Glaucoma Patient Expression of Medication Problems and Nonadherence

Abstract

Purpose The purpose of this study was to examine if patient demographic factors influenced self-reporting of medication side effects, difficulty with drop instillation and nonadherence to glaucoma therapy. Methods English-speaking adult glaucoma patients (n=279) from six ophthalmology clinics were enrolled. Patients’ medical visits were videotaped and patients were interviewed immediately afterwards by research assistants. The videotapes were transcribed verbatim and coded to identify patients who expressed problems with medication side effects, eye drop administration, and non-adherence during the glaucoma office visits. Generalized estimating equations were performed to identify whether patient characteristics were associated with expression of problems with glaucoma medication and medication non-adherence during the office visit. Results Patients with lower health literacy were significantly less likely to express problems with side effects (OR (95%CI) = 0.47 (0.25, 0.88)) and eye drop administration (OR (95%CI) = 0.26 (0.11, 0.63)) during the visit. Patients who reported eye drop administration and side effect problems during the interview were significantly more likely to express these problems to their ophthalmologists, (OR (95%CI) = 3.13 (1.82, 5.37)); (OR (95%CI) = 1.86 (1.12, 3.08)) respectively. Patients who expressed a problem with eye drop administration and with side effects were significantly more likely to express medication non-adherence to their ophthalmologist (OR (95%CI) = 2.89 (1.44, 5.80)); (OR (95%CI) = 2.03 (1.16, 3.54)). Patients who reported greater than 80% medication adherence during the interview were significantly less likely to express non-adherence to their ophthalmologist (OR (95%CI) = 0.22 (0.12, 0.40)). Conclusions Eye care providers should be aware that glaucoma patients with lower health literacy are less likely to express problems with side effects and eye drop administration. Providers should work with patients to assess medication-related problems in order to mitigate potential barriers to medication adherence since patients who expressed medication problems were also more likely to express non-adherence.

Medication adherence in patients with ocular hypertension or glaucoma

“…Laser trabeculoplasty is often as effective as a single medication for lowering IOP and has been reported to have few adverse effects [28]. Topically applied medications can be effective at lowering IOP, but their effectiveness is based on a patient's ability to maintain their daily treatment plan [29,30]. Adherence to glaucoma medication requires the patient to consistently perform specific actions, including appropriately administering eyedrops (i.e., ability to instill a drop within the eye) and continuing to instill drops as prescribed.…”

“…A patient may purport to be adherent but is actually using a medication incorrectly or not taking any medication due to difficulty self-administering drops. Numerous studies in the United States and other countries have documented that poor technique is a considerable concern in nonadherence [29,[65][66][67][68][69].…”

Preliminary findings from the Implementation of a wet macular degeneration patient-reported outcome and experience measure

“…A study by Slota et al identified that patients often felt more comfortable expressing treatment concerns to research assistants (at 41% of the cohort), rather than their treating ophthalmologist (at 10%). [20] A POEM can be a useful tool in providing transparency and in helping a team of clinicians to adapt their practice by highlighting any deficiencies that can be addressed in the consultation. Question 3 demonstrated that patients were very accepting of the treatment and possible side effects.…”

Assessing the clinical impact of CYP2C9 pharmacogenetic variation on phenytoin prescribing practice and patient response in an integrated health system

“…Side effects, even those deemed too minor to report to clinicians, are known to decrease medication adherence, as patients are more likely to self-titrate by reducing or missing doses in order to reduce side effect symptoms. [33][34][35][36] The effects of side effects on decreased medication adherence have been observed in patients with chronic conditions, such as hypertension 31,32 , diabetes 30 , and mental health disorders 29 . Furthermore, although nearly all participants began treatment with 300 mg/day, the lower the predicted function of CYP2C9, the more likely participants were to have a lower dose after one year.…”