Patient and Provider Perspectives on Glaucoma Treatment Adherence: A Delphi Study in Urban Alabama

Poleon, Shervonne; Racette, Lyne; Fifolt, Matthew; Schoenberger, Yu-Mei; Abu, Sampson Listowell; Twa, Michael D.

doi:10.1097/opx.0000000000001776

Cited by 11 publications

(7 citation statements)

References 50 publications

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“…Until such improvements are made, providers should maintain awareness of the negative impact of the pandemic on adherence and highlight this during clinic visits. The patient-provider relationship has previously been described as a facilitator of good adherence, 38 and is a promising vehicle for identifying barriers as they arise in patients, as well as for developing individualized solutions.…”

Section: Discussionmentioning

confidence: 99%

The Impact of the Coronavirus Disease 2019 Pandemic on Adherence to Ocular Hypotensive Medication in Patients with Primary Open-Angle Glaucoma

Racette¹,

Abu²,

Poleon³

et al. 2022

Ophthalmology

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Objective Emerging evidence suggests that the COVID-19 pandemic is disrupting health behaviors such as medication adherence. The objective of this study was to determine whether adherence to ocular hypotensive medication was affected by the pandemic and to identify factors associated with this change. Design In this cohort study, we used a controlled interrupted time series design in which the interruption was the declaration of the COVID-19 pandemic in the United States on March 13, 2020. The 300-day monitoring period, which evenly bracketed this declaration, started on October 16, 2019, and ended on August 10, 2020. Participants Patients with primary open-angle glaucoma enrolled in an ongoing longitudinal NIH-funded study initiated prior to the onset of the pandemic were selected if they were prescribed ocular hypotensive medication and had adherence data spanning the 300-day period. Methods We applied segmented regression analysis using a “slope change following a lag” impact model to obtain the adherence slopes in the periods preceding and following the segmentation. We compared the two slopes using the Davies test. Main outcome and measure The main outcome measure was daily adherence to ocular hypotensive medication—defined as the number of doses taken divided by the number of doses prescribed, expressed in percent. Adherence was measured objectively using Medication Event Monitoring System (MEMS) caps. We assessed the associations between change in adherence and demographic, clinical, and psychosocial factors. Results The sample included 79 patients (mean age, 71 years [SD, 8 years]). Segmented regression identified a breakpoint at day 28 following the declaration of the pandemic. The slope in the post-breakpoint period (-0.04%/day) was significantly different from zero ( P < 0.001) and from the slope in the period preceding the breakpoint (0.006%/day) ( P < 0.001). A significant positive association was observed between the Connor-Davidson Resilience score and the change in slope between the pre- and post-breakpoint periods ( P = 0.002). Conclusions and Relevance Adherence to ocular hypotensive medication worsened during the COVID-19 pandemic and appears to be related to patient resilience. This collateral consequence of the pandemic may translate into vision loss that may manifest beyond its containment.

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Section: Discussionmentioning

confidence: 99%

The Impact of the Coronavirus Disease 2019 Pandemic on Adherence to Ocular Hypotensive Medication in Patients with Primary Open-Angle Glaucoma

Racette¹,

Abu²,

Poleon³

et al. 2022

Ophthalmology

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“…This may strengthen and lengthen the patient-provider relationship, which has also been associated with higher adherence ( 29 ). The patient-provider relationship has been identified as a facilitator of good adherence ( 30 ), and research has shown that non-adherent patients were less likely to believe that their eye doctors spent sufficient time talking with them about their eye condition ( 31 ). Increased focus on patient education regarding the clinical impact of poor adherence may also help to increase engagement in eye care and improve adherence to prescribed medical therapy.…”

