriers to adherence, and implementing techniques and strategies to overcome these barriers, can begin to set the stage for improvement.

Keywords

Adherence, persistence, glaucoma, medications

Article:

In the treatment of any chronic disease, even the most effective medical therapies cannot achieve optimal success without patients’ co-operation with their prescribed regimens. Patient behaviors, outlooks, and circumstances that lead them to not take prescribed medications are still poorly understood. Such behaviors are probably the result of a complex interplay of many factors that are not easily generalized. What has been commonly referred to as patient compliance can be more accurately described as adherence—the degree to which a patient follows the instructions to take a prescribed treatment during a defined period of time.1 Persistence represents a measure of the time until the patient first discontinues a medication.1 Patient adherence and persistence represent a pervasive problem in the care of patients with glaucoma. Although glaucoma is a major cause of blindness worldwide, the typical course of the disease—a chronic process that is initially asymptomatic—appears to set the stage for suboptimal patient adherence and persistence. Patients with glaucoma are largely not reminded by the disease process itself of the importance of taking medications as prescribed. Indeed, in the care of patients with glaucoma, adherence and persistence rates are not as good as one would hope. And poor adherence to medications can lead to worsening disease.2,3 Moreover, ophthalmologists are not great detectors of non-adherence, with one large study finding that approximately one-fifth of patients had non-adherence undetectable by their physician.4,5 Thus, non-adherence represents a major obstacle in the effective treatment of this sight-threatening condition.

An emerging body of evidence examining factors that influence adherence is providing greater insight into the complexities surrounding why patients have difficulty with adhering to glaucoma therapy and why doctors are poor at detecting this. In this article, we review methods of measuring adherence and persistence, and discuss some of the predominant barriers to adherence and possible strategies to improve it.

Measuring Adherence and Persistence
How does one really know whether a patient is taking a medication as prescribed? Detection of adherence in the clinical setting most commonly uses patient self-reporting in some form or another. When determining adherence in larger cohorts, self-reporting through interviews or questionnaires is a simple method, but also one that has several weaknesses. Self-reports are affected by selection bias and recall bias, and will reflect only the patients who submit to them.2 Those who fail to attend follow-up appointments are excluded from such measurements.2

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Disclosure

The authors have no proprietary or commercial interests in the topic. Anand Mantravadi, MD, has served as a consultant for Glaukos Co and as a speaker for Allergan. Leslie Jay Katz, MD, has served as a consultant and/or speaker for Glaukos Co., Allergan, and Alcon.

Correspondence

Leslie Jay Katz, MD, Wills Eye Institute, 840 Walnut Street, Suite 1110, Philadelphia, PA 19107, US. E: LJayKatz@willseye.org

Received

2011-08-08T00:00:00

References

  1. Friedman D, Introduction: new insights on enhancing adherence to topical glaucoma medications, Ophthalmology, 2009;116(11 Suppl.):S29.
  2. Schwartz GF, Quigley HA, Adherence and persistence with glaucoma therapy, Surv Ophthalmol, 2008;53(Suppl. 1):S57–68.
  3. Stewart WC, Chorak RP, Hunt HH, et al., Factors associated with visual loss in patients with advanced glaucomatous changes in the optic nerve head, Am J Ophthalmol, 1993;116(2):176–81.
  4. Budenz DL, A clinician’s guide to the assessment and management of nonadherence in glaucoma, Ophthalmology, 2009;116(11 Suppl.):S43–7.
  5. Gelb L, Friedman DS, Quigley HA, et al., Physician beliefs and behaviors related to glaucoma treatment adherence, The Glaucoma Adherence and Persistency Study, J Glaucoma, 2008;17(8):690–8.
  6. Jampel HD, Schwartz GF, Robin AL, et al., Patient preferences for eye drop characteristics: a willingness-to-pay analysis, Arch Ophthalmol, 2003;121(2):540–6.
  7. Tsai JC, McClure CA, Ramos SE, et al., Compliance barriers in glaucoma: a systematic classification, J Glaucoma, 2003;12(5):393–8.
  8. Kass MA, Gordon M, Meltzer DW, Can ophthalmologists correctly identify patients defaulting from pilocarpine therapy? Am J Ophthalmol, 1986;101(5):524–30.
  9. Kass MA, Meltzer DW, Gordon M, et al., Compliance with topical pilocarpine treatment, Am J Ophthalmol, 1986;101(2):515–23.
  10. Friedman DS, Quigley HA, Gelb L, et al., Using pharmacy claims data to study adherence to glaucoma medications: methodology and findings of the Glaucoma Adherence and Persistency Study (GAPS), Invest Ophthalmol Vis Sci, 2007;48(11):5052–7.
  11. Friedman DS, Hahn SR, Gelb L, et al., Doctor–patient communication, health-related beliefs and adherence in glaucoma. Results from the Glaucoma Adherence and Persistency Study, Ophthalmology, 2008;115(8):1320–7.
  12. Tsai JC, A comprehensive perspective on patient adherence to topical glaucoma therapy, Ophthalmology, 2009;116(11 Suppl.):S30–6.
  13. Nordstrum BL, Friedman DS, Mozaffari E, et al., Persistence and adherence with topical glaucoma therapy, Am J Ophthalmol, 2005;140(4):598–606.
  14. Tsai, JC, Medication adherence in glaucoma: approaches for optimizing patient compliance, Curr Opin Ophthalmol, 2006;17(2):190–5.
  15. Feinstein AR, On white-coat effects and the electronic monitoring of compliance, Arch Intern Med, 1990;150(7):1377–8.
  16. Friedman DS, Hahn SR, Quigley HA, et al., Doctor–patient communication in glaucoma care: analysis of videotaped encounters in community-based office practice, Ophthalmology, 2009;116(12):2277–85.
  17. Hahn SR, Patient-centered communication to assess and enhance patient adherence to glaucoma medication, Ophthalmology, 2009;116(11 Suppl.):S37–42.
  18. Lin CT, Albertson GA et al., Is patients’ perception of time spent with the physician a determinant of ambulatory patient satisfaction?, Arch Int Med, 2001;161(11):1437–42.
  19. Osterberg L, Blaschke T, Adherence to medication, N Engl J Med, 1006;353(5):487–97.
  20. Kaplan SH, Greenfield S, Ware JE Jr, Assessing the effects of physician-patient interactions on the outcomes of chronic disease, Med Care, 1989 27(3 Suppl.):S110–27.
  21. George L Spaeth, MD, Wills Eye Institute, personal communication, Philadelphia, US, 2008.

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