Factors associated with adherence to glaucoma pharmacotherapy in the primary care setting

Abstract

Background.Primary open-angle glaucoma is a leading cause of irreversible blindness.Objectives.To identify factors associated with adherence to glaucoma pharmacotherapy in the primary care setting, focusing on physicians’ role.Methods.Patients were recruited from primary care clinics and telephone-interviewed using a structured questionnaire that addressed patient-, medication-, environment- and physicians-related factors. Patients’ data on pharmacy claims were retrieved to calculate the medication possession ratio for measuring adherence.Results.Seven hundred thirty-eight glaucoma patients were interviewed. The multivariate analysis identified eight variables that were associated independently with adherence. Barriers to adherence were found to be low income, believing that ‘It makes no difference to my vision whether I take the drops or not’ and relying on someone else for drop instillation (exp(B) = 1.91, P = 0.002; exp(B) = 2.61, P < 0.0001; exp(B) = 2.17, P = 0.001, respectively). Older age, having a glaucoma patient among close acquaintances, taking a higher number of drops per day, taking a prostaglandin drug and reporting that the ophthalmologist had discussed the importance of taking eye drops as prescribed, were found to promote adherence (exp(B) = 0.96, P < 0.0001; exp(B) = 0.54, P = 0.014; exp(B) = 0.81, P = 0.001; exp(B) = 0.37, P < 0.0001; exp(B) = 0.60, P = 0.034, respectively). No association was found between the patient’s relationship with the family physician and adherence to glaucoma treatment.Conclusion.Adherence to glaucoma pharmacotherapy is associated with patient-related, medication-related, physician-related and environmental factors. Ophthalmologists have a significant role in promoting adherence. However, the potential role of family physicians is unfulfilled and unrecognized.

The Maccabi Glaucoma Study

“…Moreover, duration of prescription was available for each purchase, obviating the need to approximate the expected refill date according to the various glaucoma eye drops and bottle volumes. 27 In conclusion, our findings support previous recommendations 12 to improve adherence among glaucoma patients, particularly among younger male patients and patients at earlier stages of the disease. This could be done by educational programs 28 to increase awareness, regular physician visits, and communicating with patients (or their caregivers) the importance of adherence for preventing glaucoma damage.…”

“…Similar to previous international studies, adherence with glaucoma therapy was particularly low among males, 18 patients under 70, 19,20 as well as individuals belonging to lower socioeconomic status. 12,20,21 In contrast, being seen by a female ophthalmologist, higher IOP at baseline, and a more aggressive type presentation of glaucoma (eg, exfoliation) were more likely to be adherent with therapy. Interestingly, patients who were treated mainly by glaucoma specialists have similar adherence to those who were treated by general ophthalmologists.…”

“…12 In this study, we aimed to objectively measure adherence with glaucoma therapy in a large and unselected patient population of Maccabi Healthcare Services (MHS) glaucoma patients, the second largest public health maintenance organization in Israel. Data were analyzed focusing on patient and physician characteristics to find factors that affect adherence and can be used later by the health system to improve adherence.…”

Adherence to treatment in patients with Behçet's disease

“…Age was not a cause of nonadherence in their patients. However, other studies showed that some demographic variables such as sex and marital status did not significantly influence medication adherence …”

Selective Laser Trabeculoplasty as a Replacement Therapy in Open Angle Glaucoma: A 3-Year Follow-Up Review

“…Hyperemia, pain, burning, and ocular discomfort are common causes of patient nonadherence [11]. On the other hand, patient-related, medicationrelated, physician-related and environmental, psychological and socioeconomical factors has been reported as important reasons for therapy adherence [12,13].…”