Section: Discussionmentioning

confidence: 99%

Whitecoat Adherence in Patients With Primary Open-Angle Glaucoma

2022

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PurposeWhitecoat adherence refers to improved medication adherence in the days surrounding clinic visits. This may lead to clinical measures that are not representative of those outside of clinical encounters. In glaucoma, whitecoat adherence to prescribed hypotensive therapy may lead to intraocular pressure readings within the target range, which may impact clinical decision-making. We aimed to quantify and identify factors associated with whitecoat adherence.MethodsIn this cohort study, patients with primary open-angle glaucoma were selected from an ongoing longitudinal NIH-funded study if they used hypotensive eyedrops, had a clinic visit during the parent study, and had adherence data during the 28 days evenly bracketing the clinic visit. Adherence within the implementation phase was measured using Medication Event Monitoring System (MEMS) caps. Wilcoxon tests were used to compare mean adherence between the following periods: Pre14−4 (days 14 to 4 preceding the clinic visit) and Pre3−1 (days 3 to 1 preceding the visit); Post1−3 (days 1 to 3 following the clinic visit) and Post4−14 (days 4 to 14 following the visit). Analyses were performed in the full sample and in patients with optimal (≥80%, n = 49) and suboptimal adherence (<80%, n = 17).ResultsSixty-six patients were included, of which 51.5% were female. Mean age was 70.8 ± 8.1 years. In the 6 months evenly bracketing the clinic visit, mean and median adherence were 86.3% (standard deviation = 17.7) and 95.6% (interquartile range = 21.2), respectively. Overall, mean adherence increased from Pre14−4 to Pre3−1 (85.5% ± 21.2 to 88.5% ± 23.2, p = 0.01) and decreased from Post1−3 to Post4−14 (87.0 ± 23.9 to 84.9 ± 23.3, p = 0.02). In patients with optimal adherence, adherence increased from Pre14−4 to Pre3−1 (94.0 ± 11.7 to 97.7 ± 7.4, p = 0.001) and from Post1−3 to Post4−14 (95.2 ± 12.0 to 95.4 ± 5.7, p = 0.007). Whitecoat adherence was not observed in patients with suboptimal adherence.ConclusionWe documented the presence of whitecoat adherence in this cohort. Due to its potential impact on clinical outcomes and decisions, providers should remain vigilant for this phenomenon and prioritize it during patient-provider discussions.

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“…Forgetfulness is a common reason for nonadherence [21,94,95], and true cognitive impairment is the most serious form thereof. Dementia is a risk factor for poor adherence to all therapies [96], including glaucoma therapy [77,97], as well as a risk factor for general self-neglect [98].…”

Section: Cognitive Limitationsmentioning

confidence: 99%

Identifying and addressing common contributors to nonadherence with ophthalmic medical therapy

Hovanesian

Singh²,

Bauskar³

et al. 2023

Current Opinion in Ophthalmology

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Purpose of reviewTo discuss common reasons for nonadherence and review existing and emerging options to reduce nonadherence with ocular medical therapy and optimize therapeutic outcomes.Recent findingsNonadherence can arise from patient-related issues (e.g. physical, cognitive) and healthcare-related issues (e.g. cost, access to care). Multiple strategies have been developed and evaluated to overcome these barriers to adherence. Identifying nonadherence and its cause(s) facilitates the development of strategies to overcome it.SummaryMany common causes of nonadherence can be mitigated through a variety of strategies presented.

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Patient and Provider Perspectives on Glaucoma Treatment Adherence: A Delphi Study in Urban Alabama

Abstract: Supplemental digital content is available in the text.

Cited by 11 publications

References 50 publications

The Impact of the Coronavirus Disease 2019 Pandemic on Adherence to Ocular Hypotensive Medication in Patients with Primary Open-Angle Glaucoma

The Impact of the Coronavirus Disease 2019 Pandemic on Adherence to Ocular Hypotensive Medication in Patients with Primary Open-Angle Glaucoma

Whitecoat Adherence in Patients With Primary Open-Angle Glaucoma

Identifying and addressing common contributors to nonadherence with ophthalmic medical therapy

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